Asymptomatic Pregnant Women Research Articles

Vulvovaginal candidiasis in pregnant women attending a tertiary care centre in North-Eastern India

BackgroundCandida colonisation in vagina was found to be 20 %, rising to 30 % during pregnancy. According to studies, the prevalence of VVC during pregnancy is higher than healthy women. During pregnancy, candidal colonisation increases, both symptomatic and asymptomatic. However, the difference between strains causing symptomatic infection and those that cause asymptomatic infection is unknown. ObjectiveThis study aimed to compare the virulence factors of Candida VVC isolates from symptomatic and asymptomatic pregnant women. MethodsThe study included 120 pregnant women- 60 symptomatic and 60 asymptomatic, who presented to the Obstetrics and Gynaecology Outpatient Department with vaginitis symptoms. High vaginal swabs from the patient and used for gram stain, direct wet mount, pH detection and fungal culture in SDA with and without antibiotics. Germ tube tests, growth in CMA, and HiCrome Candida Differential Agar were used to identify yeast colonies grown in culture. The isolates were then examined for virulence factors like biofilm formation, phospholipase, coagulase, and hemolysin. Antifungal susceptibility was determined using E-test. ResultsThe current study reveals a high prevalence of Vulvovaginal Candidiasis in pregnant women(35 %). Asymptomatic patients had lower proportion of VVC than symptomatic patients. Non albicans Candida(NAC) outnumbered Candida albicans. Although Candida albicans growth was predominant in asymptomatic patients. Virulence studies revealed that Candida spp. isolated from symptomatic patients expressed a higher proportion of virulence factors. Besides NAC has higher proportion of expressing virulence factors than Candida albicans and has higher propensity to cause infection especially in symptomatic pregnant women. Antifungal susceptibility testing shows Itraconazole to be most sensitive for VVC treatment but Candida albicans was most susceptible to fluconazole while NAC had the least. ConclusionsThe study emphasizes the importance of routine screening of symptomatic pregnant women for VVC, as syndromic treatment will increase antifungal resistance, particularly in NAC.

Prevalence of bacterial vaginosis, sexually transmitted infections and their association with HPV infections in asymptomatic women attending antenatal care in Ethiopia.

Sexually transmitted infections (STIs) and human papillomavirus (HPV) infections are common among women of reproductive age and can lead to infertility, adverse pregnancy outcomes, neonatal infections and cervical cancer. In countries with limited medical coverage, untreated infections contribute to high morbidity. This study aimed to expand the current knowledge on the prevalence of bacterial vaginosis (BV) and STIs in pregnant Ethiopian women and assess the association of these conditions with HPV infections. Socio-demographic data and vaginal lavage samples were collected from 779 asymptomatic women aged 18 to 45 years (median age, 25.9 years) attending antenatal care in seven centres across Ethiopia. Multiplex polymerase chain reaction was used to test for BV, Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, herpes simplex virus types 1 and 2 (HSV-1/2), Mycoplasma, Ureaplasma, Candida species and HPV. Overall, 26.8% (95% confidence interval (CI): 23.7-29.9) of women tested positive for BV or one of the following STIs: C. trachomatis, T. vaginalis, N. gonorrhoeae, Mycoplasma genitalium, HSV-1/2 or Ureaplasma urealyticum. Additionally, 22.1% tested positive for at least one high-risk HPV type. Chlamydia trachomatis and HSV-2 were significantly more common among women who were positive for HPV and high-risk HPV. This study reveals a high prevalence of asymptomatic pregnant women who are positive for BV, STIs or HPV, putting them at risk of adverse pregnancy outcomes, secondary infertility or cervical cancer in a country with limited medical coverage. Screening and treating these women could be crucial in reducing morbidity.

A clinical Study of heart disease among asymptomatic antenatal women detected using Echocardiographic screening

Background: Pregnancy causes reversible changes in the maternal cardiovascular system. Adverse cardiac events during and after pregnancy continue to be the important causes of maternal mortality and morbidity. The signs and symptoms of pregnancy may confuse with signs and symptoms of heart disease. Echocardiography is safe, effective, noninvasive and does not expose the pregnant women to radiation hazards , so it plays a vital role in identifying the hemodynamic and structural changes in cardiovascular disease in asymptomatic antenatal women. Aim & objective: This study aims to screen asymptomatic pregnant women using transthoracic echocardiography. Material & Methods: Purposive sampling was done. The study was conducted at Apollo hospital Bilaspur from January 2024 to April 2024 enrolling 50 pregnant women from all trimester. Those with previous history of heart disease were excluded. Data was analysed for descriptive statistics using Microsoft excel and SPSS V 22 and was summarised using proportions, percentages, and contingency tables. Results: Out of 50 enrolled study participants ,60%(n-30), 28 %(n-14),12%(n-6) were in third, second , first trimester respectively . we found that 6%(n-3) of the patient have either congenital heart disease or acquired heart disease. Out of 3 study participants, 1 had congenital heart disease and 2 had acquired heart disease. Conclusion: Our study shows screening echocardiography will helpful in identifying the heart disesase and reducing maternal mortality and morbidity related to heart disease & this will justify the routine cardiac assessment in each and every pregnant women even in absence of cardiopulmonary symptoms.

