Title Participants Abstract "Implications of a Reduced Length of Postpartum Hospital Stay on Maternal and Neonatal Readmissions, an Observational Study" "Amber Stas, Maria Breugelmans, Lynn Geerinck, Julie Laats, An Spinnoy, Sven Van Laere, Leonardo Gucciardo, Monika Laubach, Gilles Faron, Katrien Beeckman" "INTRODUCTION: Reducing the Length Of postpartum Stay (LOS) is associated with lower hospital costs, a major reason for initiating federal projects in Belgium. Disadvantages following the reduction of LOS are the risks of maternal and neonatal readmissions. This study compares readmissions with or without reduced LOS, by introducing the KOZI&Home program in the university hospital Brussels.METHODS: This is an observational study comparing the readmission rates of the length of postpartum hospital stay between two groups: the non-KOZI&Home group (> 2 days for vaginal birth and > 4 days for caesarean section) and KOZI&Home group (≤ 2 days for vaginal birth and ≤ 4 days for caesarean section). A follow-up period of 16 weeks was set up.RESULTS: The maternal readmission rate was 4,8% for the non-KOZI&Home group (n = 332) and 3.3% for the KOZI&Home group (n = 253). Neonatal readmission rates were 7.2% and 15.9% respectively. After controlling influencing factors in a multivariate model for maternal and neonatal readmissions, there were no statistical significant differences. Factors negatively affecting neonatal readmissions are (1) dismissal period October-January (OR:3.22;95% CI 1.10-9.42) and (2) low education level (OR:3.44;95% CI 1.54-7.67), for maternal readmissions it concerns whether or not LOS is known (OR:3.26;95% CI 1.21-8.81).DISCUSSION: There is no effect of the KOZI&Home program on maternal nor neonatal readmission rates. Systematically informing about postpartum LOS antenatally will enforce preparation and is important to reduce maternal readmissions. Personalized information should be given to women discharged in the period October-January and to those with a lower education level, in order to reduce neonatal readmissions." "Maternal satisfaction with reduced postnatal length of stay in Brussels" "Amber Stas, Maria Breugelmans, Lynn Geerinck, An Spinnoy, Sven Van Laere, Leonardo Gucciardo, Monika Laubach, Gilles Faron, Katrien Beeckman" "BACKGROUND: Reducing the length of stay (LOS) after childbirth is a trend, including cost savings, a more family-centered approach and lower risk for nosocomial infection. Evaluating the impact of reduced LOS is important to improve the outcomes of care, which include maternal satisfaction. The aim of this study was to compare the maternal satisfaction, before and after the reduced LOS.METHODS: This study was conducted in the University Hospital Brussels, before and after implementing the KOZI&Home program (intervention). This KOZI&Home program consisted of a reduced length of stay of at least one day for both vaginal delivery and caesarean section. It also included three extra antenatal visits with the midwife, preparing for discharge and postnatal home care by an independent midwife. Women completed a questionnaire, including the Maternity Satisfaction Questionnaire (MSQ) and Home Satisfaction Questionnaire (HSQ), respectively at discharge and two weeks postpartum. Satisfaction was split into five dimensions: 'Midwives time investment', 'Provision of information', 'Physical environment', 'Privacy' and 'Readiness for discharge'. A combination of forward and backward model selection (both directions) was used for statistical analysis.RESULTS: In total, 585 women were included in this study. 332 women in the non-intervention group and 253 women in the intervention group. Satisfaction with 'provision of information' at home had a higher mean score of 4.47/5 in the intervention group versus 4.08/5 in the non-intervention group (p " "Usability, accuracy, and cost-effectiveness of a medical software for early pregnancies" "Frédéric Michel L Blavier, D Grobet, C Duflos, Romy Rayssiguier, Noemie Ranisavljevic, M Duport Percier, A Rodriguez, Christophe Blockeel, S. Santos-Ribeiro, Gilles Faron, Leonardo Gucciardo, Florent Fuchs" "STUDY QUESTION: Can early pregnancies be accurately and cost-effectively diagnosed and managed using a new medical computerized tool?SUMMARY ANSWER: Compared