Previous History Of Abortion Research Articles

Síndrome de banda amniótica: reporte de 18 casos

El síndrome de banda amniótica es una entidad congénita fetal que consiste en la presencia de bandas fibrosas y anomalías disruptivas muy variadas y variables en presentación y complejidad, algunas incompatibles con la vida. Se presenta 18 casos de síndrome de banda amniótica con estudio anatomopatológico de los fetos o neonatos y revisión de la historia clínica materna. Se encontró 5 neonatos y 13 fetos, 9 de ellos de sexo masculino y 9 de sexo femenino. El menor pesó 19 g y el mayor fue un neonato de 3 680 g; 9 fetos pesaron < 110 g. Las lesiones encontradas estuvieron en dedos 13, en labio 6, en cara 6, en cráneo 5, en abdomen 2, en cordón umbilical 8, en pared abdominal 2, en extremidades 5. Se encontró malformaciones asociadas en 8 casos, de tipo renal, cardiaca, pulmonar, digestiva, musculoesquelética, neurológica y del cordón umbilical. Las del cordón umbilical fueron arteria única, cordón corto, inserción velamentosa y circular de cordón. En relación a la madre, la edad fue entre 17 y 41 años, promedio 26 años; 11 casos ocurrieron en primigestas; de las 7 multigestas, 5 tuvieron abortos previos. No se encontró otros antecedentes familiares o patológicos de importancia. Se concluye que el síndrome de banda amniótica produce en los fetos anomalías polimorfas y asimétricas que es necesario diferenciarlas de aquellas de tipo cromosómico o genético. Así mismo, existe la posibilidad de una intervención intraútero que elimine las bandas fibrosas diagnosticadas ecográficamente a temprana edad gestacional.

Rubella virus seroprevalence and associated factors in pregnant women with and without previous spontaneous abortion

Background: Rubella virus infection is associate with various pregnancy outcomes. Usually, such infection is more prevalent among women with low positivity for protective immunoglobulin G (IgG). Several factors are known to influence the seroprevalence of this virus. Objectives: This study aimed to investigate the seroprevalence of anti-rubella IgG and immunoglobulin M (IgM) antibodies and associated factors among pregnant women with and without a history of abortion. Materials and Methods: A total of 91 pregnant women (79 women with a history of previous abortion and 12 women without such history) were enrolled in this cross-sectional study. Sera were collected from each woman, and the levels of rubella IgG and IgM were measured using enzyme-linked immunosorbent assay. Demographic and reproductive data for the women were also collected. Univariate logistic regression was used to find the association of factor with serostatus of the virus. Results: The overall seropositivity for IgG and IgM was 95.6%, (95% confidence interval [CI] = 91.3–99.9) 9.89%, (95% CI = 9.68–10.1), while six women (6.59%) were positive for both types of Igs. Two factors showed a significant association with rubella IgG seropositivity: A history of previous abortion (odds ratio [OR] = 0.68, 95% CI = 0.45.0.99, P

Ectopic Pregnancy and its Risk Factors: A Case Control Study in Nepalese Women

Introduction: Ectopic pregnancy is a significant cause of maternal mortality and morbidity during the first trimester. The major risk factors for ectopic pregnancy include prior tubal infections, previous ectopic pregnancy, previous abortions, use of intrauterine contraceptive devices, contraception failure, tubal surgeries, infertility and use of artificial reproductive pregnancies. This study was carried out to evaluate the effect of different risk factors in the causation of ectopic pregnancies among women in the Nepalese setting. 
 Materials and methods: This was a case-control study conducted at Kathmandu Medical College comparing 39 cases of ectopic pregnancies with 39 controls consisting of intra-uterine pregnancies. The suspected cases were confirmed through clinical examination, trans-abdominal or trans-vaginal ultrasonography and serum β-hCG levels with further confirmation obtained after laparotomy / laparoscopy among cases who underwent surgery. The two study groups matched with age, gravidity and contraceptive uses were studied. History of previous abortions, previous ectopics and past abdomino-pelvic surgeries were also studied. 
 Results: There was statistically significant difference in the incidence of contraceptive failure among the two groups (p-value= 0.032) with women with such history having a relative risk of 1.667 with odds ratio of 3.400. The risk posed by previous abortions and previous ectopics wasn’t found significant (RR= 1.000 and 2.053 respectively). The history of past abdomino-pelvic surgeries also showed significant role in causation of ectopics (RR= 1.094). 
 Conclusion: Among different risk factors studied, the contraception usage was the most significant risk factors. Oral contraceptive pills was the most identified among the contraception used in cases of ectopic pregnancy.