Performance of rapid diagnostic test, light microscopy, and polymerase chain reaction in pregnant women with asymptomatic malaria in Nigeria

ObjectivesRapid diagnostic tests (RDTs) offer an attractive tool for diagnosing malaria in pregnancy. This study assessed the effectiveness of a Plasmodium falciparum–specific RDT compared with microscopy and polymerase chain reaction (PCR) in diagnosing asymptomatic malaria in pregnant women in southwest Nigeria. MethodsThe study included 406 asymptomatic pregnant women seeking antenatal care. Blood samples were collected and tested using RDT (SD Bioline, Standard Diagnostics Inc. Korea) and light microscopy and confirmed using nested PCR. ResultsThe study revealed that the malaria parasite positivity rate was 8.9% by RDT, 21% by microscopy, and 32% by nested PCR. RDT had a sensitivity of 51.4% and specificity of 69.5%, whereas microscopy had a sensitivity of 65.3% and specificity of 98.2%. The combined testing of microscopy and RDT had a sensitivity and specificity of 100%. The study also showed a high prevalence of mild anemia among participants. ConclusionsDespite the RDT's low sensitivity, its high negative predictive value suggests it could be useful in combination with microscopy in ruling out asymptomatic malaria in pregnancy. Further study will help identify more suitable RDTs for routine malaria diagnosis in Nigeria and strengthen malaria prevention programs in pregnant women.

Mid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth.

To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD). Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve. Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1β, TNFβ, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%. IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response.

PREVALENCE OF ASYMPTOMATIC BACTERIURIA AND ITS MICROBIOLOGICAL PROFILE IN PREGNANCY AT TERTIARY CARE HOSPITAL, JABALPUR

Objective: To determine the prevalence of asymptomatic bacteriuria (ASB), microbiological profile, and pregnancy outcome in asymptomatic pregnant women. Methods: Pregnant women attending outpatient clinic were selected randomly. Urine sample by clean catch method collected and battery of tests were performed. Prevalence of ASB and pregnancy outcome studied. Results: Total 114 pregnant women were studied, out of which 6 cases were positive for urine culture. Prevalence rate in our study found to be 5.3%. Study depicted that 33.4% women with asymptomatic bacteriuria had premature rupture of membranes, 16.7 % women had pre-eclampsia and 16.7% had severe anemia. 50 % babies were premature, 33.4% had fetal growth restriction and 16.7% developed acute respiratory distress syndrome. Conclusion: Urinary tract infections are common during pregnancy. Asymptomatic bacteriuria can progress to pyelonephritis and may result in adverse pregnancy outcome. Prevalence rate found to be 5.3%. Premature rupture of membranes and premature births were major adverse pregnancy outcome. E. coli was most common bacterial isolate found in the study and was highly sensitive to cefuroxime sodium. Pregnancy complications may be avoided by using regular screening with urine cultures.

Prevalence of clinical malaria and associated symptoms in pregnant women at Hamusit health center, Northwest Ethiopia

