Background The host adaptive immune response helps determine which cervical HPV infections persist and progress to precancer and cancer, and systematic characterisation of T-cell infiltration would help inform key steps in cervical carcinogenesis. Methods A systematic review and meta-analysis were conducted of infiltrating T-cells in normal cervix, low-grade lesions, high-grade lesions, and invasive cancers including epithelial, stromal, and total tissue and the following markers: CD3, CD4, CD8, FoxP3, CD25, and the CD4:CD8 ratio. An additional qualitative review summarised longitudinal data on associations between infiltrating T-cells and cervical disease persistence, regression, progression, or prognosis. Results There were fewer CD3+, CD4+, and CD8+ cells in cervical lesions and more cells in cancers compared to normal epithelium. FoxP3 and CD25+ regulatory T-cell infiltration is high in persistent and precancerous lesions, and longitudinal data show improved outcomes with lower regulatory T-cell levels. Conclusions Successful immune evasion may reduce T-cell infiltration in HPV infected and precancerous epithelium, while invasive cancers are highly immunogenic, and regulatory T-cell infiltration increases with cervical disease progression. Understanding these factors may have prognostic value and could aid in novel treatment development and clinical guidelines, but published data are highly heterogeneous and leave important gaps to be filled by future studies.

Objective The study aimed to examine the incidence of hypertensive disorders of pregnancy in women diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, also known as COVID-19). Study Design This was a retrospective cohort study of all women who delivered at MedStar Washington Hospital Center in Washington, DC from April 8, 2020 to July 31, 2020. Starting April 8, 2020, universal testing for COVID-19 infection was initiated for all women admitted to labor and delivery. Women who declined universal testing were excluded. Hypertensive disorders of pregnancy were diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions.1 Maternal demographics, clinical characteristics, and labor and delivery outcomes were examined. Neonatal outcomes were also collected. Laboratory values from admission were evaluated. Our primary outcome was the incidence of hypertensive disorders of pregnancy among women who tested positive for COVID-19. The incidence of hypertensive disorders of pregnancy was compared between women who tested positive for COVID-19 and women who tested negative. Results Of the 1,008 women included in the analysis, 73 (7.2%) women tested positive for COVID-19, of which 12 (16.4%) were symptomatic at the time of admission. The incidence of hypertensive disorders of pregnancy was 34.2% among women who tested positive for COVID-19 and 22.9% women who tested negative for COVID-19 (p = 0.03). After adjusting for race, antenatal aspirin use, chronic hypertension, and body mass index >30, the risk of developing any hypertensive disorder of pregnancy was not statistically significant (odds ratio: 1.58 [0.91–2.76]). Conclusion After adjusting for potential confounders, the risk of developing a hypertensive disorder of pregnancy in women who tested positive for COVID-19 compared with women who tested negative for COVID-19 was not significantly different. Key Points

Objective To evaluate the ability of estimated blood loss (EBL) and quantitative blood loss (qBL) to predict need for blood transfusion in women with postpartum hemorrhage (PPH). Study Design This is a retrospective chart review that identified women with PPH (>1,000 mL for vaginal or cesarean delivery) between September 2014 and August 2015, reported by EBL (n = 92), and October 2015 and September 2016, reported by qBL (n = 374). The primary metric was the area under the receiver-operating characteristic curve for blood transfusion. Results The rate of PPH by EBL and qBL was 2.8 and 10.8%, respectively (p < 0.01). The rate of transfusion for women meeting criteria for PPH by EBL and QBL were 2% (66/3,307) and 2.7% (93/3,453), respectively (p = 0.06). Postpartum transfusion was predicted by an EBL of 1,450 mL with AUC 0.826 and qBL 1,519 mL with AUC 0.764, for all modes of delivery. Postpartum vital signs and change in pre- and postdelivery hematocrit were poor predictors for transfusion. Conclusion The rates of PPH increased with the implementation of qBL. Overall, qBL did not perform better than EBL in predicting the need for blood transfusion.

Objective Postpartum hypertension is a leading cause of readmission in the postpartum period. We aimed to examine the prevalence of racial/ethnic differences in postpartum readmission due to hypertension in women with antepartum pregnancy-associated hypertension. Study Design This was a multi-institutional retrospective cohort study of all women with antepartum pregnancy-associated hypertension diagnosed prior to initial discharge from January 2009 to December 2016. Antepartum pregnancy-associated hypertension, such as gestational hypertension, preeclampsia (with or without severe features), hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome, and eclampsia was diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions. Women with chronic hypertension and superimposed preeclampsia were excluded. Our primary outcome was postpartum readmission defined as a readmission due to severe hypertension within 6 weeks of postpartum. Risk factors including maternal age, gestational age at admission, insurance, race/ethnicity (self-reported), type of antepartum pregnancy-associated hypertension, marital status, body mass index (kg/m2), diabetes (gestational or pregestational), use of antihypertensive medications, mode of delivery, and postpartum day 1 systolic blood pressure levels were examined. Multivariable logistic regression models were performed to calculate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs). Results Of 4,317 women with pregnancy-associated hypertension before initial discharge, 66 (1.5%) had postpartum readmission due to hypertension. Risk factors associated with postpartum readmission due to hypertension included older maternal age (aOR = 1.44; 95% CI: 1.20–1.73 for every 5 year increase) and non-Hispanic black race (aOR = 2.12; 95% CI: 1.16–3.87). Conclusion In women with pregnancy-associated hypertension before initial discharge, non-Hispanic black women were at increased odds of postpartum readmission due to hypertension compared with non-Hispanic white women.

OBJECTIVE:We sought to evaluate maternal and neonatal outcomes in women with differing COVID-19 severity (asymptomatic versus symptomatic) to those without COVID-19 infection. STUDY DESIGN: We conducted a multicenter retrospective cohort study of all pregnant women delivering at three hospitals in a large not-for-profit health care organization from March through July 2020. Coarsened exact matching was performed to match women with and without COVID-19 using maternal age, body mass index, gestational age at delivery, parity and institution of delivery. Women without COVID-19 infection was the reference group. The primary outcome was a composite of maternal complications: stillbirth, postpartum hemorrhage, intraamniotic infection, endometritis and ICU admission. Outcomes were examined by adjusted binomial logistic regression analysis incorporating matched weights. RESULTS: Of 2,714 women who delivered at the three hospitals, 122 (4.5%) women had COVID-19 in the pregnancy. After coarsened exact matching, the study cohort included 486 women, 55 (11.3%) asymptomatic women, 36 (7.4%) symptomatic women and 395 (81.3%) women without disease. Demographic data (Table 1) showed that more Hispanic women were diagnosed with COVID-19 disease and represented the largest proportion in both the symptomatic and asymptomatic groups. Although there was an increase in the maternal composite outcome in both asymptomatic and symptomatic women compared to COVID-19 negative women, this was not statistically significant (Table 2). When compared to COVID-19 negative women, symptomatic women are more likely to be diagnosed with intraamniotic infection ) and require ICU admission (aOR 31.9 [95% CI 2.9-344.8]. There were no statistically different neonatal outcomes. CONCLUSION: Women with symptomatic or asymptomatic COVID-19 infection does not lead to increased odds of overall maternal morbidity compared to women without COVID-19 in pregnancy. This can be considered reassuring information to share with women who are contemplating or are pregnant in the pandemic.