Previous History Of Abortion Research Articles

PREVALENCE OF BRUCELLOSIS IN BLACK BENGAL GOATS IN BANGLADESH

Brucellosis is an important bacterial zoonotic disease causing significant economic loss in dairy industries worldwide including Bangladesh. But limited studies are devoted to determine the prevalence of brucellosis in goat in all districts of Bangladesh. Therefore, a cross-sectional study was undertaken to determine the seroprevalence of brucellosis in Black Bengal goats in Nilphamari Sadar and Kishoreganj upazillas of Nilphamari district of Bangladesh using Rose Bengal Test (RBT) as screening test and I-ELISA as confirmatory test. A total of 154 sera samples from Black Bengal goats were collected from Nilphamari district. Epidemiological data on the selected Black Bengal goats were collected using a structured questionnaire. The overall seroprevalence of brucellosis was found to be 2.59% in Black Bengal goats. A significantly (p<0.01) higher prevalence of brucellosis was found in Black Bengal goats with the history of previous abortion (33.33%). An insignificant (p>0.05) but higher prevalence of brucellosis was found in adult Black Bengal goats (>24 months) than young. The prevalence was relatively higher in cross-bred than pure Black Bengal goats, in female than male and in pregnant than non-pregnant Black Bengal goats. The result of the study will provide baseline data for control of brucellosis in goat in Bangladesh.DOI: http://dx.doi.org/10.3329/bjvm.v10i1-2.15646

High-risk human papillomavirus among HIV-infected women with normal cervical cytology: a pilot study in Jos, Nigeria

Cervical cancer is strongly linked to high-risk human papillomavirus (HR-HPV) and is typically preceded by cytological abnormalities. Less is known in patients with normal cervical cytology (NCC). We investigated the epidemiology of HR-HPV among HIV-infected women with NCC. We conducted a cross-sectional study between January and June 2011 among HIV-infected women with NCC at an adult HIV clinic in Jos, Nigeria. Cervical sampling and analysis for HR-HPV by hybrid capture (HC2) with signal amplification was done to determine presence of one or more of the following HR-HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 or 68. Epidemiologic factors associated with HR-HPV were determined using bivariate statistics and multivariate logistic regression. We evaluated 103 HIV-infected women with Pap cytology. The median age of the women was 32 years (range 21-49). Ninety-seven (94.2%) had NCC. Cervical samples for HR-HPV DNA testing were available from 89/97 (91.8%) of the HIV-infected women with NCC. Of the 89 women with cervical samples for HR-HPV DNA testing, 40 (44.9%) had detectable HR-HPV by HC2 giving a HR-HPV prevalence of 44.9% (95% CI 33.9-55.5%). Age < 30 years was associated with HR-HPV (OR 2.69 [95% CI 1.05-6.91, p = 0.039]) while history of previous abortion showed an inverse association with HR-HPV (OR 0.33[95% CI 0.15-0.94, p = 0.039]). The prevalence of HR-HPV is seemingly high among HIV-infected women with NCC in our clinical setting. These data provide support for further investigation of the clinical implications of positive HR-HPV among HIV-infected women with NCC report in cervical cancer prevention programs in Nigeria.

Analysis on related factors of female genital tract infection and its nursing strategy in Xianyang semi-rural area of Shaanxi Province

Objective To study the prevalence and risk factors of various types of female genital tract infection (RTI) in semi-rural area of Xianyang,so as to provide basic data and evidence for the nursing intervention.Methods Totals of 501 married women at child-bearing age who were inhabited in Xianyang semi -rural area were attended into a normal gynecological exam between May 2010 and May 2011.And their medical history,the exam and lab test and corresponding treatment were observed.Results The cervical infection rate of women whose husband working outside and working inside were respectively 42％ and 19％,and the differences was statistically significant (x2 =10.79,P =0.005),as well as the women who had previous history of abortion and had not (26％ vs 16％,x2 =4.01 ; P =0.045).The correcting rate of women to understand the condom prevention was 38.7％,29.1％ of the women had washing privates habit before sexual activity,51.3％ of the women had correct clean way after defecate,50％ of the women hadn' t appropriate health care seeking behavior.Conclusions Married women at child-bearing age have high prevalence rate of genital trace,less knowledge on genital health.The reproductive health education and promotion should be enhanced to improve theirs cognitive behavior for RTI.Thus they could change their behavior on early RTI detection,early consult and got early diagnosis and treatment and consequently improved theirs life quality and the health level of female reproductive. Key words: Genital tract; Infection factors; Nursing strategies; Semi-rural area

