Previous History Of Miscarriage Research Articles

SEROPREVALENCE OF TOXOPLASMA GONDII INFECTION AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN MAJOR HEALTH CENTERS IN JOS NORTH, NIGERIA

Toxoplasmosis is an infection caused by Toxoplasma gondii. It is reported that one third of the world’s population is infected with the parasite. T. gondii represents the risk of miscarriages and congenital abnormalities in pregnancy. This study was carried out to ascertain the sero-prevalence of Toxoplasma gondii among pregnant women attending antenatal clinics in three major Health Centres in Jos North Local Government Area, Plateau State, Nigeria. Three hundred and eight four (384) pregnant women attending antenatal clinics were recruited for the study. Participants were screened for T. gondii specific antibodies using the Chromatographic Immuno-Assay (CIA) test method. Information on risk factors were obtained by the administration of a structured questionnaire. An overall seroprevalence of 11.7% was established. IgG antibodies represented 11.7% seroprevalence and 0.0% seroprevalence recorded for IgM antibodies. The highest seroprevalence of Toxoplasma gondii infection was established in women in their second trimester. Seropositivity was found to be significantly associated (p<0.05, 95%CI) with type of drinking water, consumption of raw or fresh vegetables, previous history of miscarriage and older child with congenital deformation.
 Akubuilo, A. S. | Department of Zoology, University of Agriculture Makurdi, Benue State, Nigeria

The trend and characteristics of stillbirth delivery in a university teaching hospital in Lagos, Nigeria.

Background:The burden of stillbirth is so huge in sub-Saharan Africa, especially in Nigeria where many mothers and mothers-to-be are denied the joy of motherhood. Despite the frequent occurrence of this obstetric problem in our environment, little priority is placed on it.Objectives:The study aims to bring to the fore, the burden, trend, and characteristics of stillbirth delivery in Lagos, Nigeria.Subjects and Methods:This was a 5-year descriptive retrospective study of the case records of women who had stillbirth delivery at Lagos University Teaching Hospital from January 2009 to December 2013. Relevant information was obtained using a study pro forma, and data analysis was carried out using SPSS version 20.0.Results:The prevalence of stillbirth was 6.2%, and the rate was 61.8/1000 total births. Women who did not book for antenatal care accounted for 76.2% of the cases, and the antenatal and intrapartum stillbirths accounted for 64.6% and 35.4%, respectively. The mean gestational age was 35.5 ± 1.2 weeks, while the mean birth weight was 2.9 ± 1.0 kg. Majority of the stillbirths were male fetuses (54.5%). Previous history of stillbirth (36.0%), hypertensive disorders in pregnancy (33.0%), placental abruption (28.8%), intrauterine growth restriction (13.0%), and ruptured uterus (11.3%) were the common clinical risk factors identified.Conclusion:The burden of stillbirth is high in our environment, and majority is due to preventable or manageable obstetric conditions. There is a need to encourage early referral of complicated pregnancies and labor to specialized centers that can cater for them, so as to avoid unnecessary and preventable deaths.

Non-typeable Haemophilus influenzae-associated early pregnancy loss: an emerging neonatal and maternal pathogen

ObjectivesThere is increasing evidence indicating an association between invasive non-typeable Haemophilus influenzae (NTHi) infection in pregnancy and early pregnancy loss. As the diagnosis relies on microbiological investigation of post-mortem placental and foetal samples, a significant proportion of NTHi-related pregnancy loss remains unrecognised. To better characterise NTHi in septic abortion, we report NTHi cases associated with early pregnancy loss.MethodsWe reviewed all post-mortems at <24 weeks gestation with histologically proven acute chorioamnionitis on placental histology and enrolled cases with at least one matched foetal and placental sample culture positive for NTHi. The study was approved by the NHS Lothian Caldicott Guardian.ResultsIn our cohort, invasive NTHi has accounted for 20% of infections associated with early pregnancy loss prior to 24 weeks gestation. All patients were young and healthy pregnant women at < 20 weeks' gestation who presented with abdominal pain, PV bleed /discharge and were septic at the time of presentation. One patient with previous history of miscarriage who presented with cervical incompetence had more severe pathology suggestive of early intrauterine pneumonia.ConclusionThe burden of invasive NTHi disease in early pregnancy loss is likely to be much larger than currently recognised. NTHi should be considered in pregnant women presenting with abdominal pain and PV bleed/discharge in whom clinical signs of sepsis are present. Active surveillance should be considered in this patient group including septic abortion to capture the true prevalence of this emerging pathogen to inform preventative and therapeutic approaches.

