Antenatal Testing Research Articles

1140 Stillbirth cause and potential preventability in tertiary care hospital population

Data on stillbirth preventability are limited. We aim to identify causes of stillbirth (fetal death >= 20 weeks) and assess the proportion of cases that were potentially preventable. A retrospective cohort of all stillbirths delivered at Yale New Haven Hospital 11/2013-12/2019 was classified according to Stillbirth Collaborative Research Network Initial Causes of Fetal Death (SCRN INCODE) to identify possible and probable cause of death. Standardized review of medical records included notes, vital signs, laboratory studies, imaging, hospital visits, procedures, antenatal testing, autopsy, placental pathology, and specialized stillbirth testing. Potential preventability was defined as stillbirth occurring in a fetus >= 24 weeks, birth weight >= 500g, without fetal anomalies incompatible with extrauterine life, and with cause of death associated with modifiable risk and management factors as determined by consensus decision. Of 35,075 total deliveries, 158 stillbirths occurred (4.50/1000) during the study. Of these cases, 123/158 (77.9%) had an identifiable cause (Figure 1). 50 of 158 cases (31.6%) were potentially preventable with the following non-exclusive causal distribution: maternal medical complications 26/50 (51.0%), placental insufficiency 23/50 (45.1%), hypertensive disorders of pregnancy 22/50 (43.1%), multiple gestation 5/50 (10%), preterm birth 2/50 (4%), and intrapartum 2 (4%). Possibly preventable cases were associated with the 32-36 week gestational age period and maternal substance use (Table 1). The majority of stillbirths had an identifiable cause, and nearly one third were possibly preventable. Possible preventability associated with 32-36 week gestational age period and maternal substance use. Maternal medical complications, placental insufficiency, and hypertensive disorders of pregnancy were the most frequently occurring modifiable factors and warrant additional targeted exploration and action.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1070 Neonatal outcomes in patients with resolved versus persistent uncomplicated fetal growth restriction

When fetal growth restriction (FGR) resolves prior to delivery, antenatal testing is discontinued. The objective of this study was to evaluate if FGR that resolves confers a similar risk of neonatal morbidity compared to persistent uncomplicated FGR. This is a secondary analysis of a large, NIH-funded medical record abstraction study of singleton pregnancies delivered at a tertiary care center between 2002 and 2013. Women with either persistent or resolved FGR who delivered at 38 weeks or more were included. FGR was defined as persistent estimated fetal weight (EFW) < 10%ile. Resolved FGR was defined as EFW < 10%ile on at least one ultrasound (US), but EFW > 10%ile at last US prior to delivery. Women with abnormal umbilical artery Doppler studies were excluded. The primary outcome was a composite of neonatal morbidity: NICU admission, Apgar < 7 at 5 minutes, neonatal resuscitation, cord pH < 7.1, RDS, TTN, hypoglycemia, sepsis or death. Secondary outcomes were individual items in the composite. Baseline characteristics, obstetric and neonatal outcomes were compared using Wilcoxon rank-sum and Fisher’s exact test. Logistic regression was used to adjust for confounders. Of 777 women studied, 686 (88%) had persistent FGR and 91 (12%) had resolved FGR. Women with resolved FGR were more likely to have higher body mass index, gestational diabetes, preexisting diabetes, diagnosed with FGR earlier, had spontaneous labor and delivered at later gestational ages. There was no difference in the composite neonatal outcome (RR 1.03, 95% CI, 0.72, 1.47) for resolved versus persistent FGR even when adjusting for confounders (aRR 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Though women with resolved FGR are managed differently than those with persistent FGR, resolved FGR fetuses do not have improved composite morbidity immediately after delivery compared to those where FGR persists. Future research is needed to determine whether additional surveillance results in improved outcomes in fetuses with resolved FGR.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Are point-of-care urine drug testing devices suitable for antenatal drug screening? A study verifying the Alere® Drug Screen Test Cup for the detection of six classes of drug in a pregnant population.