to the standard clinical approach, retrospective implementation of the new medical software in a gynaecological emergency unit was correlated with more accurate diagnosis and more cost-effective management.WHAT IS KNOWN ALREADY: Early pregnancy complications are responsible for a large percentage of consultations, mostly in emergency units, with guidelines becoming complex and poorly known/misunderstood by practitioners.STUDY DESIGN, SIZE, DURATION: A total of 780 gynaecological emergency consultations (446 patients), recorded between November 2018 and June 2019 in a tertiary university hospital, were retrospectively encoded in a new medical computerized tool. The inclusion criteria were a positive hCG test result, ultrasonographical visualization of gestational sac, and/or embryo corresponding to a gestational age of 14 weeks or less. Diagnosis and management suggested by the new computerized tool are named eDiagnoses, while those provided by a gynaecologist member of the emergency department staff are called medDiagnoses.PARTICIPANTS/MATERIALS, SETTING, METHODS: Usability was the primary endpoint, with accuracy and cost reduction, respectively, as secondary and tertiary endpoints. Identical eDiagnoses/medDiagnoses were considered as accurate. During follow-up visits, if the updated eDiagnoses and medDiagnoses became both identical to a previously discrepant eDiagnosis or medDiagnosis, this previous eDiagnosis or medDiagnosis was also considered as correct. Four double-blinded experts reviewed persistent discrepancies, determining the accurate diagnoses. eDiagnoses/medDiagnoses accuracies were compared using McNemar's Chi square test, sensitivity, specificity, and predictive values.MAIN RESULTS AND THE ROLE OF CHANCE: Only 1 (0.1%) from 780 registered medical records lacked data for full encoding. Out of the 779 remaining consultations, 675 eDiagnoses were identical to the medDiagnoses (86.6%) and 104 were discrepant (13.4%). From these 104, 60 reached an agreement during follow-up consultations, with 59 medDiagnoses ultimately changing into the initial eDiagnoses (98%) and only one discrepant eDiagnosis turning later into the initial medDiagnosis (2%). Finally, 24 remained discrepant at all subsequent checks and 20 were not re-evaluated. Out of these 44, the majority of experts agreed on 38 eDiagnoses (86%) and 5 medDiagnoses (11%, including four twin pregnancies whose twinness was the only discrepancy). No majority was reached for one discrepant eDiagnosis/medDiagnosis (2%). In total, the accuracy of eDiagnoses was 99.1% (675 + 59 + 38 = 772 eDiagnoses out of 779), versus 87.4% (675 + 1 + 5 = 681) for medDiagnoses (P " "Effect of air temperature on human births, preterm births and births associated with maternal hypertension" "Frédéric Michel L Blavier, Kurt Barbé, Gilles Faron, Sébastien Doutreloup, Malik Boukerrou, Florent Fuchs, Leonardo Gucciardo" "OBJECTIVE: We studied potential effects of outdoor air temperatures or barometric pressure on births, preterm births and births associated with maternal hypertension.METHODS: 12,269 births were retrospectively reviewed in Brussel and 25,880 in South Reunion Island. National Belgium and French weather reference centers provided outdoor air temperatures and barometric pressures from the nearest weather stations on the corresponding birthdays. Poisson regression models were used to assess if outdoor air temperatures or barometric pressure could be correlated, immediately and several days later, with the number of daily births, preterm births and births associated with hypertension.RESULTS: Outdoor air temperature was significantly correlated to the number of daily births in Brussels. For each additional degree Celsius, overall births increased by 0.4% during the same day. Four days later, overall births increased by 1.8%, preterm births by 2.6% and births associated with hypertension by 5.7%. Similar observations on numbers of daily births were reported in South Reunion Island, without reaching statistical significance (p = .08).CONCLUSION: As previously demonstrated in recent studies, increased air temperature leads progressively to higher rates of births and preterm births. An even stronger delayed effect of air temperature was observed on births associated with