Prevalence and determinants of antenatal depression among pregnant women in Ethiopia: a systematic review and meta-analysis

BackgroundAntenatal depression is more prevalent in low and middle income countries as compared to high income countries. It has now been documented as a global public health problem owing to its severity, chronic nature and recurrence as well as its negative influence on the general health of women and development of children. However, in Ethiopia, there are few studies with highly variable and inconsistent findings. Therefore, the aim of this study was to determine the prevalence of antenatal depression and its determinants among pregnant women in Ethiopia.MethodsIn this systematic review and meta-analysis, we exhaustively searched several databases including PubMed, Google Scholar, Science Direct and Cochrane Library. To estimate the pooled prevalence, studies reporting the prevalence of antenatal depression and its determinants were included. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and transferred to STATA 14 statistical software for analysis. To assess heterogeneity, the Cochrane Q test statistics and I2 test were used. Since the included studies exhibit considerable heterogeneity, a random effect meta- analysis model was used to estimate the pooled prevalence of antenatal depression. Finally, the association between determinant factors and antenatal depression were assessed.ResultsThe overall pooled prevalence of antenatal depression, in Ethiopia, was 24.2% (95% CI: 19.8, 28.6). The subgroup analysis of this study indicated that the highest prevalence was reported from Addis Ababa region with a prevalence of 26.9% (21.9–32.1) whereas the lowest prevalence was reported from Amhara region, 17.25 (95% CI: 6.34, 28.17). Presence of previous history of abortion (OR: 3.0, 95% CI: 2.1, 4.4), presence of marital conflict (OR: 7.2; 95% CI: 2.7, 19.0), lack of social support from husband (OR: 3.2: 95% CI: 1.2, 8.9), and previous history of pregnancy complication (OR: 3.2: 95% CI: 1.8, 5.8) were found to be determinants of antenatal depression.ConclusionThe pooled prevalence of antenatal depression, in Ethiopia, was relatively high. Presence of previous history of abortion, presence of marital conflict, lack of social support from husband, presence of previous history of pregnancy complications were the main determinants of antenatal depression in Ethiopia.

Experience with Ectopic Pregnancy in a Tertiary Care Teaching Hospital

Ectopic pregnancy is a common life-threating condition. Diagnosis is frequently missed and should be considered in any women in the reproductive age group presenting with abdominal pain or vaginal bleeding. This prospective observational study was conducted in RMCH to determine the incidence, risk factors, clinical presentation, treatment, morbidity and mortality associated with ectopic pregnancy. A total of 50 cases of ectopic pregnancy were operated during the study period giving the incidence of ectopic pregnancy of 8.02/1000 pregnancies. The age of the patient ranged from 18-37 years, with maximum (40%) between 26-30 years age group. 36% patients had delivered one child and 24% were nulliparous. 30% patients had pelvic inflammatory disease and 22% had history of previous abortion/ MR. All patients presented with lower abdominal pain, 68% presented with abnormal vaginal bleeding and 60% had amenorrhoea. Most of the patients were diagnosed by high clinical suspicion and confirmed by USG. 96% cases ectopic pregnancy occurred in the fallopian tube and ampullary part was mainly affected. Laparotomy followed by unilateral salphingectomy was performed in majority (60%) of cases. 22% cases ipsilateral salpingectomy with tubectomy other side and 12% cases salpingostomy were performed. The recovery of majority of patients was smooth and uneventful. There was no death in this study.TAJ 2014; 27(2): 22-26

Coxiella burnetii in Tunisian dromedary camels (Camelus dromedarius): Seroprevalence, associated risk factors and seasonal dynamics