Currently, there are no national guidelines for antenatal drug testing. At Colchester Hospital, we use a strategy of screen-only using point-of-care testing to detect illicit drug use in pregnancy. To determine the suitability of this approach, we have compared the results of urine analysis by point-of-care testing with another NHS specialist clinical toxicology service that uses confirmation mass spectrometry. A total of 482 anonymized random urine specimens from antenatal clinics were tested for six drug classes: amphetamine, benzodiazepines, buprenorphine, cocaine, methadone and opiates using the Alere™ Drug Screen Urine Test Cup. The manufacturer's claims for positive cut-off and result stability were verified using spiked blank urine. Confirmatory testing was performed using ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) for detection of 26 individual drugs. Of 473 urine samples with adequate volume for point-of-care screening, 4.4% tested positive: 19 opiate and 2 cocaine. Concordance between point-of-care screening and UPLC-MS/MS confirmation was 97.9% for all drugs and 78.9% for opiates. Using spiked urine, only positive results for opiates were stable when read up to the manufacturer's recommended time of 60 min. The key advantages of using point-of-care devices to detect drug use in pregnancy are that is convenient and cheap. However, the clinical utility of point-of-care testing is limited by its poor sensitivity. Best practice is to confirm results using a more specific and sensitive method. As a result of this study, we are now reviewing our own procedures to consider introducing routine confirmation by mass spectrometry.

940 Frequency of and indications for preterm birth in pregnancies with non-immune hydrops fetalis spectrum disorder

Non-immune hydrops fetalis (NIHF) is associated with poor perinatal outcomes, including preterm birth (PTB). However, the frequency and causes of PTB are not well understood. We hypothesize that PTB is common and frequently iatrogenic in pregnancies complicated by NIHF spectrum. Secondary analysis of a prospective cohort of singleton pregnancies with NIHF spectrum. NIHF spectrum was defined as: isolated nuchal translucency (NT) ≥3.5mm, or 1 or ≥2 effusions (pleural effusion, pericardial effusion, ascites, and/or skin edema). The primary outcome was frequency of PTB (<37 weeks). Secondary outcomes were reasons for PTB (spontaneous, iatrogenic for maternal or fetal indication), PTB by type of effusion(s) and presence of genetic diagnosis. Multivariable logistic regression generated adjusted odds ratios (aOR). Among 152 cases of NIHF spectrum enrolled between 10/2018 and 7/2020, 68 did not result in termination, early spontaneous loss, or stillbirth. Of these, 76% (52/68) delivered preterm at a median gestational age of 33.4 weeks (IQR 30.9-36.5). Among the 52 PTBs, 19 (36.5%) were spontaneous, 9 (17.3%) were iatrogenic due to maternal indications (primarily pre-eclampsia), and 24 (46.2%) were iatrogenic due to fetal indications (primarily non-reassuring antenatal testing or worsening NIHF). PTB occurred in 9.1% (1/11), 77.8% (7/9), and 91.7% (44/48) of isolated enlarged NT, 1 effusion, and ≥2 effusions, respectively (figure). A genetic diagnosis was present in 36.5% of cases with PTB, compared to 18.8% who delivered at term (aOR 2.8, 95% CI 0.4-21.1). Polyhydramnios complicated 50.0% of all PTBs versus only 6.3% of term births (aOR 15.8, 95% CI 1.1-229.8). Pregnancies with 1 or ≥2 effusions frequently result in PTB, most often iatrogenic due to non-reassuring fetal status. Additionally, PTB was observed more frequently in cases with a genetic diagnosis and with polyhydramnios. These data are informative for counseling patients as well as for developing strategies to reduce PTB in this population.

68 Dichorionic twin-specific versus singleton growth standards for diagnosis of fetal growth restriction

To compare a twin-specific growth standard (NICHD) and a singleton growth curve (Hadlock) in diagnosing fetal growth restriction (FGR) associated with adverse neonatal outcomes in dichorionic diamniotic (DiDi) twin gestations. A retrospective cohort study of DiDi twin gestations ≥32 weeks delivered at a single institution between 2004-2019 with serial growth ultrasounds and neonatal outcomes data. Twins were classified based on last ultrasound before delivery with FGR: by both Hadlock and NICHD, by Hadlock only, and not by either curve, with FGR defined as estimated fetal weight <10%. Multivariate generalized linear mixed models were used to assess adverse neonatal outcomes via pairwise comparisons by FGR group, with a random effects component to account for twin-pair correlations. 1,460 twin infants were included with 8.1% FGR by both NICHD and Hadlock, 8.8% FGR by Hadlock only, and 83.1% with no FGR by either. Compared to twins with no FGR by either curve, twins with FGR by both curves were more likely to experience mild (aOR 2.38; CI 1.38-4.13) and severe (aOR 2.82; CI 1.16-6.88) composite neonatal morbidity. Compared to twins with FGR by Hadlock only, twins with FGR by both curves were more likely to experience mild (aOR 2.03; CI 1.00-4.14), but not severe (aOR 3.70; CI 0.72-18.90), composite neonatal morbidity. No significant differences were found for the studied outcomes between twins with FGR by Hadlock only and twins with no FGR by either curve (Table 1). The NICHD growth standard is a more sensitive marker of FGR that is associated with adverse neonatal outcomes in DiDi twin gestations. Use of Hadlock appears to identify more twins as FGR that are at low risk for neonatal morbidity, which could lead to unnecessary maternal anxiety, increased antenatal testing and possible iatrogenic preterm delivery.