Characteristics of first trimester miscarriages assesed by chromosomal analysis of products of conception with next generation sequencing

Chromosomal abnormalities are the major cause of early pregnancy loss. Chromosome testing of products of conception (POC) provides valuable information for counseling and clinical managing of patients. We previously showed that next generation sequencing (NGS) can be utilized as a technique demanding lesser specimen with a lower failure rate, higher resolution, and shorter turnaround time than conventional karyotyping which is requiring labor-intensive and time-consuming cell culture with possible maternal cell contamination. We aimed to assess the efficacy of NGS method for chromosomal analysis of POC. In addition, we attempted to identify any associations between the incidence of chromosomal abnormalities and the profile of patients as well as fetal development in an assisted reproductive technology (ART) program. Retrospective study with a single reference genetic laboratory. Total of 131 consenting patients with first trimester miscarriages after vitrified-warmed embryo transfer were involved. POC samples were obtained bydilation and curettage between 7 to 10 gestational weeks. Chorionic villi were isolated under a dissecting microscopy, subsequently processed for NGS chromosomal analysis. Incidence of each chromosomal abnormality was reported and evaluated according to the patient profile, such as maternal age, previous history of miscarriage and fetal development. Finally, frequency of mosaics was also assessed. After NGS analysis, 28 cases (21.4%) were found to be normal, and the remaining 103 (78.6%) were abnormal, including 10 (7.6%) mosaics. Among normal karyotypes, ratio of female to male was 1.15 (15/13). Trisomies were the most common abnormalities except for the chromosome X monosomy (10.7%). Aneuploidy of chromosome 22 (20/113, 17.7%), 15 (16/113, 14.2%), 16 (16/113, 14.2%), X (13/113, 11.5%) and 21 (11/113, 9.7%) including overlaps, were most frequently involved. Mean maternal age of chromosomally abnormal cases was significantly higher than that of normal karyotypes (39.0 ± 18.5 vs 36.9 ± 16.5 years, P<0.05). Patients with more than equal 3 previous miscarriages showed a significantly lower rate of abnormalities than those with <3 miscarriages (28.6% vs 81.5%, P<0.01). Rate of abnormalities with positive fetal cardiac activity was not different from that of anembryonic pregnancies (80.0% vs 76.1%), although fetal cardiac activity was detected in all the 45,XO cases. Interestingly, however, mosaic abnormalities were significantly more often detected in anembryonic pregnancies than the other (15.2% vs 3.5%, P<0.05). With more conclusive and accurate results and higher resolution by NGS, we were able to characterize early pregnancy loss after ART, demonstrating relatively high rate of abnormalities with gender ratio being close to 1. Patients with repeated pregnancy loss showed lower chromosomal abnormalities indicating other causes for miscarriages in this group of patients. A higher incidence of mosaics detected in anembryonic pregnancies warrants further investigation.

How many roads lead to stillbirth rate reduction? A 30-year analysis of risk factors in a Northern Italy University care center

Background Stillbirths affect more than 2.5 million pregnancies worldwide every year and the progress in reducing stillbirth rates is slower than that required by World Health Organization. The aim of the present study was to investigate which factors were associated with stillbirths in a University Hospital in the North of Italy, over a time span of 30 years. The goal was to identify which factors are potentially modifiable to reduce stillbirth rate. Methods Retrospective case-control study (358 stillbirths, 716 livebirths) subdivided into two study periods (1987–2006 and 2007–2017). Results The prevalence of conception obtained by assisted reproductive technologies, pregnancy at advanced maternal age, and complications of pregnancy such as preeclampsia, fetal growth restriction (FGR), and other fetal diseases (abnormal fetal conditions including fetal anemia, fetal hydrops, TORCH infections) increased through the years of the study. Despite a rising prevalence, the last 10 years showed a significant reduction in stillbirths associated with preeclampsia and FGR. Similarly, the risk of stillbirth related to abnormal fetal conditions decreased in the second study period and a history of previous stillbirth becomes a nonsignificant risk factor. Conclusions Altogether these results suggest that in pregnancies perceived as “high risk” (i.e. previous stillbirth, preeclampsia, FGR, abnormal fetal conditions) appropriate care and follow-up can indeed lower stillbirth rates. In conclusion, the road to stillbirth prevention passes inevitably through awareness and recognition of risk factors.