BackgroundMalaria is the disease caused by intracellular parasites known as Plasmodium species and is mainly transmitted by blood sucking female Anopheles mosquitoes. During pregnancy, malaria results in severe complications to the mother, the fetus and the newborn. Symptoms of malaria, such as fever, malaise, headache, nausea and vomiting, in pregnant women can be mistakenly attributed solely to pregnancy. In Ethiopia, the prevalence of malaria in asymptomatic pregnant women has been well documented. However, studies indicating the prevalence and clinical presentation of malaria in pregnant women are lacking. Therefore, there is little information on the prevalence of malaria and significantly associated signs and symptoms in pregnant women. The aim of this cross-sectional study was to determine the prevalence of malaria and identify clinical signs and symptoms associated with malaria which suggest presence of malaria in pregnant women at Hamusit Health Center, Northwest Ethiopia. MethodsA health facility-based cross-sectional study was conducted on 231 malaria symptomatic pregnant women from April to June 2023. A convenience sampling technique was employed. The socio demographic and clinical data of the study participants was collected through face-to-face interview using questionnaire. Thick and thin blood films were prepared from capillary blood and stained with 10 % Giemsa. The stained blood smear was washed with clean water, air dried and examined under a light microscope. The Statistical Package for Social Sciences software version 20 (SPSS 20) was used to analyses data. Logistic regression was used to assess signs and symptoms associated with malaria. An adjusted odds ratio with a 95 % confidence interval was calculated, and a P value < 0.05 was considered statistically significant. ResultsThe overall prevalence of malaria among symptomatic pregnant women in the study area was 22.9 % (53/231) (95 % CI: 17.3–29 %). The most prevalent species was P. falciparum, with a frequency of 14.3 % (33/231) (95 % CI: 10 %–18.6 %), followed by P. vivax, 5.2 % (12/231) (95 % CI: (2.6 %–8.2 %). The remaining 3.5 % (8/231) (95 % CI: 1.8 %–6.7 %) were mixed infections of P. falciparum & P. vivax. Primigravidae (62.3 %) and first trimester pregnancies (52.8 %) were more affected. Malaria signs and symptoms mainly, fever [(P = 0.002, AOR (95%CI); 5.1(1.84, 14.30)], joint pain [(P = 0.001, AOR (95%CI); 7.8(2.24, 27.32)], vomiting [(P = 0.007, AOR (95%CI); 2.9(1.34, 6.43)], malaise [(P = 0.005, AOR (95%CI); 3.6(1.48, 8.67)] and fatigue [(P = 0.0039, AOR (95%CI); 2.1(1.04, 4.37)], were significantly associated with malaria infection in pregnant women. ConclusionsMalaria positivity in pregnant women with fever, joint pain, vomiting, malaise and fatigue is considerably high in the study area. These signs and symptoms in pregnant women are strong indicators of malaria infection.

Assessing mean corpuscular volume as a screening tool for gestational vitamin B12 deficiency based on NHANES.

Vitamin B12 can lead to neurological deficits. We assessed whether the mean corpuscular volume (MCV) could be a sufficiently sensitive measurement for abnormal serum methylmalonic Acid (MMA) and total plasma homocysteine (tHCY) (biomarkers of vitamin B12 or folate deficiency) and if so, at what cutoff value. A total of 26,397 participants (12,730 males and 13,667 females) were included in the analysis. Weighted analysis was performed using NHANES data to calculate crude/adjusted associations between MCV-MMA/tHCY, using linear regression. Unadjusted odds ratios (OR) 95% CIs were estimated from logistic regression models. Receiver Operating Curve and the Youden Index were used to identify the MCV level that most accurately distinguished those with abnormal MMA and tHCY (dependent variables) from those without. A positive and significant correlation between MCV-MMA/tHCY was found in the general population between ages 18-85, 0.95 (95% C.I. 0.75-1.17) and 2.61 (95% C.I. 2.15-3.08). In pregnant women, for every unit increase in MCV there was a 19% increase in odds of abnormal MMA, OR 1.19 (95% C.I. 1.08-1.31), p=0.001 and the Area Under the Curve for MCV as a test for abnormal MMA was 78%. An MCV cutoff of 93.1 correctly identified abnormal MMA in pregnant women with 81% sensitivity and 77% specificity. In the general population the MCV test performed poorly in identifying abnormal MMA/tHCY. MCV is an inexpensive measurement that may be useful to screen asymptomatic pregnant women for vitamin B12 abnormalities. This may have a significant impact on reducing adverse neurological outcomes in their children.

Evaluation of the thyroid gland vascularity during pregnancy using 2-dimensional color Superb Microvascular İmaging vascularization index technique

PurposeWe aimed to investigate maternal thyroid parenchymal vascularity with 2-dimensional color superb microvascular imaging vascularization index (2D-cSMIVI) levels and thyroid gland volume in the first, second and third trimesters. MethodsThis longitudinal prospective study was carried out with participants selected from 30 healthy asymptomatic pregnant women. Ultrasonography (US) for the thyroid gland was performed in each trimester. The vascularization index (VI) values obtained by manually drawing the contours of the thyroid parenchyma in the longutidinal plane, using the free region of interest (ROI) with 2DcSMIVI mode. VI values obtained in each trimester, thyroid hormone levels (TSH, T3, T4) and thyroid volumes were compared. ResultsWe have detected that thyroid gland vascularity increased significantly as pregnancy progresses. The mean VI values of thyroid gland in third trimester were significantly higher than first and second trimester (p < 0.001), and the mean VI values of the thyroid gland in the second trimester were significantly higher than first trimester (p < 0.001). During pregnancy, we detected the increase in VI values, TSH levels and thyroid gland volumes. ConclusionMaternal thyroid gland gray scale findings, parenchymal vascularization, thyroid volumes should be evaluated routinely for the healthy fetal development. 2D-cSMIVI method allows us to evaluate vascularization with quantitative numerical values objectively. We have detected that the VI values and volume of the thyroid gland increases as pregnancy progresses. In the complex situation of pregnancy process, the thyroid gland can be evaluated quantitatively with SMI method effectively.