Household air pollution and stillbirths in India: Analysis of the DLHS-II National Survey

BackgroundSeveral studies have linked biomass cooking fuel with adverse pregnancy outcomes such as preterm births, low birth weight and post-neonatal infant mortality, but very few have studied the associations with cooking fuel independent of other factors associated with stillbirths. MethodWe analyzed the data from 188,917 ever-married women aged 15–49 included in India's 2003–2004 District Level Household Survey-II to investigate the association between household use of cooking fuels (liquid petroleum gas/electricity, kerosene, biomass) and risk of stillbirth. Prevalence ratios (PRs) were obtained using Poisson regression with robust standard errors after controlling for several potentially confounding factors (socio-demographic and maternal health characteristics). ResultsRisk factors significantly associated with occurrence of stillbirth in the Poisson regression with robust standard errors model were: literacy status of the mother and father, lighting fuel and cooking fuel used, gravida status, history of previous abortion, whether the woman had an antenatal check up, age at last pregnancy >35 years, labor complications, bleeding complications, fetal and other complications, prematurity and home delivery. After controlling the effect of these factors, women who cook with firewood (PR 1.24; 95% CI: 1.08–1.41, p=0.003) or kerosene (PR 1.36; 95% CI: 1.10–1.67, p=0.004) were more likely to have experienced a stillbirth than those who cook with LPG/electricity. Kerosene lamp use was also associated with stillbirths compared to electric lighting (PR 1.15; 95% CI: 1.06–1.25, p=0.001). The population attributable risk of firewood as cooking fuel for stillbirths in India was 11% and 1% for kerosene cooking. ConclusionBiomass and kerosene cooking fuels are associated with stillbirth occurrence in this population sample. Assuming these associations are causal, about 12% of stillbirths in India could be prevented by providing access to cleaner cooking fuel.

480 – The effect on pregnancy outcome of drug (substance) abuse during pregnancy

Introduction Substance abuse during pregnancy is one of the most important problems in maternal and neonatal health. Being familiar with the risk of poor pregnancy outcome in these individuals may help them to reduce that risk. Objective The purpose of the present study is to evaluate the effects on Pregnancy outcome of substance abuse during pregnancy. Method The study was conducted as a historical cohort study between two groups of pregnant women with or without substance abuse. Both groups were Iranian housewives, with the same socio economical status, singleton and without any known medical systemic disorder. Results 1268 women were evaluated in total. 317 women were drug abusers and 951 women were not. The woman in both groups had no significant differences according to neonates’ gender, gestational age, pregnancy-induced hypertension, intra uterine fetal death (IUFD), and ruptured membranes. Maternal age (P = 0.000), maternal weight (P = 0.000), neonatal weight (P = 0.000) were found to be lower in drug abusers. History of previous abortion (p = 0.000) and gravidity (P = 0.000) were higher in drug abusers. Also cesarean delivery [(P = 0.049, RR=1.1 (1.02–1.12)], placental abruption [(P = 0.000, RR=2.7 (1.8–4.1)], meconium passage [P = 0.000, RR=2.6 (2.3–2.8)], neonatal weight of less than 2500 gram [P = 0.000, RR=1.9 (1.8–2)], Apgar score of less than 7 in minute 5 [P = 0.001, RR=1.7 (1.5–1.7)], NICU admission [P = 0.000, RR=3.7 (3.5–3.8)] and neonatal death [P = 0.009, RR= 2.1 (1.8–2.5)] were all higher in drug abusers. Conclusion Substance abuse causes poor outcomes in pregnancy, and with control, patients may improve these poor conditions.