Q fever, caused by Coxiella burnetii, is a zoonotic disease responsible of abortion in ruminants. Few studies have investigated the prevalence of this infection in camels (Camelus dromedarius). The present report aimed to highlight the epidemiological status and identify the risk factors associated with C. burnetii infection in one-humped dromedary that is the most productive livestock species in arid areas. A total of 534 sera of healthy camels were collected in eight governorates from southern and central Tunisia. Samples were tested by an indirect Enzyme linked Immunosorbent Assay (ELISA). Results were analyzed using the Chi-square test and logistic regression. Overall, 237 camels (44%, 95%CI: 0.40-0.49) were seropositive to C. burnetii. Statistical analysis pointed out four potential risk factors associated with infection. A meaningful high seropositivity was observed in female camels with a previous history of abortion (70%) (OR = 4.186, 95%CI: 2.05–8.51). Seroprevalence was higher in aged camels (>10 years-old) (48%) (OR = 2.91, 95%CI: 1.37–6.17). Besides, camels, intended for meat production from small herds showed a high level of infection (52%) (OR = 2.43, 95%CI: 1.3–4.5). Coxiellosis evolved in dromedary herds throughout the year, however infection was significantly important in autumn (60%) (OR = 4.13, 95%CI: 1.86–9.17) and winter (56%) (OR = 5.52, 95%CI: 2.50–12.16). Bioclimatic stage, gender, tick infestation and contact with other ruminants were not risk factors in camel’s infection by C. burnetii. Our reports confirm that Tunisian one-humped dromedaries had been exposed to this bacterium and could contribute to its dissemination among farmers and other livestock animals. Furthers studies are required to evaluate the prevalence of Q fever among people professionally exposed like farmers, veterinarians and slaughterhouse workers.

Maternal Predictors of Intrauterine Growth Retardation.

To identify maternal factors associated with intrauterine growth restriction (IUGR). A case-control study. Neonatal Unit of The Aga Khan Hospital for Women (AKHW), Karimabad, from January 2014 to December 2015. Cases were IUGR live born babies (n=90), while control were appropriate-for-gestational age (AGA) babies (n=180). Information recorded in pre-designed proforma included gestational age and birth weight of baby, demographics of mothers, pregnancy related medical and obstetric complications. Data were analysed through SPSS-19. Multivariable logistic regression was used to determine the maternal factors associated with the intrauterine growth restriction. Maternal factors associated with IUGR after adjusting for confounders in the multivariable model included younger age (OR=0.9, CI=0.8-0.9), poor gestational weight gain (OR=3.0, CI=1.6-6.1) and history of previous abortion (OR=3.06, CI=1.1-8.0). Significant interaction was found between pregnancy-induced hypertension (PIH) and parity of mother, primary-para mother with PIH having an increased risk for IUGR babies (OR=10.1, CI=1.0-23.2). Young age, primigravida status, low gestational weight gain, previous history of abortion, PIH and GDM have strong association with IUGR; hence, special consideration is essential to overcome these issues in order to improve maternal and neonatal health.

Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital.

Objective We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. Methods This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05). Conclusion The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole.

The prevalence of ectopic pregnancy in Jos, north central Nigeria: A reproductive health challenge

Background: Ectopic pregnancy is a life threatening gynecological emergency with a rising incidence of maternal morbidity especially in resource poor settings. Most cases present in the emergency unit when ruptured.Objective: The objective of this study was to determine the prevalence, identifiable risk factors, clinical presentation and management outcome of ectopic pregnancy.Method: This was a retrospective review of cases of ectopic pregnancies seen and managed in the gynecological unit of Plateau State Specialist Hospital (PSSH) Jos from 1st September 2012 to 31st August, 2017. The medical records of the patients managed for ectopic pregnancy as well as the delivery register from the labor room, theater register and gynecological admissions during the study period were retrieved. The data were collected with the aid of data entry form designed for this purpose. The relevant data collected were analyzed using epi info 16 version and presented in tables.Results: During the period, a total number of 13,596 deliveries were recorded while there were 2067 gynecological admissions. One hundred and seventy two (172) patients had ectopic pregnancies accounting for 1.27% of all deliveries and 8.3% of gynecological admissions. The mean age of the patients was 29±5years. The peak age group was 20-25 years (32.0%); 92(53.5%) had secondary school as their highest level of education; 135(78.5%) were married and 49(28.4%) were multigravida. All the patients; 172(100%) presented with a history of abdominal pain while 8(4.7%) presented in shock. A total of 161(93.6%) were diagnosed based on history and clinical examination findings; 152(88.4%) had trans-abdominal scan and 12(7.0%) had abdominal paracentesis (though frowned at in modern day practice). The commonest identifiable risk factors for ectopic pregnancies were pelvic inflammatory disease(PID) in 111(64.5%) of patients followed by previous history of abortions in 17(9.9%) of patients. A total number of 169(98.3%) of the patients had total salpingectomy for ruptured ectopic pregnancies via open abdominal surgeries with 87(50.6%) done on the right fallopian tubes. Three (1.7%) of the patients had oophorectomy. Eighty one(47.1%) of the patients had blood transfusion with no case fatality.Conclusion: Ectopic pregnancy still remains a major health challenge among women of reproductive age group in Nigeria. Efforts should therefore be directed at prompt and timely management to reduce maternal morbidity and mortality in developing countries, availability and accessibility of contraceptive methods, accessibility to healthcare centers and affordable healthcare, proper treatment of PID, use of better technologies in management of cases and human capacity development.Keywords: Prevalence, reproductive age group, ectopic pregnancy, resource poor settings, life threatening, emergency