Knowledge, Practices and Attitudes of Traditional Birth Attendants towards Intermittent Preventive Treatment for Malaria Prevention among Pregnant Women within Ondo West Local Government Area of Ondo State, Nigeria

Intermittent preventive treatment (IPT) for malaria among pregnant women is a recommendation of the World Health Organization (WHO) to combat the various adverse outcomes of malaria in pregnant women. This adverse outcomes includes low birth weight, preterm delivery, severe anemia, maternal morbidity and mortality especially among primigravids. Traditional Birth Attendants (TBAs) has emerged as a significant influence in our society, particularly in the realm of maternal care and childbirth. Several economic, religious and socio-cultural factors have contributed to the preference of some pregnant women for the services of TBAs over medical facilities. Therefore, the study was carried out to assess the knowledge, practices and attitudes of traditional birth attendants within Ondo West Local Government area towards IPT for pregnant women reporting to them for care and delivery. The design employed in the study was descriptive cross-sectional survey. Data were collected by means of an adapted semi-structured interviewer administered-questionnaire. The analysis of the data was done using SPSS version 26.0. Demographic parameters were summarized with simple percentages and non-parametric chi-square test was used to determine the different associations of the variables. P values less than 0.05 were considered statistically significant. The findings indicated that most of the TBAs have good knowledge of the malaria vector and factors promoting the transmission of malaria. Majority (mean=82.9%) also demonstrated excellent understanding of the symptoms associated with malaria in pregnancy however, their knowledge on the risk associated with malaria in a pregnant woman remains comparably low (mean=61.1%) thereby affecting significantly their attitudes and practice to intermittent preventive treatment for malaria prevention. This is because 50% of the TBA have not heard about IPT (P=0.01) and therefore do not administer treatment to asymptomatic pregnant women as recommended by WHO (P=0.00) and report of this study shows that majority (57.40%) of them attend to more than 31 pregnant women in a year. There is need for a government-sponsored partnership between formal health workers and TBAs in this study to ensure they are trained, retrained and equipped. The integration of the TBAs into maternal health care will ensure the sustenance of government policy on the free treatment of all pregnant women intermittently for malaria as recommended by WHO.

Staphylococcus spp. and mecA gene in pregnant women: a neglected health risk to mother and child

This study aimed to determine the phenotypic, molecular and epidemiological profile of methicillin resistant Staphylococcus spp. in pregnant women. Were included 100 asymptomatic pregnant women between 16 and 38 years old, who underwent microbiological examination by collecting a vaginal swab at the first trimester of pregnancy. The isolates were subjected to isolation, characterization, phenotypic and molecular tests were performed. Among the samples analyzed, were detected coagulase-negative Staphylococcus in 83%, coagulase-positive Staphylococcus, 6% and Streptococcus spp. in 5%, and there was no bacterial growth in 6%. The antibiotics that showed the highest resistance were amoxicillin + clavulanic acid and sulfamethoxazole + trimethoprim (92.77%) in coagulase-negative Staphylococcus and penicillin and sulfamethoxazole + trimethoprim in coagulase-positive Staphylococcus (100%), where in the latter S. aureus was the species identified in 66.67% of the samples. As for the identification of the mecA gene in Staphylococcus spp. samples, this gene was detected in 40.5% of the samples of coagulase-negative Staphylococcus, and it was not detected in the samples of coagulase-positive Staphylococcus. The epidemiological study showed that prior treatment with antibiotics was significantly (p≤0.016) associated with oxacillin resistance in vaginal swab samples. The presence of the mecA gene in coagulase-negative Staphylococcus isolates demonstrated a bacterial profile in this type of biological sample, different from what is already presented in the scientific literature. New studies are warranted to understand the epidemiology of the bacterial species involved and later to implement health education actions both in the target population and in health care professionals.

