Objective: To evaluate population characteristics and obstetrical complications post-myomectomy vs. fibroids in situ. Design: Retrospective cohort study. Setting: Hospital discharges from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (2004-2014). Population: 14,206 pregnancies post-myomectomy and 81,517 with fibroids in situ. Methods: Multivariate logistic regression with adjustment. Main Outcome Measures: Pregnancy, delivery, and neonatal outcomes. Results: Post-myomectomy patients were younger, with lower BMIs, higher IVF use, more commonly Caucasians or Hispanics, and had higher rates of pregestational diabetes, smoking, illicit drug use, previous cesarean delivery, and multiple gestations, compared to the in situ fibroids group. Post-myomectomy patients had decreased rates of gestational hypertension (aOR 0.87, 95%CI 0.77-0.97), eclampsia (aOR 0.76, 95%CI 0.32-0.81), gestational diabetes (aOR 0.83, 95%CI 0.77-0.90), spontaneous vaginal deliveries (aOR 0.09, 95%CI 0.08-0.11), postpartum hemorrhage (aOR 0.77, 95%CI 0.68-0.88), and intra-uterine fetal death (aOR 0.64, 95%CI 0.43-0.97). Conversely, they had increased risks of placenta previa (aOR 1.40, 95%CI 1.20-1.64), preterm delivery (aOR 1.16, 95%CI 1.07-1.24), cesarean section (aOR 8.64, 95%CI 7.71-9.69), uterine rupture (aOR 2.21, 95%CI 1.31-3.74), transfusions (aOR 1.79, 95%CI 1.59-2.02), and congenital anomalies (aOR 2.35, 95%CI 2.01-2.75). Conclusions: The in situ fibroid group experienced different complications than the post-myomectomy group. Pregnancies post-myomectomies could benefit from additional screening or interventions during pregnancy to reduce complications from malplacentation and ensure delivery in specialized centers to mitigate risks. Patients should be counseled regarding these potential risks. Increased understanding of the role of myomectomies on reproductive outcomes requires further prospective studies.

Lung cancer during pregnancy is exceptionally rare, with only 93 reported cases from 1953 to 2024. Our study identified 40 cases of lung cancer during pregnancy from a 9 million patient database, contributing to a total to 133 documented instances in the literature, and the only powered case series. Using the HCUP-NIS database (2004-2014), we conducted a retrospective analysis comparing maternal and fetal outcomes in women with and without lung cancer. Results showed that pregnant women with lung cancer were older and had higher rates of smoking, chronic hypertension, and pregestational diabetes (P<0.01, all). Significant risks included placenta previa (OR: 5.67, 95% CI:1.36-23.65, p=0.017), abruptio placenta (OR: 4.99, 95% CI: 1.49-16.74, p=0.009), operative vaginal delivery (OR: 4.88, 95% CI: 2.14-11.11, p<0.001), and transfusion (OR: 8.92, 95% CI: 3.28-24.28, p<0.001). They also have markedly higher odds of venous thromboembolism (OR:21.83, 95% CI: 2.92-163.47, p<0.001), disseminated intravascular coagulation (OR:  8.45, 95% CI: 1.14-62.42, p=0.04), and maternal death (OR: 195.02, 95% CI: 40.61-936.55, p<0.001), highlighting the necessity for specialized care and further research into this rare and complex condition.

Objective: to compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. Design, setting, and sample: A retrospective population-based cohort study from the Healthcare-Cost-Utilization Project-Nationwide-Inpatient-Sample(HCUP-NIS) included-3,846,342 births(2010-2014). Of them 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. Main Outcome Measures and Results: After adjustent for confounders, women with bicornuate uteri were more likely to deliver vaginally(aOR 1.4, 95%CI: 1.1-1.9), P=0.01), less likely to deliver by cesarean(CD) and had lower risk of SGA(aOR 0.8, 95%CI: 0.7-0.9, P=0.03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5-0.6), P=0.0001). Pregnant women with arcuate uterus had lower risks of preterm delivery((aOR 0.6, 95%CI: 0.5-0.8), P=0.0001), less chance of operative vaginal delivery(aOR 0.5, 95%CI: 0.2-0.9), P=0.04), and higher risk for CD(aOR 1.6, 95%CI: 1.4-2, P=0.0001). Pregnant women with didelphys uteri had higher risk of PPROM(aOR 1.6, 95%CI: 1.3-1.9), P=0.0001), preterm delivery(aOR 1.5, 95%CI: 1.3-1.6), P=0.0001), CD(aOR 1.4, 95%CI: 1.2-1.5, P=0.0001) and wound complications (aOR 1.6, 95%CI: 1.1-2.4), P=0.02). Pregnant unicornuate uteri had increased risks of preterm delivery(aOR 1.4, 95%CI: 1.1-1.6), P=0.0001), CD(aOR 2, 95%CI: 1.6-2.5), P=0.0001) and of SGA(aOR 1.8, 95%CI: 1.4-2.3, P=0.0001). Pregnant septate uteri had higher risk of chorioamnionitis(aOR 1.5, 95%CI: 1.1-2.1), P=0.048) and CD(aOR 1.4, 95%CI: 1.2-1.6), P=0.0001). Conclusion: We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies

Objectives: Women with Down syndrome (DS) suffer from several health issues, however, their fecundity is not affected. Despite that, there are no studies in the literature to address pregnancy, delivery, or neonatal outcomes among women with DS. Design: We conducted a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database over 11 years from 2004 to 2014. Methods: A delivery cohort was created using ICD-9 codes. ICD-9 code 758.0 was used to extract the cases of maternal DS. Pregnant women with DS (study group) were matched based on age and health insurance type to women without DS (control) at a ratio of 1:4. A multivariant logistic regression model was used to adjust for statistically significant variables (P-value < 0.5). Results: There were a total of 9,096,788 deliveries during the study period. Of those, 185 pregnant women were found to have DS. The matched control group was 740. Maternal pregnancy risks mostly did not differ between those with and without DS including pregnancy-induced PIH, gestational diabetes, preeclampsia, PPROM, chorioamnionitis, cesarean section, operative vaginal delivery, or blood transfusion (P >0.05, all). However, they were at extremely increased risk of delivering prematurely (aOR 3.86, 95% CI 1.25-11.93), and to have adverse neonatal outcomes such as small for gestational age (aOR 13.13, 95% CI 2.20-78.41), intrauterine fetal demise (aOR 20.97, 95% CI 1.86-237.02), and congenital anomalies (aOR 9.59, 95% CI 1.47-62.72). Conclusion: Women with DS should be counseled about their increased risk of premature delivery and adverse neonatal outcomes.