Prospective study on role of folic acid and vitamin B12 in early pregnancy and spontaneous abortion

Background: Vitamin B12 maintains normal folate metabolism during pregnancy. Maternal folate status has been associated with various adverse pregnancy outcomes. The aim of this study is to predict the risk of abortion in early pregnancy by studying the relation between folate, Vitamin B12 levels, and rate of abortion. This prospective, observational study was carried out on 100 pregnant women with singleton pregnancy of 6–12 weeks of gestation. Methods: The patients were divided into three groups, namely, Group 1 (control group) comprising of 30 normal pregnant women with no history of abortion; Group 2 (control group) comprising of 35 pregnant females with history of previous abortion; and Group 3 (study group) comprising of 35 pregnant women were coming with chief complaint of bleeding per vaginum. About 5 ml blood was taken and serum was separated using centrifugation. Serum folate and Vitamin B12 levels were estimated by chemiluminescence. Data so obtained were computed as mean + standard deviation and SPSS/ANOVA was applied. Results: Serum folate and Serum B12 levels were comparable in all the three groups and the difference was statistically significant. 26.66%, 37.13%, and 31.42% patients had folate deficiency in Groups 1, 2, and 3, respectively. Out of which, 3.33%, 5.71%, and 5.71% patients aborted from folate deficient Groups 1, 2, and 3, respectively. Thus, folate deficiency was not found to be associated with abortion (P = 0.944). Patients with Vitamin B12 deficiency were 73.33%, 82.85%, and 37.13% in Groups 1, 2, and 3, respectively; out of which 3.33% patients from Group 1, 8.57% from Group 2, and 2.85% patients from Group 3 were aborted. Correlation between maternal serum B12 deficiency and abortion was found to be insignificant (P = 0.551). Conclusion: A positive correlation was seen between serum folate and B12 levels. All females planning for conception should be given folate and Vitamin B12 supplementation.

Risk Factor Assessment for Preeclampsia: A Case Control Study

International Journal of Medicine and Public Health,2017,7,3,172-177.DOI:10.5530/ijmedph.2017.3.35Published:Aug 2017Type:Original ArticleRisk Factor Assessment for Preeclampsia: A Case Control StudyManoj Kumar Verma, Priyanka Kapoor, Rajeev Yadav, and Ravindra Kumar Manohar Manoj Kumar Verma, Priyanka Kapoor,* Rajeev Yadav, Ravindra Kumar Manohar M.B.B.S. M.D. (Community Medicine) Senior Resident Department of Community Medicine S.M.S. Medical College, Jaipur (Rajasthan) INDIA. Abstract:Background: Knowledge and identification of risk factors for preeclampsia will help in estimating each woman’s individualized risk and possibly reduce the recurrence risk of preeclampsia. So this study was conducted to assess and compare the socio-demographic profile of women with and without preeclampsia and to determine the risk factors associated with preeclampsia. Methodology: This Hospital based Case control analytical study was conducted among 180 preeclampsia case and 180 control subjects at Mahila chikitsalaya, Jaipur, from June 2014 to May 2015. Results: Bivariate analysis found that preeclampsia was significantly associated with rural residence (p=0.033), joint family type (p=0.025), low education of head of family(p=0.007), young age at menarche (11-12years) (p<0.001) Anemia (P=0.034) and primiparity (p<0.001), Family history of preeclampsia (p<0.001) and hypertension (p=0.007) and Non veg. diet (p=0.042). Preeclampsia was not found to be significantly associated with history of previous abortion, inter pregnancy period and sex of last child of multiparous women and ANC characteristics, TT immunization, IFA tablets, twin pregnancy or gestational diabetes. In the multiple regression analysis, Age >30 years, Preobese (BMI=25-29.9), obese (BMI≥30 Kg/ m2), Primiparity, age of menarche at 12 years and rural residence were found to be independent risk factors associated with Preeclampsia. Conclusion: Age>30 years, Preobese, Obese, Primiparity, early age of menarche (12 years) and Rural residence were found as significant predictor for development of Preeclampsia. Most of these factors are non modifiable, but can be used to screen women during antenatal visits to identify those at higher risk of Preeclampsia. Keywords:preeclampsia, Pregnancy, risk factorView:PDF (204.78 KB)