Gir tidligere aborter fødselsangst?

Abortion is a matter that concerns many women, and we have little knowledge about the effects of such experiences with regard to later pregnancies. The objective of the study was to investigate whether a previous history of abortion has an effect on later development of fear of childbirth, adjusted for the woman's mental health, parity, previous stillbirths and socio-demographic factors. The study included 2,753 pregnant women from Akershus University Hospital. Information was collected with the aid of questionnaires in the 18th and 32nd week of gestation, as well as retrievals from the hospital's system of birth records. Fear of childbirth was measured on the Wijma scale (W-DEQ). The prevalence of fear of childbirth (defined as W-DEQ ≥ 85) amounted to 11.7% among women who had undertaken two or more elective abortions and 7.8% among those who had no previous abortions. This trend was not statistically significant and disappeared completely in the adjusted analyses. Nor did we find any correlation between spontaneous abortions and fear of childbirth. The mental health of the woman was the one factor that was most strongly associated with fear of childbirth, an association that we have found also on a previous occasion in analyses of a smaller proportion of this cohort. We found no co-variance between previous abortion history and fear of childbirth.

Immediate Post-Abortion Insertion of Intrauterine Contraceptives (IUC) in a Diverse Urban Population

Ethnic minority women have a higher incidence of unintended pregnancy and abortion than Caucasian women, with significant individual and social implications. Post-abortion intrauterine contraceptive (IUC) use may reduce future unintended pregnancy. This was a retrospective review of 265 women undergoing abortion at a Los Angeles County Reproductive Options Clinic. Demographic factors, reproductive history, and post-abortion contraceptive choice were evaluated and analyzed. The population was predominantly Latina (73%) and single, with a mean age of 27. Immediate post-abortion IUC insertion was chosen by 48% overall and more frequently by Latinas (55%) than by African Americans (33%) or Asians (43%) (p = 0.02). IUC use increased with age, undesired future fertility, increasing gravidity, and history of previous abortion in univariate analysis. In multivariate analysis, IUC use increased with Latina ethnicity and increasing gravidity. In a clinic serving low-income urban women in Los Angeles, post-abortal IUC uptake is highest among Latinas and those with prior pregnancies. Future research should examine reasons for and barriers to IUC uptake in diverse communities and methods to improve post-abortion IUC uptake to prevent subsequent unintended pregnancies.