hypertension. This would be worth further investigating." "Artificially prepared vitrified-warmed embryo transfer cycles are associated with an increased risk of pre-eclampsia" "Caroline Roelens, Annalisa Racca, Shari Mackens, Lisbet Van Landuyt, Laura Buelinckx, Leonardo Gucciardo, Herman Tournaye, Michel De Vos, Christophe Blockeel" "RESEARCH QUESTION: What is the association between the development of pre-eclampsia and endometrial preparation prior to vitrified-warmed embryo transfer (frozen embryo transfer, FET)?DESIGN: A retrospective cohort study at a tertiary university-based hospital, including a total of 536 pregnant patients who underwent a FET between 2010 and 2019 and delivered in the same institution; 325 patients underwent natural cycle FET (NC-FET) and 211 artificial cycle FET (AC-FET).RESULTS: Unadjusted, the incidence of pre-eclampsia was significantly higher in AC-FET cycles than in NC-FET cycles (3.7% versus 11.8%, P < 0.001). Multivariable logistic regression analysis showed that, when adjusting for type of endometrial preparation (artificial cycle versus natural cycle), oocyte recipient cycles and African ethnicity, the risk of developing pre-eclampsia was significantly associated with artificial endometrial preparation or oocyte recipient cycles (AC-FET versus NC-FET: odds ratio 2.9, 95% confidence interval 1.4-6.0, P = 0.005).CONCLUSIONS: The current data show a higher incidence of pre-eclampsia in AC-FET versus NC-FET cycles, adding further strength to the existing data on this topic. Together, these recent findings may result in a change in clinical practice, towards a preference for NC-FET cycles over AC-FET cycles in ovulatory patients. Screening for high-risk patients and the development of strategies to mitigate their risk profile could reduce the risk of pre-eclampsia. Further understanding of the different vasoactive substances excreted by the corpus luteum is vital." "Haemophagocytic lymphohistiocytosis during pregnancy: a case presentation and literature review" "Larissa Fávero Vanraes, Veerle Beckers, Kim Van Berkel, Leonardo Gucciardo, Gilles Faron" "Objectives: Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder of the immune system that typically occurs in the paediatric population. Diagnosing this rare disease in the adult population is challenging, particularly during pregnancy. Case presentation: We present a case of a gravid patient developing HLH at week 13 of gestation undergoing a medical termination of pregnancy at 27 weeks due to anhydramnios and associated stopped foetal growth. Conclusions: Disease triggers could vary from a simple viral infection to the pregnancy as such causing the disorder. Treatment should benefit the mother and limit the foetal harm." "Enhancing the value of the sFlt-1/PlGF ratio for the prediction of preeclampsia" "Frederic Chantraine, Kristel Van Calsteren, Damien Gruson, Joachim Van Keirsbilck, Ana Dubon Garcia, Katleen Vandeweyer, Leonardo Gucciardo" "OBJECTIVE: To evaluate the economic impact of introducing the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test into clinical practice in Belgium for the prediction of preeclampsia (PE).STUDY DESIGN: We developed a one-year time-horizon decision tree model to evaluate the short-term costs associated with the introduction of the sFlt-1/PlGF test for guiding the management of women with suspected PE from the Belgian public healthcare payers' perspective. The model estimated the costs associated with the diagnosis and management of PE in pregnant women managed in either a test scenario, in which the sFlt-1/PlGF test is used in addition to current clinical practice, or a no test scenario, in which clinical decisions are based on current practice alone. Test characteristics were derived from PROGNOSIS, a non-interventional study in women presenting with clinical suspicion of PE. Unit costs were obtained from Belgian-specific sources. The main model outcome was the total cost per patient.RESULTS: Introduction of the sFlt-1/PlGF ratio test is expected to result in a cost saving of €712 per patient compared with the no test scenario. These savings are generated mainly due to a reduction in unnecessary hospitalizations.CONCLUSIONS: The sFlt-1/PlGF test is projected to result in substantial cost savings for the