Risk factors of preeclampsia: a case control study among mothers in Sana’a, Yemen

The aim of this study was to assess the risk factors of preeclampsia among mothers at Al-Sbeen Hospital in Sana’a City, Yemen. A hospital-based case control study was carried out at Al-Sbeen Hospital in Sana’a City. The total sample size was 206 and divided into 103 cases and 103 controls. Data were collected from 2014 to 2016. A designed chart was used to collect data from the medical files. Young and advanced mother’s age, living in rural areas, prior preeclampsia, prior hypertension, prior anemia, multiple pregnancy, gestational age, family history of preeclampsia, history of previous abortion and cesarean, and induction modes of delivery were determinant factors of preeclampsia (p < 0.05). The determinants of preeclampsia in this study can be prevented by health education, increased awareness of the community and encouraging women to attend health services. Changing these factors can decrease preeclampsia related to maternal factors.

Prevalence and risk factors associated with anti-Neospora caninum antibodies in dairy herds in the central region of Minas Gerais State, Brazil.

Neospora caninum is one of the parasites that frequently causes reproductive loses in cattle herds all over the world. Surveys have shown a high prevalence of the parasite in herds; in certain locations, 90% to 100% of dairy holdings are positives according serological tests. The aim of this study was to estimate the prevalence and risk factors associated with the increased number of seropositive dairy cattle in the central region of Minas Gerais, the largest milk producer state in Brazil. Samples were collected from 151 dairy herds and from 2915 lactating cows, and were evaluated by an indirect ELISA assay. According to results, animal prevalence was 21.9% (CI 95%: 18.9 to 24.9%), while the herd prevalence it was 98.5% (CI 95%: 97.0 to 99.9%). Poisson regression estimate the herd risk factors associated with the increased number of cases. An increased number of positive animals was related to the previous history of abortion and the presence of dogs. The use of individual natural colostrum feeding and reproductive techniques such as embryo transfer and in vitro fertilization are associated with a reduced number of seropositive animals in the herd. In conclusion, Neospora caninum is overspread across the dairy herds of the region, and it may be causing major economic losses for dairy farmers. The use of reproduction techniques, the access of dogs to the herds and the management of calf colostrum are important issues to be considered in the control of the disease.

MILK AS A SUBSTITUTE FOR SERUM IN DIAGNOSIS OF TOXOPLASMOSIS IN GOATS

The present study determined the milk value rather than serum in diagnosis of toxoplasmosis in goats using ELISA and Modified Agglutination Test (MAT). ELISA proved to be more specific and sensitive (92% & 85%), than MAT (90% & 80%) in diagnosis of Anti-T. gondii Antibodies (ATAb) in group of microscopically proved T gondii aborted goats respectively. There was a direct relationship between.the mean ELISA O.D. value and the level of Ab-titer in MAT positive sera. The overall prevalence of infection in 600 serum samples from grazing goats was 22% and 20% after examination using ELISA and IAT respectively. It was lower after examination of their milk (20%) and (18%) by both techniques respectively. ATAb were significant high in serum (P < 0.05) during January, February and March, decreased significantly in April (P < 0.05) till August, then significant increased (P < 0.05) from September to December using ELISA. In time where ATAb were present by different levels among the whole year in serum, it didn't diagnose in milk from June to September. The infection was high in Egyptian Baladi breed in serum and milk (30% and 27%), while the Barki breed was the lowest one (13.33% and 12%) respectively. High rate of infection (30% in serum and 27% in milk) was recorded in goats > 2 years old, while no ATAb could be detected in goats less than one year old. The highest prevalence of infection (39.28% in serum and 37.14% in milk) was in Qalyoubia, the lowest one (11.25% & 9.58%) was in Giza governorate. The prevalence of infection was high after examination of serum and milk of goats with previous history of abortion in comparison with the other goats.