LOW BIRTH WEIGHTS: I- MATERNAL RISK FACTORS – A HOSPITAL- BASED STUDY IN CAIRO CITY, EGYPT

Background: Low birth weight (LBW) is an important public health problem. The problem is prevalent world-wide and has negative impacts. So, its prevention is a major challenge. Objective: To determine maternal risk factors of LBW in Cairo city. Design: A case-control, hospital-based, study design. Subjects: Mothers of 270 LBW neonates were recruited in this study. A control group of mothers of an equal number of normal birth weight (NBW) neonates was chosen. Methods: The mothers of LBW and NBW neonates were interviewed using a specially designed questionnaire. All mothers had been subjected to full examinations. The neonates were weighted and examined after labor. Results: Low education, unskilled occupation, and husband unavailability are significant sociodemographic risk factors of LBW; OR=1.75, 1.62, and 2.21, respectively. Mother’s height (≤145 cm), BMI (<18 kg/m²), history of previous abortion, and maternal family history of LBW are significant personal characteristic risk factors of LBW; OR=3.26, 5.11, 3.27, and 3.23, respectively. The significant obstetric risk factors are congenital malformations, weight gain during pregnancy ≤6 kg, multiple gestations, bleeding at first/second trimester, presence of complications during delivery, gestation age <37 weeks, and birth spacing <2 years; OR=13.61, 7.61, 7.15, 5.92, 3.93, 3.17, and 2.84, respectively. Absence of antenatal care, inadequate healthy diet intake, physical hard activities, exposure to tobacco smoke, and living nearby heavy air pollution are significant health care behavioral and life-style risk factors of LBW; OR=2.49, 2.72, 2.96, 3.64, and 4.8, respectively. Anemia, hypertension, and history of recurrent chronic/specific infections are significant medical risk factors of LBW; OR=2.68, 4.35 and 4.84, respectively. Anorexia nervosa/stress, oligo/polyhydramnios, and gestational hypertension are significant gynecological/obstetric conditions risk factors; OR=3.53, 3.32, 3.23, and 3.36, respectively. Lastly, the most important risk factors of LBW as weighted by partial F-test are multiple gestations, neonate congenital malformations, weight gain during pregnancy ≤6 kg, maternal BMI <18 kg/m², gestation age <37 weeks, and mother’s weight at early pregnancy ≤45 kg, (F test=2.9, 2.7, 2.6, 2.3, 2.2, and 2.2, respectively). Recommendations: There is a need for improving the quality and utilization of ANC services, nutritional education, birth spacing, and avoidance exposure to tobacco smoke. Also, increasing promotion of reproductive health services in relation to safe motherhood at community level in order to reduce risk factors of LBW is needed. Lastly, further population based studies are needed in different areas in Egypt.

Lymphocyte subpopulations among pregnant women in Agbor, Delta State, Nigeria

ObjectiveTo determine the peripheral blood CD3 and CD8 T-lymphocytes subpopulation in healthy pregnant women in our environment. MethodsPregnant women attending the antenatal care clinic (ANC) of the Central Hospital, Agbor, Nigeria, who gave informed consent were recruited for the study. Blood samples (10 mL) was collected by venipuncture from 121 healthy pregnant women (aged 17-47 years; mean 28.5±0.43). Tweenty four non-pregnant healthy women (aged 18-30years; mean 21.12±0.64) were enrolled as control. CD3+ and CD8+ counts were determined with the Partec flow cytometer. ResultsThe mean CD3+ count for pregnant women was 1311.10±71.50 μ/L when compared to the controls which was 9.67±0.99 μ/L. This was statistically significant(P<0.005). The mean CD8+ count for pregnant women was 340.91±18.53 μ/L as against the 583.58± 47.30 μ/L (P>0.005). Primigravidas had a higher CD3+ mean count than multiparas while mean CD8+ count was higher in multiparas than in primigravidas. Similarly, the mean CD3+ count was significantly different between all the trimesters with the highest count of 1, 353.23±43.90 μ/L in the first trimester as compared to the 9.67±0.99 μ/L in the control. Mean CD3+ was highly significant in pregnant women with history of previous abortions while the CD8+ cells were not. ConclusionThe results suggest the need for routine determination of T lymphocyte subsets apart from CD4 in pregnant women attending ANC clinic to prevent any possible immunological /pregnancy disorder during the period of pregnancy.

Prevalence and Risk Factors for Patients Undergoing Abortion In Zagazig University Hospitals

Background: Abortion is a public health concern because of its impact on maternalmorbidity and mortality. Each year, about 79 million unintended pregnancies, excludingmiscarriage, occur worldwide. More than half of these unintended pregnancies end inabortion. The aims of the present study were to; assess the prevalence, risk factors associatedwith abortion in Zagazig university hospitals. A cross sectional design with nested casecontrol design were selected in carrying out this study and representative samples of 800women (400 aborted women and 400 non aborted women) were recruited for this study. Thetools used for data collection were; an interview questionnaire sheet, clinical assessmentform. The results were; the prevalence of abortion as estimated from the registries ofZagazig University Hospital was 25.0 % during the period from August 2010 till July 2011.Risk factors for abortion include; women’s age, consanguinity, education, job status,exposure to pesticide, passive smoking, coffee intake and previous abortion as well asunwanted the current pregnancy. Eleven women were exposed to illegal and unsafe abortionand use misoprostol to induce abortion. It can be concluded that, the prevalence of abortionwas 25.0 % during the period from August 2010 till July 2011. Risk factors for abortioninclude; unhealthy life style, pregnancy complications and history of previous abortion. Thestudy recommended that; relevant nursing curricula must entail a detailed portion aboutabortion, management and post abortal hygiene. And nursing role for women underwentabortion should be recommended in maternity hospital protocols.

