Gestational Diabetes Mellitus in Pregnant Women with Beta-Thalassemia Minor: A Matched Case-Control Study.

Pregnancy in women with thalassemia minor is considered safe. However, a higher incidence of maternal and neonatal complications in women with the disorder has been reported in the literature. This study aimed to determine whether there is an increased risk of gestational diabetes mellitus (GDM) in pregnant women with beta-thalassemia minor. We conducted a retrospective matched case-control study of 230 pregnant women who delivered at the Department of Obstetrics and Feto-Maternal Medicine at the Medical University of Vienna between the years 2008 and 2020, whereof 115 women had beta-thalassemia minor. We found no significant difference in the occurrence of GDM between the case group and control group of age and BMI-matched healthy women. However, we observed a significantly lower hemoglobin (Hb) and hematocrit (Ht) level during the first, the second, and the third trimesters of pregnancy, and postpartum (all: p < 0.001) among women with beta-thalassemia minor compared to the healthy controls. Neonates of women with beta-thalassemia were more likely to experience post-natal jaundice and excessive weight loss (p < 0.001). We conclude that GDM is not more likely to occur in pregnant women with beta-thalassemia minor. However, clinicians should be made aware of the risk of adverse maternal and neonatal outcomes. Furthermore, women with beta-thalassemia minor should undergo regular laboratory screening and multidisciplinary pregnancy care.

Personality traits and stress coping among obstetricians diagnosing and communicating fetal death: A cross-sectional study.

OBJECTIVE: To assess obstetricians' personality traits (empathy, locus of control [LoC], situational affect) and relate these to stress coping when making the diagnosis and delivering the news of late fetal death to parents. METHODS: Cross-sectional questionnaire study. RESULTS: 341 Austrian obstetricians (72.7% females) participated in this online survey. Participants' mean age was 46.4 ± 10.8 years. The majority of participants (n = 158, 46.3%) had been previously involved in the diagnosis of fetal death and subsequent breaking news up to five times. We observed no gender-specific differences in physicians' stress coping, including situational affect, perceived stress, challenge, self-concept, or perceived control, nor in internal or external LoC, and perspective taking. Female obstetricians showed significantly higher trait empathy and reported higher levels of distress regarding fetal death than males. Obstetricians with greater experience in dealing with fetal death (>11 times) reported a higher ability to cope with stress as reflected by lower situational affect, less perceived stress, less challenge, and higher situational control. CONCLUSION: While obstetricians' stress coping in diagnosing and communicating fetal death is independent of physicians' gender, greater ability to empathize with the parents diminishes overall sense of control and affect over the situation, whereas increased level of clinical experience with fetal death supports all domains of control and stress coping.

Epidemiology of Antepartum Stillbirths in Austria-A Population-Based Study between 2008 and 2020.

(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22+0 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20+0/40 was 3.10, ≥22+0/40 3.14, and ≥24+0/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33+0 (27+2-37+4) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58-8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83-3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.

Facilitators and Strategies for Breaking the News of an Intrauterine Death-A Mixed Methods Study among Obstetricians.

(1) Background: The death of a baby in utero is a very sad event for both the affected parents and the caring doctors. By this study, we aimed to assess the tools, which may help obstetricians to overcome this challenge in their profession. (2) Methods: We conducted a cross-sectional online survey in 1526 obstetricians registered with the Austrian Society of Obstetrics and Gynecology between September and October 2020. (3) Results: With a response rate of 24.2% (n = 439), our study shows that diagnosing fetal death was associated with a moderate to high degree of stress, regardless of position (p = 0.949), age (p = 0.110), gender (p = 0.155), and experience (p = 0.150) of physicians. Coping strategies for delivering the news of intrauterine death to affected parents were relying on clinical knowledge and high levels of self-confidence (55.0%; 203/369), support from colleagues (53.9%; 199/369), and debriefing (52.8%; 195/369). In general, facilitators for breaking bad news were more commonly cultivated by female obstetricians [OR 1.267 (95% CI 1.149-1.396); p < 0.001], residents [χ2(3;369) = 9.937; p = 0.019], and obstetricians of younger age [41 (34-50) years vs. 45 (36-55) years; p = 0.018]. External facilitators were most frequently mentioned, including professional support, training, professional guidance, time, parents' leaflets, follow-up consultations, a supporting consultation atmosphere, and preparation before delivering the bad news. Internal facilitators included knowledge, empathy, seeking silence, reflection, privacy, and relief of guilt. (4) Conclusions: Communicating the diagnosis of fetal death evokes moderate to high levels of stress among obstetricians. Resources from both the professional and private environment are required to deal with this professional challenge on a personal level.

Timing of hospital admission for stillbirth delivery on maternal and obstetric outcome: a retrospective cohort study.