1083 Adverse pregnancy outcomes associated with maternal syphilis infection

We sought to examine the association of maternal syphilis infection with adverse pregnancy and perinatal outcomes. We performed a retrospective cohort study of women with singleton pregnancies who delivered between 23 and 42 weeks in California between 2007 and 2011. We compared demographic characteristics and outcomes between pregnant women with syphilis and without syphilis. Maternal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes, preterm delivery, cesarean delivery, induction of labor, and severe maternal morbidity. Neonatal outcomes included neonatal intensive care unit admission, congenital anomaly, congenital syphilis, small for gestational age, stillbirth, neonatal death, and infant death. Descriptive statistics were assessed using chi-square/Fisher’s Exact tests. Multivariable logistic regression was used to estimate the association between syphilis and adverse outcomes. Statistical comparisons with a p-value of less than 0.05 and 95% CI that did not cross the null were considered statistically significant. Among a cohort of 2,566,246 women, there were 991 pregnancies complicated by maternal syphilis infection (0.04%). We found during multivariable logistic regression that maternal syphilis infection was significantly associated with preterm delivery (aOR 1.27, 95% CI: 1.05 - 1.54), NICU admission >24 hours (aOR 2.54, 95% CI: 2.13 - 3.04) and stillbirth (aOR 5.01, 95% CI: 3.16 - 7.92) after adjusting for confounders including maternal age, race/ethnicity, education, parity, prenatal visits, body mass index, smoking and insurance status. Maternal syphilis infection in pregnancy is associated with specific adverse pregnancy outcomes, even after adjusting for potential confounders. These data can be used to counsel patients with syphilis in pregnancy, and in developing approaches to clinical care. Due to the increased risk of stillbirth, perhaps such patients should receive antenatal testing. Further research is necessary to investigate the mechanisms of morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Late-Onset GBS Lower Extremity Cellulitis in Premature Neonate with a GBS Negative Mother with Alternative Modes of Transmission: A Case Report

Purpose: To report a case of cellulitis-causing late-onset Group B streptococcus (GBS) GBS in a neonate with a previously negative antenatal tested mother. This report aims to discuss the various transmission modes potentially causing this case of cellulitis, such as contaminated breast milk. Case Description: A preterm neonate, born via cesarean section (C-section) at 29 weeks gestation to a G1P0 mother with a negative GBS rectovaginal antenatal swab test, subsequently developed late-onset cellulitis in the lower extremity due to GBS 19 days later. Methods: This is a retrospective case report followed by clinical observation, blood cultures, imaging, and antibiotic interventions. Results: A neonate with left lower extremity cellulitis was found to be GBS positive from a previously negative antenatal GBS-negative mother. Discussion: As GBS is a common pathogen of neonatal sepsis and less commonly cellulitis, testing rectovaginal fluids once may not be enough to prevent neonates and preterm infants from protecting against transmission. As there have been rare cases of GBS-contaminated breast milk, culturing and testing of breast milk should also be considered, especially in preterm infants.

Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa\u2019s Eastern Cape province

BackgroundTo effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa.MethodsA Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance.ResultsA total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2–43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42–141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value< 0.0001).ConclusionDespite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Knowledge, attitudes, and practices of male partners on antenatal human immunodeficiency virus screening for the prevention of mother-to-child human immunodeficiency virus transmission in a private tertiary hospital