Sex Preferences Among Mothers Delivering at Patan Hospital

High sex ratios at birth (SRB) are seen in China, Taiwan, South Korea, parts of India and Vietnam. The imbalance is the result of son preference, accentuated by declining fertility. Prenatal sex determination and female feticides are common in many countries. It is reflected in sex ratio To determine reasons for the preferences for different sex; to find out whether there is altered sex ratio at birth and to find out whether female feticide are common among women who had abortion. It is a prospective study. Women who had previous history of abortion and had delivered at Patan Hospital in the year 2066 were interviewed as per questionnaires. Among 560 women with total live births of 965, (462 male and 503 female) during their life time the overall sex ratio was 92 male per 100 female birth; total abortions were 663. Preferences for male were 10%, female 15.4% and either was for 74%. The reason for male preference was to continue family lineage, to bring honor, old age security, and performing funeral rites while the reasons for daughter preferences were that they understand mothers pain, help in household work. The sex ratio of the babies born during the study period was 113 male per 100 female births. The Sex ratio at birth from 1st to 6th deliveries was 61, 79, 101, 210, 286 and 1100 male per 100 female birth respectively. Prenatal sex selection was 8% (by USG) but none had sex selected abortion. Sex ratio of those delivered during the study period was skewed (136 boys per 100 girls) towards male. There was shift in SRB in 4th and subsequent pregnancies in favor of boys. As the male sex ratio increased the number of induced abortion decreased in subsequent pregnancies.

PP068. Catastrophic antiphospholipid-syndrome (CAPS) – A severe pregnancy complication

Antiphospholipid syndrome (APS), is an autoimmune, hypercoagulable state caused by antibodies against cell-membrane phospholipids provoking arterial and venous thromboses as well as pregnancy-related complications such as miscarriage, stillbirth, preterm delivery, or severe preeclampsia. The syndrome occurs due to the autoimmune production of antibodies against phospholipid (aPL), a cell membrane substance. In particular, the disease is characterised by antibodies against cardiolipin (anti-cardiolipin antibodies) and β2 glycoprotein I. In rare cases, APS can lead to rapid organ failure due to generalised thrombosis. This life-threatening complication is termed "catastrophic antiphospholipid syndrome" (CAPS) and is associated with a high maternal mortality. To describe the characteristics of patients who developed catastrophic APS triggered during pregnancy and to possibly identify potential risk factors for the development of this complication. Patients charts of women with autoimmune disorders (such as APS or systemic lupus erythematodes) observed and treated at the University of Graz and The University of Jena between 2007 and 2012 were evaluated. Four cases of CAPS were identified. In all women CAPS occurred as a severe early onset complication (<34 weeks of gestation) and all women had to be delivered by caesarean section between 27 and 32 weeks. With an "individualized" treatment including plasmapheresis, pregnancy can be prolonged for a short period to at least achieve lung maturation by steroids. Several specific features could be found: HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome-like symptoms, eclampsia-like symptoms (headache, amaurosis), abdominal pain resistent to conventional analgesic therapy, and intrauterine growth restriction. Histologic examination after delivery revealed placental infarctions. It is important to consider the possibility of the development of catastrophic APS in those patients with signs of HELLP syndrome and multiorgan failure during pregnancy or puerperium, especially in those patients with previous history of abortions and/or thrombosis. In specialised centers prolongation of pregnancy with an individualized treatment including plasmapheresis may be an option.

Frequency of hydatidiform mole in tissue obtained by curettage

To determine the frequency of hydatiform mole in tissues obtained by curettage. A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel(®) software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ(2) test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.