Maternal Risk Factors and Perinatal Characteristics in Congenital Diaphragmatic Hernia: A Nationwide Population-Based Study

Background: The etiology of congenital diaphragmatic hernia (CDH) remains poorly understood. We hypothesize that environmental factors play an important role in the development of CDH. Aim: The objective of this study was to investigate associated maternal risk factors in pregnancies with CDH. Material and Methods: The study was a nationwide, population-based prospective case-control study consisting of a cohort of newborn children entered into the records of pregnant women receiving antenatal care in Sweden, registered in the Medical Birth Registry during the period from January 1, 1982 to December 31, 2015. The study outcome CDH and the different exposures were assessed through linkage to the Swedish National Patient Registry for both cases and mothers. Results: A total of 972 cases of CDH were registered into one of the national registries in Sweden between 1982 and 2015. The incidence of neonates with CDH in Sweden from 1982 to 2015 was 3/10,000 live births. The mortality rate during the study period was 31%. Maternal age, ethnicity, parity, exposure to tobacco, BMI, IVF, previous history of spontaneous abortion or intrauterine fetal demise, and coexisting chronic diseases (urinary tract infection, chronic renal disease, pregestational diabetes, epilepsy, asthma, ulcerative colitis, inflammatory bowel disease, or systemic lupus erythematous) were not associated with an increased risk of CDH in the fetus. There was a significant association between maternal hypertension and the risk of the child being affected by CDH (OR 3.32, 95% CI 1.41–7.79, p = 0.01). No association was found between preeclampsia and CDH. Conclusions: Pregestational hypertension is associated with an increased risk of giving birth to a baby with CDH, but no association was observed in pregnancies developing preeclampsia and the occurrence of CDH.

Pregnancy outcome following previous history of spontaneous abortion

Introduction: Pregnancy period is crucial for the health of the mother and baby. Spontaneous abortion is the most common adverse pregnancy outcome. Spontaneous pregnancy loss is a surprisingly common occurrence with approximately 15% of all clinically recognized pregnancies resulting in pregnancy failure. Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses. Objective: To determine pregnancy outcome following previous spontaneous abortion and to evaluate any complication associated with previous abortion as compare to previous normal delivery. Method: A prospective and observationalstudy was done on 100 patient that include 50 patient of control group who have history of previous normal delivery and 50 patients in study group who have history of previous abortion history. All the antenatal, postnatal complications and mode of delivery were noted and compared between these two groups. Result: Shows that Pregnancy complications including threatened miscarriage, premature rupture of membranes (PROM), preterm delivery, intra uterine growth restriction (IUGR) are more commonly associated with pregnancy following history of previous abortion. Rate of caesarean section was significantly increased in women with previous spontaneous abortion and give significant p value 0.000008; Statistical analysis was carried out using Statistical Package for Social Scientists (SPSS). Conclusion: Women with a history of previous spontaneous abortion are at an increased risk of complications in the next pregnancy. So careful surveillance should be provided to every women and not to be restricted only to females with history of recurrent pregnancy loss.

Prevalence of gestational diabetes mellitus and associated factors in Southern Ethiopia

Background: Presence of gestational diabetes mellitus during pregnancy has serious complications for both mother and child. Its burden is increasing in low and middle-income countries but, little is known about its contribution in Ethiopia.&#x0D; Aims and Objective: The aim of this study was to determine the prevalence of gestational diabetes mellitus and to identify associated factors in Wolaita Zone, Southern Ethiopia.&#x0D; Materials and Methods: Institution based cross sectional study was carried out from August 2017 to October 2017 in Wolaita Zone, southern Ethiopia. A total of 518 pregnant women were participated from 2 hospitals and 4 health centers. Capillary blood samples were collected at fasting and 2 hours after 75gm glucose load to measure blood sugar and diagnosis of gestational diabetes mellitus was made by using 2013 World Health Organization (WHO) criteria. Binary logistic regression model was applied to assess risk factors of gestational diabetes mellitus.&#x0D; Results: Prevalence of gestational diabetes mellitus was 4.2% (95% CI, 2.5, 6.2) with mean post glucose load level of 160.1 mg/dl (6.3) and 15(4%) among urban residents and 7(4.9%) among rural residents. The proportion of gestational diabetes mellitus increases with increase in number of pregnancies. Previous history of spontaneous abortion (AOR: 3.5; 95%CI: 1.7-14.6), family history of type II diabetes (AOR: 4.3; 95%CI: 1.3-8.7) and previous caesarean section (AOR: 7.5; 95%CI: 1.3-14.4) were found to be significantly associated with gestational diabetes mellitus.&#x0D; Conclusions: The prevalence of gestational diabetes mellitus is higher as compared to other studies conducted in the country. Strengthening screening, care and prevention strategies for gestational diabetes mellitus are important to improve maternal and child health.