Background: Human immunodeficiency virus (HIV) transmission remains to be a significant problem in the country despite preventive efforts in the past years. In children, mother-to-child vertical transmission during pregnancy is the most common route. The World Health Organization has implemented the Prevention of Mother-to-Child HIV Transmission (PMTCT) program, which promotes a comprehensive approach in addressing this problem. Male partner involvement in antenatal voluntary HIV counseling and testing has been proposed to be a vital part of this approach. Their role in the process has not been studied in depth in the local setting. Objectives: The study aimed to describe the knowledge, attitudes, and practices of male partners of pregnant women toward antenatal HIV screening in a local private tertiary hospital using a survey created by Belato et al. in 2016. Methodology: A descriptive analysis was done to present the sociodemographic and clinical characteristics of the participants. The association between the level of male partner involvement and independent variables was also tested. Results and Conclusions: The results of the study revealed a high level of male partner involvement in the PMTCT of HIV services at 69.1%. Age of the male partner and the duration of the couple living together were significant factors associated with male partner involvement. However, there was lack of knowledge regarding HIV transmission, antenatal HIV testing, and PMTCT services among majority of the male partners. Community sensitization of men about the benefits of antenatal HIV testing and PMTCT services need to be prioritized to improve their awareness and their involvement in the program.

Современные аспекты генетической диагностики недостаточности 21-гидроксилазы

Objective of the Review: To discuss the current peculiarities of 21-hydroxylase insufficiency diagnostics. Key Points. Congenital adrenal hyperplasia (CAH) is a group of autosomal-recessive pathologies, associated with a defective enzyme or transport protein participating in cortisol biosynthesis. Currently, there is information on CAH genetics including information on 21-hydroxylase insufficiency. Neonatal screening, antenatal and postnatal methods to diagnose 21-hydroxylase deficit have been developed. Timely diagnosis and correct therapy have been found to facilitate normal physical and mental development of patients. Molecular genetic testing for CAH associated with 21-hydroxylase deficit is widely used both in Russia and globally and is of importance for differential diagnosis, identification of pathogenic CYP21A2 gene carriers and adequate genetic counselling. The best strategy to diagnose 21-hydroxylase insufficiency is 2-stage CYP21A2 gene analysis. The test should include both gene sequence analysis and identification of point replacements, minor deletions and duplication (e.g., dideoxynucleotide chain-termination method or Next Generation Sequencing), and identification of extended deletions and duplication (multiplex ligation dependent probe amplification, real-time polymerase chain reaction). Such a comprehensive approach can help finding a majority of types of possible changes. Conclusion. Correct genetic testing methods ensure detection of pathogen variants in CYP21A2 gene; evaluation of the possible rate of clinical manifestations of the disease, both during antenatal testing and if an unknown clinical CAH form is encountered; prescribing an adequate therapy; and ensuring genetic counselling in order to develop a management strategy, including when planning for pregnancy in a woman with confirmed CAH. Keywords: congenital adrenal hyperplasia, CYP21A2 gene, genetic counselling, 21-hydroxylase

Assessment of quality antenatal care-linked HIV counseling and testing as an intervention for prevention of mother-to-child transmission of HIV at government health facilities in Harari region, Eastern Ethiopia.

Objective:To assess quality of antenatal care-linked to HIV counseling and testing as an intervention for prevention of mother-to-child transmission at government health facilities in Harar Town, Eastern Ethiopia, 2020.Methods:Institutional-based cross-sectional study was done from 1 February to 30 February 2020 by applying quantitative method conducting in government health facilities in Harar town, Eastern, Ethiopia. A total of 422 participants were recruited from four governmental hospitals in Harar Town. Simple random sampling method was used to select the participants. Data were collected by three nurses selected from prospected hospitals. The collected data were cleaned, checked for quality, coded, and analyzed using “Software package Social Science, version 20” computer program.Result:From a total of 422 participants, 348 (82.5%) were satisfied with the counseling room’s privacy, and having pre-test and post-test counseling by the same person provided comfort for 357 (98.9%) of clients. Three hundred eighty-nine (92.2%) felt comfortable with the counselors’ client handling/respect; 386 (91.5%) were satisfied with technical competence of the counselors. About a quarter (25.4%) of clients had no discussion of prevention of mother-to-child transmission at all, and the majority (68.2%) comprehended that HIV counseling and testing could benefit prevention of mother-to-child transmission.Conclusion:Exit interview revealed that the basic topics were covered in most of the pre- and/or post-test sessions, and the majority of those counseled comprehended the information; however, nearly a quarter of the clients did not understand why they were offered HIV counseling and testing particularly during their pregnancy time.