A study of psychiatric morbidity during second trimester of pregnancy subsequent to abortion in the previous pregnancy

IntroductionPregnancy plays a unique role in the transformation of women towards completeness. For those women who have had a previous unsuccessful outcome, pregnancy may bring a lot of inevitable negative emotions. We studied psychiatric morbidity during second trimester of pregnancy subsequent to abortion in the previous pregnancy. MethodsThe study was carried out in Dayanand Medical College and Hospital, Ludhiana, India. A total of 120 patients were divided into 4 groups depending on their pregnancy status. All the groups were compared with each other regarding their psychiatric morbidities, which were measured using various rating scales such as Hamilton Depression rating scale, Hamilton Anxiety Rating Scale, State Trait Anxiety Inventory, Presumptive Stressful Life events Scale, and Brief Psychotic Rating Scale. ResultsWe found that subjects with history of previous abortion, whether single or more had significantly higher mean depression and anxiety score than primigravida or subjects with history of previous successful pregnancy; depression and anxiety scores decreased with increase in time gap between abortion and current pregnancy. High anxiety was found in 36.67%(11) of females with history of previous abortion. We also found that 36.67%(11) of subjects with previous single abortion and 30%(9) of subjects with previous 2 or more abortions were suffering from depressive episode. None of the female suffered from psychotic disorder. ConclusionsThe incidence of depression and anxiety is high in pregnancy after previous abortion and more in subjects who conceive earlier after previous abortion. These results warrant the need for screening all pregnancies for psychiatric morbidity after a previous abortion.

Maternal risk factors for preterm birth: a country-based population analysis

ObjectiveThe aim of this study was to identify maternal risk factors for spontaneous preterm birth (PTB) compared to delivery at term, in order to recognize high risk women and to provide a global overview of the Italian situation. Study designA multicenter, observational and retrospective, cross-sectional study was designed. The study population comprised 7634 women recruited in 9 different University Maternity Hospitals in Italy. The main criteria for inclusion were: women having had vaginal preterm or term spontaneous delivery in each participating centre during the study period. The records related to deliveries occurring between April and December 2008. A multivariable logistic regression was employed to identify independent predictors of spontaneous preterm birth. Odds ratios (ORs) and 95% confidence intervals (95% CI) were reported with two-tailed probability (p) values. Statistical calculations were carried out using SAS version 9.1. A two-tailed p-value of 0.05 was used to define statistical significant results. ResultsA significant increased risk of PTB was found in women with BMI>25 (OR=1.662; 95% CI=1.033–2.676; p-value=0.0365) and in women employed in heavy work (OR=1.947; 95% CI=1.182–3.207; p-value=0.0089). Moreover there was a significant association between PTB and previous reproductive history. In fact a history of previous abortion (OR=1.954; 95% CI=1.162–3.285; p-value=0.0116) or previous cesarean section (OR=2.904; 95% CI=1.066–7.910; p-value=0.0371) was positively correlated to the increased risk of PTB and an important statistically significant association was calculated between PTB and previous pre-term delivery (OR=3.412; 95% CI=1.342–8.676; p-value=0.0099). All the other covariates examined as potential risk factors for PTB were not found to be statistically significantly related (p-value>0.05). ConclusionsThe present study, applied to a substantial sample of Italian population, demonstrates that there are peculiar risk factors for spontaneous PTB in the Italian population examined. It shows an association between preterm delivery and certain maternal factors as: BMI, employment, previous abortions, previous PTBs and previous cesarean section.