Chromosomal study for Assessment of Recurrent Spontaneous Miscarriage by Fluorescence in situ Hybridization (FISH) technique in Erbil City Iraqi- Kurdistan Region

Spontaneous miscarriage is the most frequent complication of pregnancy and, classically, defined as the occurrence ofat least two miscarriages before 20 weeks of gestation. Over 50 % of first trimester pregnancy losses are attributed tochromosomal abnormalities. This study aimed to investigate aneuploidy in spontaneous miscarriage by fluorescence in situhybridization (FISH) using probes for 13, 18, 21, X and Y chromosomes. A total of 100 tissue samples from concepts materialswere collected and examined by FISH. The incidence and type of chromosomal abnormality and sex ratio were analyzedfor each samples. Moreover, the relationship between the rate of aneuploidy and maternal age also the relationship betweenmaternal age and type of aneuploidy and the difference in incidence of aneuploidy between samples from previous miscarriageand those with no previous miscarriage were investigated. Results obtained from this study revealed that, 52 of 100 cases werewith aneuploidy. Trisomy 21, 18, and 13 was the major aneuploidy followed by monosomy X. Cases of miscarriages whichcontain chromosomal abnormalities were higher in females than males. Cases with advanced maternal age and history ofprevious miscarriage were significantly have higher aneuploidy rate compared with young age cases and those with no previousmiscarriage. However, rates of trisomies 18, 13, and 21 of the advanced maternal age group were remarkably higher thanthose of the young maternal age group.Keywords: Recurrent miscarriage, Aneuploidy, Florescence In Situ Hybridization, Maternal age, Sex Ratio.

Mental health problems of reproductive age group women in a rural community of south west Nigeria

Background: Mental health is a component of reproductive health which is generally not given priority in low and middle income countries. Efforts to improve women’s health have focused majorly on issues associated with reproduction such as family planning and child-bearing while women's mental health has been relatively neglected.Aim: This study was conducted to determine prevalence and factors influencing mental health problems in non-pregnant reproductive age women in a rural community of south west Nigeria.Methods: A community-based cross-sectional survey was conducted using a cluster sampling technique to select the study population. Mental health was assessed based on respondents’ experience of any symptoms of depression and anxiety. Data were analysed using descriptive statistics, Chi-square and multivariate logistic regression model at p < 0.05.Results: The mean age of the respondents was 25.6 ± 7.8 years. The prevalence of depression and anxiety was 28.9% each while 19.8% experienced both. Gynecological conditions were a predictor of anxiety (OR 2.7; 95% CI 1.3–5.6) while previous history of miscarriage was a predictor of depression (OR 10.5; 95% CI 1.0–108.8).Conclusions: Our study demonstrated that mental health problems were quite prevalent in women of reproductive age group. We recommend that mental health be integrated into reproductive health policies.

Case Control Study of Anxiety and Depression Among Patients with Miscarriage Compared to Those with Successful Pregnancy

Miscarriage is one of the most common complications in pregnancy. There is emerging evidence that psychological impact following miscarriage is not unusual. Understanding the magnitude of psychological morbidity is important in the management of miscarriage. The main objective of this study was to compare the mean Hospital Anxiety and Depression Scale (HADS) score between women with miscarriage and women with successful pregnancy and to determine the socio-demographic factor and clinical characteristic that are associated with anxiety and depression. A descriptive case control study was conducted in a teaching hospital, over a period of 12-months (from October 2014 till September 2015). A total of 65 women were recruited with 32 women as the study group (miscarriage) and another 33 women as the control group (women with successful pregnancy). Mean HADS-anxiety score was higher in the study group compared to control group although it was not statistically significant (6.53 ± 3.427 vs 5.73 ± 2.875, p=0.309). Mean HADS-depression score was higher in the control group (4.34 ± 2.695 vs 4.45 ± 3.073, p=0.878). Women with maternal age more than 35 years and history of previous miscarriage had a higher tendency of anxiety and depression with higher mean HADS score. There was no association between other socio-demographic data and clinical characteristic with risk of anxiety and depression. As conclusion, there was no significant difference in women with miscarriage as compared to those with successful pregnancies, although older women with history of miscarriage had a preponderance to both disorders.