Belgian public healthcare payers through reduction of unnecessary hospitalization of women with clinical suspicion of PE that ultimately do not develop the condition. The test also has the potential to ensure that women at high risk of developing PE are identified and appropriately managed." "Midwifery students' satisfaction with perinatal simulation-based training" "Joeri Vermeulen, Ronald Buyl, Florence D'Haenens, Eva Swinnen, Lara Stas, Leonardo Gucciardo, Maaike Fobelets" "Background: Simulation-based training has proved to be an effective teaching and learning approach in healthcare. Nevertheless, any assessment of its effectiveness should also take the students’ perspective into account. Aim: To validate the Satisfaction with Simulation Experience Scale (SSES) for use with midwifery students and evaluate midwifery students’ satisfaction with perinatal simulation-based training. Methods: Satisfaction with simulation was assessed using the SSES, a measurement tool translated from English to Dutch. Data was collected in four consecutive years (2016–19). A mixed methods design was used to capture both qualitative and quantitative data. Using the quantitative data, factor analysis was performed to assess the construct validity, while Cronbach's alpha was used to assess internal consistency. Qualitative data was assessed using thematic content analysis. Findings: 367 SSES questionnaires were completed by 251 students. The exploratory factor analysis resulted in a three-factor model covering debriefing and reflection, clinical reasoning and clinical learning. Cronbach's alpha showed good internal consistency. Students were very satisfied with perinatal simulation-based training for all three factors: 4.30 (SD = 0.47) for debriefing and reflection, 3.97 (SD = 0.55) for clinical reasoning and 4.10 (SD = 0.46) for clinical learning. Satisfaction scores remained high and stable over the years investigated. Thematic content analysis identified 6 categories: simulation-based training is valuable, the need for more simulation-based training, fidelity, students, negative feelings, and preparation is vital. Conclusion: Students were satisfied with the simulation-based training, experiencing it as providing added value to their education. Simulations gave them the opportunity to make and learn from mistakes in a safe learning environment." "Optimal timing to screen for asymptomatic bacteriuria during pregnancy" "Lisa-Marie Langermans, Wilfried Cools, Ingrid Van Limbergen, Leonardo Gucciardo, Gilles Faron" "Objectives: Although current guidelines advice to screen for asymptomatic bacteriuria during pregnancy, little is known about the best moment of testing. The goal of this study is to analyze the optimal timing (first vs. second trimester) to screen for asymptomatic bacteriuria during pregnancy.Methods: A retrospective cohort analysis, comparing patients that were screened for asymptomatic bacteriuria in the first vs. second trimester was performed. The main question was to compare the rate of positive urinary culture in both trimesters. Study included patients all followed a prenatal consultation at the University Hospital of Brussels between 2012 and 2017. Other outcomes considered were the nature of identified germs, treatments, possible risk and confounding factors (age, BMI, gravidity-parity-abortus [GPA], type of conception, ethnicity, education, prior urinary tract infection (UTI), diabetes, hypertension, prior preterm delivery and sickle cell disease) and complications (UTI, preterm delivery, preterm rupture of the membranes and chorio-amnionitis).Results: A total of 2,005 consecutive files were reviewed, 655 concerned patients screened during the first trimester group and 1,350 in the second trimester group. Asymptomatic bacteriuria was present in only 71 cases (3.54%), 23 in the first trimester group (3.50%) and 48 in the second trimester group (3.55%). Escherichia coli was the most frequently identified germ (37 cases (1.8%), 14 in the first trimester group and 23 in the second trimester group). Our logistic regression analysis shows no statistical difference according to the moment the urinary culture was done for the presence of asymptomatic bacteriuria (E. coli or others), for its association with hospitalization for