Uterine–umbilical artery Doppler velocimetry and pregnancy outcome in SLE patients: Relation to disease manifestations and activity

Aim of the workTo evaluate the uterine–umbilical artery Doppler velocimetry and determine its relation to pregnancy outcome and disease manifestations in SLE patients. Patients and methodsBlood flow velocity waveforms of the umbilical and uterine arteries were studied by color Doppler ultrasound in 36 pregnant SLE patients referred from the Rheumatology Department for follow up and delivery in the Obstetrics Department. Resistance index (RI) and pulsality index (PI) were measured at the 1st week and then every 4weeks from the 20th and 30th weeks till delivery. ResultsThe mean age was 27.33±4.03years and disease duration of 5.72±2.57years. The nulliparity rate and history of previous abortions were higher in those with poor fetal outcome (50% and 62.5%, respectively). Lupus anticoagulants and anticardiolipin were obviously higher in those with a poor outcome (25% and 37.5%, respectively) with a higher association with APS in spite of anticoagulation. The SLEDAI was higher in those with a poor fetal outcome and the difference reached significance at the 24th week gestation (12.13). Eight (22.22%) of the patients had abnormal fetal outcome: 5 IUGR (13.89%), 1 IUFD (2.78%) and 2 (5.55%) with missed abortion. Uterine and umbilical artery Doppler abnormalities were higher in those with poor obstetric outcomes and were earlier revealed by the uterine. ConclusionUterine artery Doppler seems to be an earlier prognostic factor for adverse outcomes compared to umbilical in SLE patients at high risk, allowing antepartum intensive care and optimal timing of delivery to early confirm a good pregnancy outcome.

Bemiparin versus low dose aspirin for management of recurrent early pregnancy losses due to antiphospholipd antibody syndrome

Study objectiveTo compare the live birth rate of women presented with recurrent miscarriages in the first trimester due to antiphospholipid antibody syndrome (APS), randomized to either low molecular weight heparin (Bemiparin) or low dose aspirin (LDA) and to determine the maternal and fetal adverse effects in both treatment groups.Patients and methodsA clinical comparative study was conducted in Maternity teaching Hospital, Erbil city, north of Iraq, Kurdistan region from 15th of September 2007 to the 1st of August 2010 on 141 women presented with 2 or more consecutive miscarriages due to APS, the women randomized to receive either prophylactic dose of Bemiparin with the diagnosis of pregnancy or LDA started preconceptioally and until 36 weeks gestation. The primary outcome was live birth rate in both treatment groups, the secondary outcomes were maternal and fetal complications in both trial groups.ResultThere was no statistically significant difference between the two groups regarding demographic characters (age groups, parity, gestational age and history of previous abortion), and mode of delivery of the viable newborns.There was a statistically significant difference between the two treatment groups regarding live birth rate. The proportions of women who gave birth to a live infant were 72.13% in the LDA group and 86.25% in the Hibor group, the mean difference between the live birth rate in both group was 0.141 (95% Confidence interval of the difference, 0.08, 0.274). The average birth weight for women received LDA was significantly lower than women who received Bemiparin.ConclusionThe use of the new second generation LMWH (Bemiparin) in comparison to LDA during pregnancy for prevention of recurrent miscarriage in women with APS is a safe, reliable method with a high live birth rate and no maternal and fetal complications.

The role of cytokines IL-6 and IL-8 in the pathogenesis of spontaneous abortions

Objective. The aim of this study was to investigate the role of interleukin-6 and interleukin-8 in the spontaneous abortion of the first and second trimester of pregnancy and the possibility of IL-6 and IL-8 being used as markers for the pregnancy outcome.Method. The patients were divided into three groups: group 1, women at the time of first trimester miscarriage (n = 35); group 2, women at the time of second trimester miscarriage (n = 35); group 3 included the women without previous history of abortions submitted to hysterectomy (n = 10). Plasma levels of interleukin-6 and interleukin-8 were measured by bioassays method (ELISA). Mann–Whitney U test and Kruskal–Wallis test were used to assess differences between two or more groups of patients, respectively. Post hoc analysis was performed using Mann–Whitney U test with Bonferroni’s correction.Results. Interleukin 6 levels in women who had a second trimester abortion were statistically higher compared to those who had a first trimester abortion. Interleukin-8 levels in patients with second trimester abortion were also statistically higher compared to the control group. No significant differences between women with first trimester abortions and those without previous history of abortions were found.Conclusions. Our data suggest that IL-6 and IL-8 might be crucial factors which take part in the defensive reaction of maternal organization during the 2nd trimester of pregnancy.