MILK AS A SUBSTITUTE FOR SERUM IN DIAGNOSIS OF TOXOPLASMOSIS IN GOATS.

The present study determined the milk value rather than serum in diagnosis of toxoplasmosis in goats using ELISA and Modified Agglutination Test (MAT). ELISA proved to be more specific and sensitive (92% & 85%), than MAT (90% & 80%) in diagnosis of Anti-T. gondii Antibodies (ATAb) in group of microscopically proved T gondii aborted goats respectively. There was a direct relationship between.the mean ELISA O.D. value and the level of Ab-titer in MAT positive sera. The overall prevalence of infection in 600 serum samples from grazing goats was 22% and 20% after examination using ELISA and IAT respectively. It was lower after examination of their milk (20%) and (18%) by both techniques respectively. ATAb were significant high in serum (P < 0.05) during January, February and March, decreased significantly in April (P < 0.05) till August, then significant increased (P < 0.05) from September to December using ELISA. In time where ATAb were present by different levels among the whole year in serum, it didn't diagnose in milk from June to September. The infection was high in Egyptian Baladi breed in serum and milk (30% and 27%), while the Barki breed was the lowest one (13.33% and 12%) respectively. High rate of infection (30% in serum and 27% in milk) was recorded in goats > 2 years old, while no ATAb could be detected in goats less than one year old. The highest prevalence of infection (39.28% in serum and 37.14% in milk) was in Qalyoubia, the lowest one (11.25% & 9.58%) was in Giza governorate. The prevalence of infection was high after examination of serum and milk of goats with previous history of abortion in comparison with the other goats.

Can hierarchical modeling improve our understanding of bovine abortion due to Neospora caninum infection?

The purpose of this study was to use mixed logistic regression to evaluate the association between Neospora caninum serostatus and abortion, accounting for the effects of farms. The main objective was to explore the interpretation of this model and discuss the contribution of this analysis to our understanding of the disease’s epidemiology. A mixed-effects logistic model using farms as a random effect and the serostatus for N. caninum, age of cattle and farm location as fixed effects was performed. The data from 1256 cows over 15 months of age from 60 farms were used, and the abortion information was obtained from farm records. A significant association between N. caninum serostatus and abortion was found (p<0.0001). Seropositive cows had 6.63 times greater odds of having a history of previous abortion (95% CI: 4.35–13.37). There was remarkable variability across farms in the probability of a cow having a history of an abortion. Including the effects of the farms in the regression, it was possible to estimate an intraclass correlation coefficient (ICC) of 16%. That means that 16% of the variation in abortion occurrence that was not explained by the fixed effects was due to farms. In practical terms, this variation means that while there are farms with several seropositive cows and no/few abortion cases, the opposite is also true, with a high number of abortions in farms with low/medium seroprevalence. The remaining variability (84%) was not explained by the effect of N. caninum, age, region, and the effect of farms, i.e., it is due to unknown factors that are causing abortions. The results of this study reinforce the importance of N. caninum as a cause of abortions and demonstrate the significant heterogeneity in the probability of a cow having a history of an abortion that cannot be explained completely by N. caninum serostatus, age or location. Including the hierarchical structure of the population along with correct interpretation of the model estimates helps us understand the effect of the farms, i.e., the probability of a cow abortion conditional to the farms, which also contributes to our understanding of the epidemiology of abortions caused by neosporosis. The use of hierarchical models and reporting the ICC should be encouraged.

Hepatitis E Virus IgG in Serum of Pregnant Women

BACKGROUND: The prevalence of anti-HEV in Egypt is among the highest of any country in the world. The outcomes of pregnancy in infected women need to be delineated. AIM: to screen pregnant females for hepatitis E IgG and to assess the effect of HEV IgG on the pregnancy outcome. METHODS: 142 consecutive pregnant women were subjected: full history- taking, thorough clinical examination, abdominal ultrasonography and IgG antibody to HEV using ELISA kits. HEV avidity index was estimated for anti-HEV positive cases. RESULTS: There was a significant elevation of HEV IgG antibody prevalence in the serum of pregnant women, especially in the countryside, in age group more than 30 years and in the third trimester of pregnancy. There was a possible association between HEV IgG antibody and liver fatty infiltration and neonatal jaundice. There was a significant inverse correlation between HEV IgG avidity index and age. No clinical correlation noticed between HEV IgG avidity index and history of previ-ous abortion, the number of pregnancy, CBC, liver enzymes, INR or serum creatinine. There was no statistically significant association between HEV IgG avidity indices and outcome of gestation. CONCLUSION: HEV IgG is prevalent in serum of pregnant women but with benign course of both the pregnant lady and her outcome.