Assessment of Proteinase and Phospholipases Enzymes Isolated from Pathogenic Candida species from Women Attending Antenatal Clinic at Mbeya Zonal Referral Hospital, Southern Highland Regions of Tanzania

Fungi are a global cause of vaginal infections, with vaginal candidiasis largely afflicting tropical regions including most parts of sub-Saharan Africa. In Tanzania, baseline studies have established the prevalence of Candida species among symptomatic and asymptomatic pregnant women in Dar es Salaam (Namkinga et al., 2005; Namkinga 2012) and in Mwanza (Mushi et al., 2019). However, no study that has been done to determine the above-mentioned enzymes form Candida species in Southern Highland Regions of Tanzania. Several factors have been reported to contribute to the virulence and pathogenicity of Candida, among others the production of extracellular hydrolytic enzymes, particularly phospholipase and proteinase. Therefore, this study was designed to investigate the in vitro production of phospholipases and proteinases enzymes from isolated pathogenic Candida spp from pregnant women.Of the 280 samples collected from symptomatic and asymptomatic pregnant women attending antenatal clinics at Mbeya Zonal Referral Hospital were tested for several microbiological methods such as the wet mount microscopic preparations (hanging drop) and the Gram stained smears for microscopy, cultures on Sabouraud’s dextrose agar and on Conidia enhancing medium (Corn meal agar), germ tube test, biochemical tests, sugar fermentation-assimilation tests and molecular test to characterize Candida species.Phospholipase production was performed in egg yolk medium while the production of proteinase was done in a medium containing bovine serum albumin. All analyses were performed in triplicates. The results showed that; out of the 280 tested, 155 (74.3%) isolates were phospholipase positive while 201 (96.6%) were positive for proteinase activity. C. albicans was the species with the highest number of positive isolates for proteinase and phospholipase 110 (95.6%), and most strains of C. albicans produce both enzymes (phospholipases and proteinases). The non-albicans Candida isolates were also producers of hydrolytic enzymes that, consequently, might be able to cause infections as favorable conditions arises.

Evaluating Chlamydia trachomatis and Neisseria gonorrhoeae screening and treatment among asymptomatic pregnant women to prevent preterm birth and low birthweight in Gaborone, Botswana: A secondary analysis from a non-randomised, cluster-controlled trial.

To evaluate the impact of screening and treating asymptomatic pregnant women for Chlamydia (C.) trachomatis and Neisseria (N.) gonorrhoeae infections on the frequency of preterm birth or low birthweight infants in Botswana. Non-randomised, cluster-controlled trial. Four antenatal care clinics in Gaborone, Botswana. Pregnant women aged ≥15 years, attending a first antenatal care visit, ≤27 weeks of gestation and without urogenital symptoms were eligible. Participants in the intervention clinics received screening (GeneXpert®, Cepheid) during pregnancy and at the postnatal visit. Participants in the standard-of-care clinics received screening at the postnatal visit only. We used multivariable logistic regression and post-estimation predictive margins analysis. Post-hoc analysis was conducted among sub-samples stratified by parity. Preterm birth (<37 weeks of gestation) and low birthweight (<2500 g). After controlling for parity, hypertension, antenatal care visits and clinic site, the predicted prevalence of preterm birth or low birthweight was lower in the intervention arm (11%) compared with the standard-of-care arm (16%) (adjusted odds ratio [aOR] 0.59; 95% confidence interval [CI] 0.28-1.24). In post-hoc analysis, the intervention was more effective than the standard-of-care (aOR 0.20; 95% CI 0.07-0.64) among nulliparous participants. A C. trachomatis and N. gonorrhoeae infection screening and treatment intervention among asymptomatic pregnant women may have reduced preterm birth or low birthweight outcomes, but results were not statistically significant. Post-hoc analysis found that the intervention reduced adverse outcomes among nulliparous participants.

Characteristics and Outcomes of Pregnant Women Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Before and During the COVID-19 Pandemic.

Respiratory syncytial virus (RSV) can cause severe disease among infants and older adults. Less is known about RSV among pregnant women. To analyze hospitalizations with laboratory-confirmed RSV among women aged 18 to 49 years, we used data from the RSV Hospitalization Surveillance Network (RSV-NET), a multistate population-based surveillance system. Specifically, we compared characteristics and outcomes among (1) pregnant and nonpregnant women during the pre-COVID-19 pandemic period (2014-2018), (2) pregnant women with respiratory symptoms during the prepandemic and pandemic periods (2021-2023), and (3) pregnant women with and without respiratory symptoms in the pandemic period. Using multivariable logistic regression, we examined whether pregnancy was a risk factor for severe outcomes (intensive care unit admission or in-hospital death) among women aged 18 to 49 years who were hospitalized with RSV prepandemic. Prepandemic, 387 women aged 18 to 49 years were hospitalized with RSV. Of those, 350 (90.4%) had respiratory symptoms, among whom 33 (9.4%) were pregnant. Five (15.2%) pregnant women and 74 (23.3%) nonpregnant women were admitted to the intensive care unit; no pregnant women and 5 (1.6%) nonpregnant women died. Among 279 hospitalized pregnant women, 41 were identified prepandemic and 238 during the pandemic: 80.5% and 35.3% had respiratory symptoms, respectively (P < .001). Pregnant women were more likely to deliver during their RSV-associated hospitalization during the pandemic vs the prepandemic period (73.1% vs 43.9%, P < .001). Few pregnant women had severe RSV disease, and pregnancy was not a risk factor for a severe outcome. More asymptomatic pregnant women were identified during the pandemic, likely due to changes in testing practices for RSV.

