In addition to revealing general features of the transcriptome of germinating spores, the results highlight a number of calcium-responsive and light-receptive transcripts. Pharmacologic assays indicate endomembrane Ca(2+)-ATPases and extracellular nucleotides may play regulatory roles in the gravity response of Ceratopteris spores.

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Venous thromboembolic events (VTE), specifically pulmonary embolisms, account for a significant portion of maternal morbidity and mortality. Due to the procoagulant physiological changes that occur, pregnancy and the postpartum period are known risk factors for thromboembolic events. The risk is greatest during the first-week postpartum and remains elevated for up to six weeks as compared to the general population. Treatment guidelines regarding the use of thrombolytics for massive pulmonary embolism occurring in pregnancy and the postpartum are not well established. In nonpregnant populations, thrombolytic agents are well known to decrease the mortality in the setting of a massive pulmonary embolism. However, in the absence of management guidelines, thrombolysis in pregnancy remains guided by case reports and case series. We present a case of a massive pulmonary embolism (PE) causing hemodynamic instability during the postpartum period treated with tissue plasminogen activator (tPA). The case was complicated by delayed postpartum hemorrhage successfully managed with the uterotonic methylergometrine. The patient was started on oral anticoagulation and continued for six months without recurrent VTE. Our case demonstrates a rare occurrence of a saddle embolism after a vaginal delivery within the first postpartum week which was successfully managed with the use of systemic thrombolysis and minimal intervention to manage the iatrogenic delayed postpartum hemorrhage. To the authors’ knowledge, no other similar case report exists. This case highlights the need to develop guidelines for the use of thrombolysis in mothers who present with massive pulmonary embolus and a noninvasive means to manage adverse bleeding events in the puerperium.

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This was a single-center retrospective cohort study of women with singleton gestations with cerclage placed between 2016-2021 who were later diagnosed with PPROM. Cerclage removal was defined as immediate if removal was < 24 hours (h) from PPROM and delayed if >24h. Primary outcome was PPROM to delivery interval in days (d) for PPROM < 37 weeks (w). Secondary outcomes were delivery interval for women with PPROM < 34w, latency >48h and >7d, antenatal corticosteroid course to delivery interval < 7d, antibiotic use, tocolytic use, chorioamnionitis and a composite neonatal outcome (admission to NICU, APGAR < 7 at 1 minute, arterial pH < 7.2 and neonatal morbidity or mortality). RESULTS: Of 257 women with cerclage, 60 (23.3%) had PPROM. Cerclage was removed immediately in 29 (48.3%), and in 31 (51.7%) removal was delayed with average delay of 7.2d (1-34). Baseline characteristics, indication for cerclage, gestational age at cerclage placement and PPROM were similar between groups. Interval from PPROM to delivery was significantly higher in the delayed removal group for PPROM < 37w (8.0AE1.4 vs 1.0AE0.4 d, p< 0.001) and PPROM < 34w (8.9AE1.6 vs 1.5AE0.7 d, p< 0.001). Women with a delayed removal were more likely to deliver >48h (58.1% vs 10.3%, p< 0.001) and >7d (45.2% vs 6.9%, p< 0.001) after PPROM. Those with immediate removal were more likely to receive antenatal corticosteroids < 7d from delivery (91.2% vs 31.8%, p¼0.01) and less likely to develop chorioamnionitis (17.2% vs 41.9%, p¼0.03). Composite neonatal outcome was similar between groups. CONCLUSION: Cerclage retention following PPROM may prolong interval to delivery by approximately one week at the expense of increased rates of chorioamnionitis and suboptimal antenatal corticosteroids exposure.