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: The aim of this study was to determine the factors predicting the probability of severe postpartum hemorrhage in women undergoing repeat cesarean delivery. Design: This multicenter, retrospective cohort study based on data from 11 public tertiary hospitals within 7 provinces of China. Setting: 11 public tertiary hospitals within 7 provinces of China. Population: 11074 eligible pregnant women who had a history of cesarean delivery and undergo cesarean delivery again after 28 weeks of gestation. Methods: The cohort was divided into the development and validation sets. The all-variables model and the multivariable logistic regression model (simple model) were fitted to estimate the probability of severe postpartum hemorrhage. Results: Six independent risk factors of severe postpartum hemorrhage in the simple model were selected from 40 clinical information features including a history of endometrial injury, complications with placenta previa or placenta accreta, lower gestational age at delivery, pelvic adhesion, and previous uterine incision status. Our final simple model showed excellent discrimination and calibration, with areas under the ROC curve of more than 0.90 in the validation set. Conclusions: Predictive tools based on patient clinical characteristics can be used to accurately estimate the probability of severe postpartum hemorrhage in patients undergoing repeat cesarean delivery. Funding National Key R&D Program of China (No. 2016YFC1000405 and 2017YFC1001402) and the National Natural Science Foundation (No. 81830045, 81671533 and 81571518). Keywords repeat cesarean deliveries; severe postpartum hemorrhage; placenta previa; placenta accrete; pelvic adhesion; prediction; obstetrics

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.