Predicting preterm birth within 2 weeks in asymptomatic women with a short cervix: Combined effects of cervicovaginal fluid cytokine levels and fetal fibronectin test.

To predict preterm birth (PTB) accurately, we conducted a comprehensive cytokine assay using cervicovaginal fluid (CVF) and evaluated the additive effects of cytokine levels on the fetal fibronectin (fFN) test. A total of 645 CVF samples were collected from 256 asymptomatic pregnant women between 24 and 35 weeks gestation, exhibiting short cervix. After selection based on specific criteria, 17 cytokines in 105 CVF samples were simultaneously measured using multiplex assay. Multivariate logistic regression analysis was performed to evaluate the association between cytokine levels and impending PTB, which is defined as PTB within 2 weeks after CVF collection. Moreover, receiver operating characteristic (ROC) analysis was performed in women with positive fFN results, which was validated using another set of 65 CVF samples. In positive fFN women, the CCL2 level was significantly higher in the impending PTB group than the other group (p < 0.01) and a predictor of impending PTB (adjusted odds ratio 1.020, 95% confidence interval [95% CI] 1.003-1.038, p = 0.020). The cutoff value of CCL2 was 64.8 pg/mL (are under the curve 0.726, p = 0.004, 95% CI 0.593-0.859, sensitivity 45.2%, specificity 91.7%). Additionally, the reliable classification performance of proposed ROC model could be validated. However, measuring cytokine levels could not help in predicting impending PTB in women with negative fFN or normal labor onset in healthy-term women. Comprehensive analysis of CVF cytokines revealed that the CCL2 level significantly improves the prediction of impending PTB in asymptomatic fFN-positive women with a short cervix, which may contribute to better clinical management.

TVS-guided cervical strain elastography is more effective than measuring cervical length as an independent predictor of spontaneous preterm delivery in asymptomatic, high-risk women during the mid-trimester

Introduction TVS (Transvaginal Sonography) guided Cervical strain elastography (CSE) is now available in tertiary referral centers of LMICs (Low- and Middle-Income Countries). TVS cervical length (CL) assessment is being used routinely. Still, elastography is not used in clinical settings, although enough evidence suggests good predictive value towards sPTD (spontaneous Preterm Delivery). The clinical utility of elastography has not been tested among high-risk populations of LMICs for the prediction of sPTD. Aim To test the performance of TVS-CSE in predicting sPTD among asymptomatic women in the mid-trimester at risk of sPTD either due to clinical factors or due to a short cervix. Method Prospective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24 weeks who had one or more clinical risk factors for sPTD or CL <2.5 cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR – softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37 weeks (after 26 weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM—was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length. Results Out of 221 recruited,17 were lost to follow-up after 32 weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5 cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63 ± 0.67 vs. 3.63 ± 0.80, p = .981) whereas SRs in all three ROIs were significantly lower among sPTD group versus no sPTD group (IN:0.65 ± 0.29 vs 0.79 ± 0.30 p = .001, WN:0.34 ± 0.13 vs 0.39 ± 0.15, p = .013, AN:0.37 ± 0.16 vs 0.48 ± 0.26, p = .002, respectively). Using ROC curves, while CL was not predictive (AUROC 0.49, p = .81), SRs showed moderate predictive value toward sPTD with the best AUC of 0.624 (p = .003) at IN. Prediction was slightly better for early sPTD <32 weeks (AUC 0.653 p = 0.03). The best cutoff for SR at IN was 0.72, below which there was a moderate accuracy in predicting sPTD (sensitivity 52.11%, specificity 60.9%, PPV 41.57%, NPV 70.44%, diagnostic OR 1.69 and overall accuracy of 57.84%). A weak positive correlation is seen between IN and CL (Pearson’s correlation R = 0.181). Multi-variable binary logistic regression analysis suggested that SRs at IN (Adjusted OR − 0.259 CI 0.079–0.850), AN (Adjusted OR 0.182 CI 0.034–0.963), Multiple Pregnancy (Adjusted OR 3.5 CI 1.51–8.13) and previous sPTD/PPROM (Adjusted OR 2.72 CI 0.97–7.61) independently predicted sPTD. Conclusions TVS CSE performed better than CL as an independent predictive tool toward sPTD, although predictive efficacy was modest at best. Since technology is now available in high-end USG machines in tertiary care centers, we propose optimal utilization of CSE in LMICs to triage at-risk populations since low SRs are strongly associated with sPTD.