Seroprevalence and risk factors of herpes simplex virus type 2 among pregnant women in Dhamar city, Yemen

Herpes simplex virus type 2 is the common cause of genital ulcer disease worldwide. Genital herpes infection is a major concern in pregnancy due to the risk of neonatal transmission. Materials and methods: A descriptive cross-sectional survey was conducted from August 2016 to March 2017 in some hospitals and health centers to assess the seroprevalence and risk factors of herpes simplex virus type 2 infection among pregnant women attending antenatal care in Dhamar city, Yemen. After taking written consent, socio-demographic, behavioral and obstetric history along with blood samples were collected from 200 pregnant women using a pre-structured questionnaire. Sera were analyzed for HSV-2 specific IgG using Electro-Chemiluminescence Immunoassay (ECLIA) method. Results: The overall seroprevalence of HSV-2 infection was 6 % (12/200) among pregnant women in Dhamar city. Levels of education and some obstetrical history such as numbers previous abortion (P=0.03), stillbirth (P=0.001). Although the study showed, there are significant differences in some symptoms, such as itching (P=0.02) and inflammation during urination (P=0.03). Conclusion: Overall, the seroprevalence of HSV-2 infection among pregnant women in Dhamar city is low. There is a critical need to adopt screening of HSV-2 into the antenatal profile tests. There is also need for more health education of this virus infection, methods of transmission, associated risk factors, and effective prevention and control strategies.

Predictability of Macrosomic Birth based on Maternal Factors and Fetal Aneuploidy Screening Biochemical Markers in Hyperglycemic Mothers.

Background: Macrosomic birth weight has been implicated as a significant risk factor for developing various adult metabolic diseases such as diabetes mellitus and coronary heart diseases; it has also been associated with higher incidences of complicated births. This study aimed to examine the predictability of macrosomic births in hyperglycemic pregnant women using maternal clinical characteristics and serum biomarkers of aneuploidy screening performed in the first half of pregnancy.Methods: A retrospective observational study was performed on a cohort of 1,668 pregnant women who 1) had positive outcomes after undergoing 50-g oral glucose challenge test (OGCT) at two university-based hospitals and 2) underwent any one of the following maternal biomarker screening tests for fetal aneuploidy: triple test, quadruple test, and integrated test. Logistic regression-based models for predicting macrosomic births using maternal characteristics and serum biomarkers were developed and evaluated for prediction power. A nomogram, which is a graphical display of the best predictable model, was then generated.Results: The study cohort included 157 macrosomic birth cases defined as birth weight ≥3,820 g, which was equivalent to the top 10 percentile of the modeling cohort. Three primary models solely based on serum biomarkers achieved area under curves (AUCs) of 0.55-0.62. Expanded models, including maternal demographic and clinical factors, demonstrated an improved performance by 25% (AUCs, 0.69-0.73).Conclusion: Our prediction models will help to identify pregnancies with an elevated risk of macrosomic births in hyperglycemic mothers using maternal clinical factors and serum markers from routine antenatal screening tests. Prediction of macrosomic birth at mid-pregnancy may allow customized antenatal care to reduce the risk of macrosomic births.

Awareness of HIV status and partner disclosure among antenatal clinic attendants: experience from a regional hospital in Ghana

Introduction: A pregnant woman’s knowledge of her human immune deficiency virus (HIV) serostatus and that of her sexual partner and the disclosure of her serostatus to the partner puts her in a better position to make informed choices about her pregnancy, adopt strategies to prevent mother to child transmission (PMTCT) of HIV and reduce sexual transmission of HIV. Some pregnant women however opt out of antenatal HIV testing while others have challenges with partner disclosure. This study sought to assess the pregnant women’s knowledge of their HIV serostatus and that of their partners, and disclosure to partners about their serostatus. Methods: An ethically approved cross-sectional descriptive study was conducted at the antenatal clinic (ANC) of the Kumasi South Hospital, Ghana from the period 8th March to 5th April, 2016. A structured questionnaire was administered to 407 ANC attendants who were randomly selected to participate in the study. Data entry was in Microsoft Excel and analyzed using R Core Team (2014). Results: The study showed that 80.1% (n = 326/407) of the participants knew their HIV serostatus. Of these, 18.1% (n = 59/326) knew prior to the current pregnancy and 81.9% (n = 267/326) were told during the current pregnancy. Among those who knew their HIV serostatus, the majority [83.1%; (n = 271/326)] had disclosed to their partners. Most of the participants [70.76%; (n = 288/407)] had no knowledge of their partners’ status. Conclusion: Every pregnant woman should know their HIV status, disclose it to their sexual partners and know the status of their sexual partners as this will PMTCT, reduce HIV transmission and acquisition among sero- discordant couples.