Cumulative live birth rates following miscarriage in an initial complete cycle of IVF: a retrospective cohort study of 112 549 women.

In women undergoing IVF/ICSI who miscarry in their first complete cycle, what is the chance of a live birth in subsequent complete cycles, and how does this compare with those whose first complete cycle ends with live birth or without a pregnancy? After two further complete cycles of IVF/ICSI, women who had miscarried or had a live birth in their first complete cycle had a higher chance of live birth (40.9 and 49.0%, respectively) than those who had no pregnancies (30.1%). Cumulative live birth rates (CLBRs) after one or more complete cycles of IVF have been reported previously, as have some of the risk factors associated with miscarriage, both in general populations and in those undergoing IVF. Chances of cumulative live birth after a number of complete IVF cycles involving replacement of fresh followed by frozen embryos after an initial miscarriage in a population undergoing IVF treatment have not been reported previously. National population-based cohort study of 112 549 women who started their first IVF treatment between 1999 and 2008. Data from the UK Human Fertilisation and Embryology Authority (HFEA) register on IVF/ICSI treatments, using autologous gametes were analysed. CLBRs were estimated in women who (i) had miscarriage (and no live birth), (ii) at least one live birth or (iii) no pregnancy in their first complete cycle of IVF/ICSI (including fresh and frozen embryo transfers following a single oocyte retrieval episode). A multivariable analysis was performed to assess the effect of first complete cycle outcome on subsequent CLBRs after adjusting for confounding factors such as female age, duration of infertility and cause of infertility. In their first complete cycle, 9321 (8.3%) women had at least one miscarriage (and no live birth); 33 152 (29.5%) had at least one live birth and 70 076 (62.3%) had no pregnancies. After two further complete cycles, conservative CLBRs (which assume that women who discontinued treatment subsequently never had a live birth) were 40.9, 49.0 and 30.1%, while optimal CLBRs (which assume that women who discontinue have the same chance of live birth as those treated) were 49.5, 57.9 and 38.4% in the miscarriage, live birth and no pregnancy groups respectively. Odds of cumulative live birth for women who miscarried in their first complete cycle were 42% higher than those who had no pregnancy [odds ratio (95% CI) = 1.42 (1.34, 1.50)], and twice as high for live birth versus no pregnancy [2.04 (1.89, 2.20)]. Negative predictors for live birth in all women included tubal infertility [0.88 (0.82, 0.94)] and increasing age [18-40 years = 0.94 (0.94, 0.95); >40 years = 0.63 (0.59, 0.66) per year]. CLBRs could not be estimated for treatments occurring after September 2008 due to potentially incomplete data following regulatory changes regarding consent for data use in research. Additionally, covariates not included in the HFEA database (including BMI, smoking, previous history of miscarriage and gestational age at miscarriage) could not be adjusted for in our analysis. Miscarriage following IVF can be devastating for couples who are uncertain about their ultimate prognosis. Our findings will provide reassurance to these couples as they consider their options for continuing treatment. N.J.C. received an Aberdeen Summer Research Scholarship funded by the Institute of Applied Health Sciences (University of Aberdeen), through the Aberdeen Clinical Academic Training Scheme. This work was supported by a Chief Scientist Office Postdoctoral Training Fellowship in Health Services Research and Health of the Public Research (Ref PDF/12/06). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office or the University of Aberdeen. The funders did not have any role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication. None of the authors has any conflicts of interest to declare.

Prevalence and Correlation of Hypothyroidism With Pregnancy Outcomes Among Lebanese Women.

Purpose:Assessment of hypothyroidism prevalence and clinical significance among pregnant women in Lebanon.Methods:We performed a single-center retrospective cohort study at the American University of Beirut Medical Center. Clinical, demographic, and laboratory data were collected and analyzed using trimester-specific ranges for hypothyroidism.Results:Of 920 pregnant women, 17% had hypothyroidism during gestation. A history of previous miscarriage and morbid obesity were associated with hypothyroidism during pregnancy. Pregnant women with hypothyroidism were more likely to experience a miscarriage during the first trimester [odds ratio, 2.9; 95% confidence interval, (1.13 to 7.5); P = 0.02] and delivery at post-term (odds ratio, 3.9; 95% confidence interval, 1.05 to 14.9; P = 0.05). We found no substantial correlation with preterm or premature delivery, cesarean section delivery, or gestational hypertension despite increased odds among the hypothyroidism group. No substantial differences were found with respect to the fetal outcomes between the control and hypothyroidism groups.Conclusions:Hypothyroidism is prevalent in 17% of pregnant women in Lebanon and was associated with a history of miscarriage and morbid obesity. The presence of hypothyroidism correlated with miscarriage during the first trimester and with post-term delivery. Despite the lack of sufficient data supporting the efficacy of treatment of hypothyroidism during gestation, more studies should be conducted to assess the effect of hypothyroidism on gestational and fetal outcomes.