The effectiveness of vaginal progesterone to prevent preterm birth in singleton pregnant women with a short cervix at 18–32 weeks gestation

Objective: Short cervix is a risk factor for preterm birth. Currently, both international and domestic studies about progesterone’s effectiveness are limited to pregnant women at 18–24 weeks gestation. However, multiple studies indicated that cervical length was associated with preterm birth even before 32 weeks of gestation. Therefore, this study expanded the gestational week range to investigate whether progesterone can reduce the rate of preterm birth in singleton pregnant women with a short cervix at 18–32 weeks gestation. Methods: Pregnant women who underwent prenatal examination at Peking University First Hospital from January 2016 to August 2020 were prospectively followed. A total of 132 asymptomatic singleton pregnant women at 18–32 weeks gestation with a cervical length <25 mm were ultimately enrolled. According to the method of treatment, the participants were divided into progesterone group (80 patients) and control group (52 patients). The rate of preterm birth (PTB) at different stages was compared between two groups. Results: (1) There was no significant difference in the total preterm birth rate (18.8% vs. 21.2%, RR 0.886[0.442–1.777], p = 0.734). (2) Stratified analysis found that, for pregnant women at <24 weeks gestation, there was a significant difference in the rate of PTB at <32 weeks (2.8% vs. 33.3%, p = 0.021). For women at 24–28weeks gestation, significant difference was not found in the rate of PTB at <37 weeks gestation (25% vs. 42.9%, RR = 0.583[0.186–1.831], p = 0.682), neither for women at after 28 weeks(12.5% vs. 11.1%,1.12[0.27–4.59], p = 1). (3) Vaginal progesterone was not associated with low birth weight (13.8% vs. 19.2%, p = 0.4), or preterm birth-related complications such as respiratory distress syndrome (3.8% vs. 7.7%, p = 0.555), aspiration pneumonia (22.5% vs. 19.2%, p = 0.653) and sepsis (2.5% vs. 7.7%, p = 0.331). Conclusion: For pregnant women with a short cervix at 18–24 weeks gestation, the rate of preterm birth before 32 weeks could be significantly reduced. For women with a short cervix at 24–28 weeks gestation, the rate of preterm birth could be reduced, while there was no significant effect for pregnant women. Further studies with a larger sample size and randomized controlled researches are needed.

Subclinical malaria among pregnant women living in refugee settlements in Northern Uganda

Background: Malaria during pregnancy contributes to significant perinatal morbidity and mortality, accounting for almost 25% of global maternal mortality. However, the epidemiology and risk factors for subclinical malaria among pregnant women living in refugee settlements is poorly understood. Objective: To determine the prevalence and predictors of subclinical malaria among pregnant women in refugee settlements in Northern Uganda. Design: We conducted a multi-center, cross-sectional study. Methods: The study was conducted between April and June 2023 and involved pregnant women aged 18–45 years attending routine antenatal care (ANC) at three health facilities serving refugee communities in Adjumani district, Uganda. We collected sociodemographic, environmental, maternal, and obstetric factors using a structured questionnaire. Both CareStart Malaria HRP-2/pLDH (Pf/Pan) combo rapid diagnostic test (RDT) and blood smear microscopy with 3% Giemsa staining were simultaneously performed on samples from each patient. Logistic regression analysis identified factors independently associated with subclinical malaria, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: We enrolled 304 pregnant women, with a mean age of 25 years. In total, 68.8% ( n = 209) had lived in the settlement for over 12 months, 25.7% ( n = 78) were primigravida, and 1.0% ( n = 3) were living with HIV. Malaria prevalence was 5.3% ( n = 16) by RDT and 3.2% ( n = 10; seven Plasmodium falciparum and three P. malariae) by microscopy. Only 4 (25.0%) of the RDT-positive cases were also positive by microscopy (Cohen’s kappa: 0.278—Fair agreement). All participants were asymptomatic. Factors associated with higher odds of subclinical malaria included primiparity (aOR: 2.79, 95% CI: 1.25–6.25, p = 0.013), ⩾4 ANC visits (aOR: 2.41, 95% CI: 1.34–4.34, p = 0.003), and residence in the settlement for less than 12 months (aOR: 2.54, 95% CI: 2.0–3.22, p &lt; 0.001). Living in the settlement for over 3 years, being primigravida, and being married were associated with 68%, 50%, and 68% lower odds of subclinical malaria, respectively (aOR: 0.32, 95% CI: 0.13–0.79, p = 0.014; aOR: 0.50, 95% CI: 1.22–5.52, p = 0.016; aOR: 0.32, 95% CI: 0.13–0.78, p = 0.012). Conclusion: Our study reveals the high prevalence of subclinical malaria among pregnant women in refugee settlements, particularly among primiparous women and recent arrivals. The poor agreement between RDT and microscopy suggests the need for dual screening in asymptomatic pregnant women.