Intrauterine Fetal Demise

Intrauterine fetal demise (IUFD) and stillbirth are interchangeable terms to describe a fetal death in the second half of pregnancy. IUFD is defined as the delivery of a fetus showing no signs of life as indicated by the absence of heart rate, breathing, umbilical cord pulsation, or voluntary muscle movements. A thorough evaluation of maternal history and risk factors, fetal evaluation involving autopsy and genetic evaluation, and placental pathology should be offered at the time of IUFD diagnosis. Significant counseling should be provided to patients regarding future pregnancies and the risk of recurrence as well as the need for increased antenatal testing and delivery planning in subsequent pregnancies. This review contains 5 tables, 10 figures and 55 references. Keywords: fetal kick counts, intrauterine fetal demise (IUFD), management of intrauterine fetal demise, microarray, placental pathology, risk factors for intrauterine fetal demise

HIV testing and self-testing coverage among men and women in South Africa: an exploration of related factors.

Uptake of HIV testing is critical to halting the spread of HIV. Our study aimed to examine the coverage of HIV testing and self-testing and the individual-level, household-level and community-level factors associated with HIV testing and self-testing awareness. We analysed data of 12 312 men and women from 2016 SADHS and used multilevel mixed-effects models to examine the factors associated with uptake of HIV testing and self-testing awareness. About 80% of participants had ever tested for HIV, and 64% had tested in the past year. Only 49% of adolescents aged 15-19years had ever tested for HIV compared with over 80% of adults. Self-testing awareness was low (22%), and only 2.9% of respondents had ever self-tested for HIV. The odds of having ever tested for HIV were significantly higher among respondents who were aged 25-29 (AOR: 4.02; 95% CI: 3.27-4.95), had a higher level of education (AOR: 3.18; 95% CI: 2.19-4.61), were married (AOR: 1.63; 95% CI: 1.36-1.94), had high media exposure (AOR: 1.23; 95% CI: 1.06-1.44) and had ever had sex (AOR: 5.57; 95% CI: 4.67-6.64), but lower among men (AOR: 0.39; 95% CI: 0.35-0.44). In conclusion, HIV testing coverage is high in South Africa relative to most countries in sub-Saharan Africa, but falls short of the UNAIDS first 95. We found no evidence of socioeconomic and geographic inequalities in access to HIV testing. However, adolescents had a lower level of HIV testing uptake, suggesting a need for interventions to expand testing in this age group.

Reproduction, fetal medicine and genomics

Identification of a genetic disorder within a family raises the question of risk of the genetic disorder to other family members and future pregnancies. This question is particularly pertinent when considering reproductive risks and choices. Primary care is crucial in identifying and managing couples at increased risk of having an affected pregnancy, both pre-conceptually and in early pregnancy, before the first midwife appointment. Genomic technologies have an increasing role in antenatal screening programmes and antenatal testing; specifically non-invasive prenatal testing considered in this article. Infertility, recurrent miscarriage and fetal abnormality may all have an underlying genetic cause.

Post-term Pregnancy: Epidemiology, Outcomes, and Management

The term pregnancy ranges from 37 and 0/7 weeks’ gestation to 41 6/7 weeks’ gestation; a pregnancy that progresses to 42 weeks and beyond is deemed a postterm pregnancy. Such pregnancies are uncommon, in well dated pregnancies, likely less than 3-5 percent. However, because of induction of labor, in the United States it is less than 1%. Postterm pregnancy is associated with a number of complications including stillbirth, meconium, both fetal growth restriction and fetal macrosomia, birth injury, preeclampsia, cesarean delivery, operative vaginal delivery, chorioamnionitis, and postpartum hemorrhage. One of the primary reasons for induction of labor prior to 42 weeks is that it has been associated with a lower risk of many of these complications including cesarean delivery. In women who do not wish to undergo induction of labor, antenatal testing is indicated certainly by 41 weeks of gestation and is commonly used at earlier gestations. This review contains 1 table, 2 figures and 83 references Key words: cesarean, induction, late term, acrosomia, meconium, postterm, stillbirth, term

A safe space for parents

Antenatal Results and Choices supports parents through antenatal testing and its consequences

Size at birth and cognitive function among rural adolescents: a life course epidemiology study protocol of the Kisalaya cohort in Mysuru, South India

IntroductionIt is proven that adverse intrauterine environment results in ‘early life programming,’ alterations in metabolism and physiological development of the fetus, often termed as ‘Developmental Origins of Health and Disease’...