Significant Bacteriuria Among Asymptomatic Antenatal Clinic Attendees In Ibadan, Nigeria

Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria.All consenting ANC attendees without UTI were enrolled in the study. Urine specimens of 5 to 10 ml collected from each subject were examined microscopically for white blood cells, red blood cells and bacteria. The specimens were further cultured on MacConkey agar using a sterile bacteriological loop that delivered 0.002 ml of urine. Colony counts yielding bacterial growth of more than 105/ml of pure isolates were considered significant.Of the 473 subjects studied, 136 had significant bacteriuria, giving a prevalence rate of 28.8%. The highest age specific prevalence (47.8%) was found in the 25–29 year olds while only one (0.7%) was found in the teenage group. A large percentage (64.0%) of subjects with significant bacteriuria had tertiary education, compared with 4.4% who had no formal education but the association was not statistically significant (X2 = 0.47, p = 0.79). The majority (75.8%) of subjects with significant bacteriuria had no previous history of abortion, while 20 (14.7%) had one previous abortion and only three (2.1%) admitted to three previous abortions (X2 = 5.16, p = 0.16). The majority (69.8%) of those with significant bacteriuria presented at second trimester while 38 (28.0%) presented at third trimester (X2 = 6.5, p = 37).Only 22 (4.6%) of the studied subjects presented at first trimester, and 3 (13.7%) of these had significant bacteriuria.The prevalence of asymptomatic bacteriuria is high among this study population. Hence we suggest that advocacy programs be initiated to urge pregnant women to access ANC services early in pregnancy.

RELATIONSHIP BETWEEN GLUCOSE METABOLISM AND MICROALBUMINURIA IN WOMEN WITH PRIOR GESTATIONAL DIABETES: PP.17.158

Aims: Relationship between glucose abnormalities and microalbuminuria in women with pGDM.W. Methods: We prospectively studied 215 women with pGDM. According to OGTT, we divided into two groups: pGDM with normal glucose tolerance post-partum (NG) (66,8%) and pGDM with abnormal glucose tolerance post-partum (AG) (33,2%). Insulin sensitivity was derived using HOMA. Metabolic syndrome (MS) was defined by ATP-III We collected obstetric history, personal history of pGDM and personal and family history of cardiovascular risk factors. Microalbuminuria and glomerular filtration by MDRD were measured. Results: Mean age was 33,45 ± 4,5 yrs.; 26,25% smoking, 15,6% history of dyslipemia, 30% had history of previous abortions. 62,34% of women had first-degree relatives with type 2 DM and 59,25% had family history of hypertension The prevalence of MS was higher (32,3%) in AG group than in NG (14,7 %); p < 0.005. In addition, AG group had higher values of BMI and WC vs. NG group (28,86 ± 4,5 vs 22,70 ± 3,1 Kg/m2; p < 0.005 and 93,76 ± 6,1 vs 80,34 ± 4,6; p < 0.05, respectively). Fasting glucose and 2h-glucose levels were higher in AG group than NG (98,85 ± 7,7 vs 80,2 ± 5,6 mg/dl, p < 0.005 and 166,57 ± 23 vs 119,4 ± 20 mg/dl). Fasting insulin and HOMA values were significantly higher in AG than NG; p < 0.005. Microalbuminuria levels in AG group were greater (29.4 ± 13 mg/24 h) vs NT (11.67 ± 4,7 mg/24 h; p < 0.05). No differences in renal function. In addition, AG group presented a higher prevalence of family history of type 2 DM (68,7% vs 48%, p < 0.01). Conclusion: Women with pGDM have a high prevalence of abnormal glucose tolerance and MS and lower values of adiponectin, particularly those with AG (and with higher levels of microalbuminuria). Thus women with pGDM and family history of type 2 DM may be especially suitable interventions aimed at preventing or reducing type 2 DM and probably cardiovascular events.