pyelonephritis, preterm contractions, preterm pre-labor rupture of the membranes (PPROM) and/or preterm delivery.Conclusions: If recommendations remain to screen for asymptomatic bacteriuria at least once during pregnancy, this study indicates that the moment of testing (first vs. second trimester) has no clinical impact on obstetrical outcomes." "Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19)" "Daniele Di Mascio, Cihat Sen, Gabriele Saccone, Alberto Galindo, Amos Grünebaum, Jun Yoshimatsu, Milan Stanojevic, Asım Kurjak, Frank Chervenak, María José Rodríguez Suárez, Zita Maria Gambacorti-Passerini, María de Los Angeles Anaya Baz, Esther Vanessa Aguilar Galán, Yolanda Cuñarro López, Juan Antonio De León Luis, Ignacio Cueto Hernández, Ignacio Herraiz, Cecilia Villalain, Roberta Venturella, Giuseppe Rizzo, Ilenia Mappa, Giovanni Gerosolima, Lars Hellmeyer, Josefine Königbauer, Giada Ameli, Tiziana Frusca, Nicola Volpe, Giovanni Battista Luca Schera, Stefania Fieni, Eutalia Esposito, Giuliana Simonazzi, Gaetana Di Donna, Aly Youssef, Anna Nunzia Della Gatta, Mariano Catello Di Donna, Vito Chiantera, Natalina Buono, Giulio Sozzi, Pantaleo Greco, Danila Morano, Beatrice Bianchi, Maria Giulia Lombana Marino, Federica Laraud, Arianna Ramone, Angelo Cagnacci, Fabio Barra, Claudio Gustavino, Simone Ferrero, Fabio Ghezzi, Antonella Cromi, Antonio Simone Laganà, Valentina Laurita Longo, Francesca Stollagli, Angelo Sirico, Antonio Lanzone, Lorenza Driul, Fabiana Cecchini D, Serena Xodo, Brian Rodriguez, Felipe Mercado-Olivares, Deena Elkafrawi, Giovanni Sisti, Rosanna Esposito, Antonio Coviello, Marco Cerbone, Maddalena Morlando, Antonio Schiattarella, Nicola Colacurci, Pasquale De Franciscis, Ilaria Cataneo, Marinella Lenzi, Fabrizio Sandri, Riccardo Buscemi, Giorgia Gattei, Francesca Della Sala, Eleonora Valori, Maria Cristina Rovellotti, Elisa Done, Gilles Faron, Leonardo Gucciardo, Valentina Esposito, Flaminia Vena, Antonella Giancotti, Roberto Brunelli, Ludovico Muzii, Luigi Nappi, Felice Sorrentino, Lorenzo Vasciaveo, Marco Liberati, Danilo Buca, Martina Leombroni, Francesca Di Sebastiano, Luciano Di Tizio, Diego Gazzolo, Massimo Franchi, Quintino Cesare Ianniciello, Simone Garzon, Giuliano Petriglia, Leonardo Borrello, Albaro Josè Nieto-Calvache, Juan Manuel Burgos-Luna, Caroline Kadji, Andrew Carlin, Elisa Bevilacqua, Marina Moucho, Pedro Viana Pinto, Rita Figueiredo, José Morales Roselló, Gabriela Loscalzo, Alicia Martinez-Varea, Vincente Diago, Jesús S Jimenez Lopez, Alicia Yeliz Aykanat, Stefano Cosma, Andrea Carosso, Chiara Benedetto, Amanda Bermejo, Otto Henrique May Feuerschuette, Ozlem Uyaniklar, Sakine Rahimli Ocakouglu, Zeliha Atak, Reyhan Gündüz, Esra Tustas Haberal, Bernd Froessler, Anupam Parange, Peter Palm, Igor Samardjiski, Chiara Taccaliti, Erhan Okuyan, George Daskalakis, Renato Augusto Moreira de Sa, Alejandro Pittaro, Maria Luisa Gonzalez-Duran, Ana Concheiro Guisan, Şerife Özlem Genç, Blanka Zlatohlávková, Anna Luengo Piqueras, Dolores Esteban Oliva, Aylin Pelin Cil, Olus Api, Panos Antsaklis, Liana Ples, Ioannis Kyvernitakis, Holger Maul, Marcel Malan, Albert Lila, Roberta Granese, Alfredo Ercoli, Giuseppe Zoccali, Andrea Villasco, Nicoletta Biglia, Ciuhodaru Madalina, Elena Costa, Caroline Daelemans, Axelle Pintiaux, Elisa Cueto, Eran Hadar, Sarah Dollinger, Noa A Brzezinski Sinai, Erasmo Huertas, Pedro Arango, Amadeo Sanchez, Javier Alfonso Schvartzman, Liviu Cojocaru, Sifa Turan, Ozhan M. Turan, Maria Carmela Di Dedda, Rebeca Garrote Molpeceres, Snezana Zdjelar, Tanja Premru-Srsen, Lilijana Kornhauser Cerar, Mirjam Druškovič, Valentina De Robertis, Vedran Stefanovic, Irmeli Nupponen, Kaisa Nelskylä, Zulfiya Khodjaeva, Ksenia A Gorina, Gennady T Sukhikh, Giuseppe Maria Maruotti, Silvia Visentin, Erich Cosmi, Jacopo Ferrari, Alessandra Gatti, Daniela Luvero, Roberto Angioli, Ludovica Puri, Marco Palumbo, Giusella D'Urso, Francesco Colaleo, Agnese Maria Chiara Rapisarda, Ilma Floriana Carbone, Antonio Mollo, Giovanni Nazzaro, Mariavittoria Locci, Maurizio Guida, Attilio Di Spiezio Sardo, Pierluigi Benedetti Panici, Vincenzo Berghella, Maria Elena Flacco, Lamberto Manzoli, Giuseppe Bifulco, Giovanni Scambia, Fulvio Zullo, Francesco D'Antonio" "Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p"