Plasmodium infections and associated risk factors among parturients in Jawi district, northwest Ethiopia: a cross-sectional study

BackgroundPregnant women have an increased risk of Plasmodium infections and disease. Malaria in pregnancy is a major public health problem in endemic areas. Assessment of the burden and risk factors of malaria in pregnancy across different malaria transmission settings is required to guide control strategies and for malaria elimination. Thus, the current study is generating such evidence from parturient women in northwest Ethiopia.MethodsA cross-sectional study was conducted among 526 pregnant women admitted to the delivery rooms of selected health facilities in Jawi district, northwest Ethiopia, between November 2021 and July 2022. Data on the socio-demographic, clinical, obstetric, and malaria prevention practices of pregnant women were collected using interviewer-administered questionnaires and from women’s treatment cards. Malaria was diagnosed by light microscopy, rapid diagnostic test, and multiplex real-time polymerase chain reaction. Risk factors for malaria were evaluated using bivariable and multivariable logistic regression models. A P-value of < 0.05 was considered statistically significant.ResultsAmong the examined parturient women, 14.3% (95% CI 11.4–17.5%) had Plasmodium infections. The prevalence of peripheral, placental, and congenital malaria was 12.2% (95% CI 9.5–15.3%), 10.9% (95% CI 8.2–14.1%), and 3.7% (95% CI 2.3–6.1%), respectively. About 90.6% of peripheral and 92% of placental Plasmodium infections were asymptomatic. Plasmodium infection at parturiency was independently predicted by maternal illiteracy (AOR = 2.03, 95% CI 1.11–3.74), primigravidity (AOR = 1.88, 95% CI 1.01–3.49), lack of antenatal care follow-up (AOR = 2.28, 95% CI 1.04–5.03), and history of symptomatic malaria during pregnancy (AOR = 4.2, 95% CI 2.32–7.59). Moreover, the blood group O phenotype was significantly associated with placental malaria among the primiparae.ConclusionsOverall, asymptomatic Plasmodium infections were prevalent among parturients in northwest Ethiopia. Maternal illiteracy, primigravidity, lack of antenatal care follow-up, and history of symptomatic malaria during pregnancy were the risk factors for malaria during parturiency. Thus, promotion of a healthy pregnancy through ANC follow-up, strengthening malaria prevention and control practices, and screening of malaria in asymptomatic pregnant women are suggested to reduce its burden in pregnancy.

A Prospective Study on the Prevalence of Coronavirus Disease 19 Infection in Antenatal Patients at Term and Its Effects on Maternal-fetal Health and on Early Childhood Development

Abstract Background: Coronavirus disease 19 (COVID-19) has become a global pandemic; its unparalleled speed of spread has left us all in a worldwide alarming situation. Aims: The aim was to study the prevalence of COVID-19 infection in asymptomatic antenatal patients at term and its maternal and fetal outcomes and neonates being followed up till 18 months for developmental assessment. This was a prospective observational study carried out from September 1, 2020, to March 31, 2023. Materials and Methods: This prospective observational study was conducted on 250 pregnant women attending the antenatal care outpatient department in a Zonal Hospital in Northeastern India expected to undergo delivery in the next 5 days, and all suspected COVID-19 pregnant women were included in the study. Asymptomatic pregnant women not expecting delivery in the next 5 days were excluded. All neonates born to these 250 mothers were followed till 18 months of age and were then assessed for the impact of COVID-19 on the developmental milestones. The prevalence of COVID-19 was calculated in the study population. The Chi-square test was used to compare categorical variables in COVID-19-positive and -negative groups. P &lt;0.05 was considered significant. Results: The prevalence of COVID-19 infection in term pregnancies was found to be 4%. The findings of the study showed no immediate impact on maternal and fetal health from COVID-19 infection. However, on follow-up of these babies (born during the pandemic) at 18 months of age, there was a delay in social and language domains of development in 18.8% of children. Most women were discharged without any significant problems, and there were no signs that COVID-19 had been transmitted vertically. Conclusion: COVID-19 infection was found to have no immediate impact on maternal and neonatal health. However, follow-up at 18 months of babies born during the COVID-19 era revealed a delay in social and language milestones in 18.8% of children. Further multicentric studies with a larger population base need to be done to substantiate this claim.