The effect of timing of hospital admission for stillbirth delivery following late intrauterine fetal death (IUFD) has not yet been described. By this study, we aimed to gain an understanding of the impact of "immediate" (i.e., on the same day of IUFD diagnosis) versus "delayed" hospital admission (i.e., on the subsequent day or two days after IUFD diagnosis) on maternal and delivery outcome parameters. This retrospective cohort study comprised all women who suffered a singleton IUFD ≥ 21 gestational weeks and delivered the stillborn at our tertiary referral center between 2003 and 2019. We excluded all terminations of pregnancy and women presenting with acute symptoms on the day of IUFD diagnosis. In total, 183 women were included of whom 69.4% (n = 127) were immediately admitted and 30.6% (n = 56) had delayed admission. Median gestational age of IUFD was 30+3 (21+0-41+3) weeks. Whilst women with early signs of labor were more frequently admitted immediately (87.5%; 14/16), neither maternal demographic and obstetric parameters, nor day of the week or presenting symptoms influenced the timing of hospital admission. 77.6% (142/183) of women after IUFD diagnosis delivered within the first 3 days after admission. Women after immediate admission equally often delivered on admission day and the day after (26.0%; 33/127 each), women after delayed admission most commonly delivered the day after admission (39.3%; 22/56). Stillbirth delivery on the day of diagnosis was more common upon immediate admission (p = 0.006), especially in early gestational weeks (p = 0.003) and with small fetal weight (p < 0.001), requiring less induction of labor. No significant difference regarding delivery mode, labor duration, use of intrapartum analgesia, need for episiotomy and risk of perineal injury was observed between the groups. Also rate of intrapartum hemorrhage was independent of admission timing, although immediately admitted women experienced greater median blood loss after vaginal delivery. Maternal laboratory parameters (hemoglobin, thrombocytes and CRP) were independent of admission timing, except for higher levels of leucocytes, neutrophils and lymphocytes in immediately admitted women. Our study shows no clinical superiority of immediate hospital admission for stillbirth delivery. Under stable medical circumstances, it, therefore, seems feasible to allow the woman delayed admission for labor and delivery.

Temporal changes in epidemiological profile and fetal indications for late termination of pregnancy: a retrospective single-center study.

PURPOSE: To explore whether epidemiological shifts regarding reproduction and pregnancy have influenced the spectrum of indications for late termination of singleton pregnancies (TOP) above 17 weeks of gestation and to evaluate temporal changes in maternal demographics and fetal indications over the last 16 years. METHODS: Retrospective single-center cohort study involving all late TOPs preceded by feticide between 1 January 2004 and 31 December 2019 at a tertiary referral hospital in Austria. Outcome variables were retrieved and a time trend assessed between two 8-year intervals (2004-2011 versus 2012-2019). RESULTS: Between January 2004 and December 2019, a total of 209 singleton pregnancies (50.7% male; 46.9% female fetuses, 2.4% no disclosed sex) were terminated medically at a median gestational age of 25+1 (17+3-37+1) weeks at our institution. Predominant conditions legally justifying the late medical abortion were abnormaltities of the brain/central nervous system (n = 83; 39.7%), chromosomal aberrations (n = 33; 15.8%), complex malformations (n = 31; 4.8%) and abnormaltities of the musculosceletal system including diaphragmatic hernias (n = 18; 8.6%), as reflected by the ICD-10-categories "Congenital malformation of the central nervous system", "Other congenital malformations" and "Chromosomal abnormalities". No changes were observed with regards to maternal age (30.1 ± 5.9 vs. 31.0 ± 6.0 years; p = 0.315) nor frequency of assisted reproductive technologies (7.0% vs. 8.5%; p = 0.550). Despite a 2.5-fold increase in incidence of late TOPs, no epidemiological changes in maternal or fetal characteristics were observed over the last 16 years. CONCLUSION: Population profile and indications for late TOPs followed by feticide remain unchanged over time.

Effect of sexual diary keeping and self-evaluation on female sexual function and depression: A pilot study.

OBJECTIVES: The aim of the trial was to assess the effect of self-evaluation and sexual diary keeping on female sexual function and depressive symptoms in women diagnosed with sexual dysfunction. METHODS: A single-arm non-randomised trial included 30 women (53 ± 7 years of age) with female sexual dysfunction (Female Sexual Function Index [FSFI] < 27) and a stable partnership duration of 5-40 years. Female sexual function was assessed by sexual, psychological and gynaecological history taking and validated questionnaires including the FSFI, Female Sexual Distress Scale (FSDS) and Hamilton Depression Scale (HDS), before and after 4 weeks of sexual diary keeping. RESULTS: A subjective improvement in communication of sexual problems was reported by 60% of participants; no participants reported any worsening of communication. FSFI and FSDS scores were, respectively, 18.0 ± 7.7 and 22.0 ± 10.0 at baseline and 20.2 ± 7.2 and 20.6 ± 11.5 after 4 weeks. HDS score decreased from 6.0 ± 4.0 at baseline to 4.4 ± 2.7 after 4 weeks (p = 0.042). CONCLUSIONS: Self-evaluation and sexual diary keeping may improve aspects of sexual life, such as couple communication, without a direct effect on variables measured with validated questionnaires on different domains of sexual function.