Thyroid dysfunction in early pregnancy and spontaneous abortion

Background: Pregnancy is associated with significant but reversible changes in thyroid function. Abnormal thyroid hormone levels could give rise to increased malplacentation increase to malplacentation that underlies the association between maternal thyroid dysfunction and adverse obstetric outcomes such as fetal brain damage, preterm births, and fetal death. Aim: The present study was planned to predict the risk of abortion in pregnancy by studying the relation between thyroid profile and rate of abortion. Methods: This prospective observational study was carried out in 100 pregnant women with a singleton pregnancy of 6–12 weeks of gestation in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology, Pt. B.D. Sharma, PGIMS, Rohtak. The patients were divided into three groups, namely, Group 1 (n = 30, control group) included normal pregnant women with no history of abortion; Group 2 (n = 35) included pregnant females with previous history of abortion; and Group 3 (n = 35) comprised pregnant women coming with chief complaint of bleeding per vaginum. A volume of 5 mL blood sample was taken and serum was separated using centrifugation. Triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) levels were estimated by chemiluminiscence. Results: T3, T4 and levels were comparable in all the three groups and the difference was not statistically significant. TSH levels were found to be negatively correlated with T3 and T4 values in the three groups. Only, 13% of the patients had spontaneous abortion. Nearly 6.66% of the patients in Group 1, 11.42% in Group 2 and 19.99% of patients in Group 3 ended up in abortion. TSH was found to be strongly associated with abortion in all the three groups (P ≤ 0.001). TSH levels were significantly higher in the first trimester in women who had an abortion than pregnant women who had a successful continuation of pregnancy. Conclusions: TSH was strongly associated with abortion in the first trimester in all the three groups.

Intramyometrial gestation: A rare localization of ectopic pregnancy

Intramyometrial pregnancy is the rarest subtype of ectopic pregnancy. It poses a diagnostic and therapeutic challenge. Preoperative diagnosis is difficult, and hysterectomy is always required due to the delay in diagnosis. Misdiagnosis can lead to uterine rupture with life threatening hemorrhage. We report a rare case of intramyometrial ectopic pregnancy in a 27-year-old lady, P3L3, with no history of previous abortions. The patient was admitted at 8 weeks of gestation with pelvic pain and hemorrhage. She underwent ultrasound and magnetic resonance imaging scans of the pelvis which revealed an intramyometrial ectopic. Findings on diagnostic laparoscopy revealed an asymmetrically enlarged anterior wall of the uterus. Hysteroscopy was performed concurrently demonstrating an empty uterine cavity. Medical management was adopted with methotrexate. She was followed up until the beta-HCG levels returned to the baseline. This case report illustrates the imaging findings of an exceptional case of intramyometrial ectopic pregnancy.

Determinant of Implanon Discontinuation among Women Who Ever Used Implanon in Diguna Fango District, Wolayita Zone, Southern Ethiopia: A Community Based Case Control Study.

Background A significant number of women make Implanon their first choice of contraception. However, they discontinue their Implanon before its expiry date was high, but factors that contribute to discontinuing their Implanon were poorly described in Ethiopia. Methods A community based unmatched case control study was conducted. Then simple random sampling technique was used to select 340 women. Data was collected by nurses using face to face interview. Epi-Info version 7 and SPSS 20 software were used. Bivariate and multiple logistic regressions were performed with COR and AOR with 95% CI. Findings Having preinsertion counseling (AOR: 0.36, 95% CI: 0.20–0.64), having follow-up appointment (AOR: 0.35, 95% CI: 0.2–0.62), age at insertion <20 years (AOR: 3, 95% CI: 1.16–7.8), women who had no formal education (AOR: 2.8, 95% CI: 1.31–6.11), women who had ≤4 children (AOR: 1.8, 95% CI: 1.01–3.21), and women who had previous abortion history (AOR: 2.3, 95% CI: 1.10–4.63) were determinants of Implanon discontinuation. Conclusions Policy makers and concerned bodies should take into account future intervention and also great emphasis should be given to follow-up appointment and counseling services, especially counseling on side effects, and informed choice for clients after Implanon insertion.