Objectives: To explore the predictive capacity of the umbilical artery velocities at 37 weeks’ gestation in identifying fetal growth restriction (FGR), small-for-gestational-age (SGA) neonates and adverse perinatal outcome (APO). Methods: We retrospectively recruited FGR and SGA with normal umbilical artery Doppler at 37 weeks, and adequate-for-gestational age (AGA) controls in a tertiary referral center. All the parameters of the umbilical artery velocities were measured at about 37 weeks’ gestation, including the umbilical artery end-diastolic velocity (UA-EDV), umbilical artery peak systolic velocity (UA-PSV), umbilical artery mean diastolic velocity (UA-MDV) and umbilical artery time-averaged maximum velocity (UA-TAMXV). Results: A total of 569 cases were included in the study and divided into three groups: FGR group, SGA group and AGA group. Of these, 39 (6.9%) were identified as FGR, 57 (10.0%) were SGA and 473 (83.1%) were AGA. Among the three groups, the UA-MDV, UA-TAMXV, UA-PSV, and UA-EDV were decreased with the severity of growth restriction. Multivariate logistic regression analyses showed that the UA-TAMXV was independent predicting factor of FGR. It had a moderate predictive value for FGR, with an area under the ROC curve of 0.821 [95% confidence interval (CI): 0.785-0.853]. Conclusions: The UA velocities were decreased with the severity of growth restriction and the UA-TAMXV was independently predictive of FGR. The results suggest that UA-TAMXV might be a new parameter to predict FGR.

Objective: To determine the factors predicting the probability of severe postpartum hemorrhage (SPPH) in women undergoing repeat cesarean delivery (RCD).Study Design: This multicenter, retrospective cohort study involved women who underwent RCD from January 2017 to December 2017, in 11 public tertiary hospitals within 7 provinces of China. The all-variables model and the multivariable logistic regression model (pre-operative, operative and simple model) were developed to estimate the probability of SPPH in development data and external validated in validation data. Discrimination and calibration were evaluated and clinical impact was determined by decision curve analysis.Results: The study consisted of 11,074 women undergoing RCD. 278 (2.5%) women experienced SPPH. The pre-operative simple model including 9 pre-operative features, the operative simple model including 4 pre-operative and 2 intraoperative features and simple model including only 4 closely related pre-operative features showed AUC 0.888, 0.864 and 0.858 in development data and 0.921, 0.928 and 0.925 in validation data, respectively. Nomograms were developed based on predictive models for SPPH.Conclusion: Predictive tools based on clinical characteristics can be used to estimate the probability of SPPH in patients undergoing RCD and help to allow better preparation and management of these patients by using a multidisciplinary approach of cesarean delivery for obstetrician.

Since December 2019, a new coronavirus (COVID-19) infection has rapidly become prevalent in central China [1]. On the basis of knowledge obtained from a previous coronavirus outbreak [2], pregnant women are believed to be susceptible to this virus. Once a maternal infection of 2019-nCoV is suspected or confirmed, childbirth becomes complicated and challenging. Efficient obstetric treatment is required, and is key to optimizing the prognosis for both mother and child. Care should be taken in determination of the timing of delivery, assessment of the indications for caesarean section, preparation of the delivery room to prevent infection, choice of the type of anesthesia, and newborn management.