Objective: To evaluate the relations between Fear of COVID-19 and postpartum depression (PPD) symptoms. Design: A multicenter prospective observational study. Setting and Population: A cohort of women who delivered during COVID-19 pandemic between 03-05/2020. Methods: Participants were virtually approached after delivery and asked to complete an online questionnaire. Data was verified with each center’s perinatal database. The validated Fear of COVID-19 Scale was in use. PPD was evaluated using the EPDS questionnaire as a categorical (≥10) and as a continuous scale. Pre-existing maternal disability was defined as any prior physiological/psychological chronic health condition. Stress-contributing complications during pregnancy or at birth included pregnancy and labor related complications. Regression analysis and ROC statistics were utilized to evaluate associations and control for confounders. Main Outcome Measure: PPD symptoms. Results: Overall, 421 women completed the questionnaires. Of them, 99(23.5%) had a high EPDS score. Fear of COVID-19 was positively correlated with PPD symptoms (r=0.35,p=0.000),ROC-AUC 0.67, 95%CI 0.61-0.74. Following adjustment to confounders (maternal age, nulliparity, ethnicity, marital status, financial difficulties, maternal disability, accessibility to medical services, and stress-contributing complications during pregnancy (, the most important factor that correlated with depression was maternal disability (aOR3,95%CI 1.3-6.9) followed by Fear of COVID-19 (aOR1.1,95%CI 1.05-1.15). High accessibility to medical services (aOR0.59,95% CI 0.45-0.77) and stress-contributing complications during pregnancy (aOR0.2, 95% CI 0.11-0.82) were both protective for PPD symptoms. Conclusions: During the COVID-19 pandemic, maternal disability and Fear of COVID-19 are positively associated with a high EPDS score. High medical accessibility was found as a protective factor for PPD.

Objective: Prematurity [gestational age (GA)<34w] is a relative contraindication to vacuum extraction (VE). Current data do not discriminate clearly between prematurity and low-birthweight (LBW). We aimed to evaluate the impact of non-metal vacuum cup extraction on neonatal head injuries related to birth-trauma (HI), among newborns with LBW (<2,500g). Design: A retrospective cohort. Population: 3,335 singleton pregnancies, delivered by VE from 2014 to 2019. All were >34w GA. Methods: We compared 207 (6.2%) neonates with LBW <2,500g to 3,128 (93.8%) neonates with higher BW, divided into 3 subgroups (2,500-2,999g, 3,000-3,499g, and >3,500g). Main outcome measures: HI and other neonatal complications. Results: The lowest rates of subgaleal hematoma occurred in neonates <2,500g (0.5%) and increased with every additional 500g of neonatal birthweight (3.2%, 4.4% and 7.6% in 2,500-2,999g, 3,000-3,499g, and >3,500g groups, respectively; p=0.001). Fewer cephalohematomas occurred among LBW neonates (0.5% in <2,500g) and increased with every additional 500g of birthweight (2.6%, 3.3% and 3.8% in 2,500-2,999g, 3,000-3,499g, and >3,500g groups, respectively, p=0.026). Logistic regression found increasing birthweight as a significant risk-factor for head injuries during VE, with adjusted odds ratios of 8.874, 10.624, 13.980 for 2,500-2,999g, 3,000-3,499g, and >3,500g, respectively (p=0.015). NICU hospitalization rates were highest among neonates weighing <2,500g (10.1%) compared to the other groups (2.7%, 1.7% and 3.3% in 2,500-2,999g, 3,000-3,499g, >3,500g respectively, p=0.000). Conclusions: VE of neonates weighing <2500g at 34w and beyond seems as a safe mode of delivery when indicated, with lower rates of HI, compared to neonates with higher BW. Funding: none.

Objective: To evaluate the relation between peripartum infection at first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. Design: Retrospective case-control study from March 2014 to October 2020. Setting: University-affiliated medical centre. Sample: Women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who had a successful vaginal birth after Cesarean section without evidence of dehiscence or uterine rupture. Methods: We compared the rate of peripartum infection during the first Cesarean delivery and other relevant variables, between the two groups. We also analysed the type of infection correlated with uterine rupture or dehiscence. Main Outcome Measures: Rate of peripartum infection. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful vaginal birth after Cesarean section as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p=0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk-factor for uterine rupture at the subsequent trial of labour after Cesarean delivery (95% CI, P=0.018). We also found that endometritis had the highest correlation to uterine rupture (9.8% vs. 0%, p=0.02) Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery. Compared to other infections, endometritis may pose the greatest risk for uterine rupture or dehiscence.