Anxiety in high- and low-risk pregnancies and its influence on perinatal outcome

ObjectiveThis study investigates pregnancy- and birth-giving-related fears of women of different risk groups and examines their influence on pregnancy and delivery. Study designProspective study. SettingPregnant out-patients were recruited in medical practices in Berlin. Data on perinatal outcome were obtained from the charts of the obstetric units. Participants589 pregnant women between 16 and 22 weeks of gestation. MethodsPregnant women were interviewed by a semi-standardized questionnaire and related to information from the charts about perinatal outcome of the obstetric units. Results77 women were at risk of anxiety influencing pregnancy and perinatal outcome due to chronic diseases, 61 had a history of previous miscarriage, 38 had a history of termination of pregnancy. 288 had no risk factors. Women with previous miscarriage had the highest degree of pregnancy-related fears. Their pregnancies were significantly more often complicated by the threat of miscarriage. A relationship between high levels of pregnancy-related fears and pregnancy complications was only found in the group of “low- risk women”. ConclusionWomen with a history of miscarriage evidently make use of special care services and social support services. For these women no correlation between pregnancy-related fears and complications was found. Low-risk pregnant women seem to have fewer means of coping with their unreasonable fear.

Risk factors for Group B streptococcal infection among women attending antenatal clinic in a tertiary health institution in Edo State, Nigeria

Introduction: Group B Streptococcus (GBS) colonisation of the anus, rectum and/or vagina in pregnant women is a known risk factor for GBS neonatal infection with high morbidity and mortality as a result of pneumonia and septicaemia mainly and less commonly from meningitis, bone and joint infections, cellulitis, otitis media, conjunctivitis, pleural empyema, peritonitis, endocarditis and deep abscess. Objectives: The aim of this study was to assess the proportion women with risk factors for Group B streptococcal infection and the association between the risk factors and recto-vaginal colonisation with GBS among women attending antenatal clinic. Materials and Methods: A cross-sectional study was conducted in Irrua specialist Teaching Hospital, South-South geo-political zone of Nigeria. A total population study was conducted among 234 pregnant women who attained 35–37 weeks gestation, and those who were admitted for preterm labour at earlier gestations were involved in the study. An interviewer-administered questionnaire was used for data collection. Data were analysed using the Statistical Package for the Social Sciences version 17.0 software (SPSS Inc., Chicago, IL, United States). Results: A total of 234 respondents were assessed in this study. Most respondents had tertiary education (53.4%). The risk factors for GBS were present in the following proportions: not living with their partners, 21.8%, previous miscarriage(s) 10.7% and multiple pregnancies, 5.6%. Other risk factors included previous preterm births, 7.7%, and preterm rupture of membranes. There was a statistically significant (P = 0.001) association between respondents’ history of previous miscarriages and GBS colonisation. There was no statistically significant association between GBS colonisation and diabetes mellitus (P = 1.000), multiple sexual partners (P = 0.425), rupture of membranes >18 (P = 0.623) and preterm labour (P = 1.000). Conclusion: The proportion of clients with risk factors for GBS colonisation was moderate (compared with other sub-Saharan countries). Identified risk factors in favour of the higher rates of GBS colonisation included frequent sexual intercourse while previous miscarriage, previous preterm birth, diabetes in pregnancy, where associated with lower rates of colonisation. There was a statistically significant relationship between the GBS status and a history of previous miscarriage (P = 0.001) and a history of previous preterm birth (P = 0.229). Guidelines on the prevention and management of GBS infection for clients attending antenatal clinics and delivery should be made available at all levels of care by regulatory agencies in Nigeria. There should be health education at all levels of care by the Federal, State and Local Government on preventing of and control GBS infection, especially at the community level.

Seroprevalence of brucellosis among women with miscarriage at Ahmadu Bello University Teaching Hospital, Zaria

Background : Brucellosis in animals has been identified as a common cause of miscarriage. It is the most common zoonotic disease that leads to considerable morbidity in humans. It is rarely diagnosed in hospitals in Nigeria, and debate exists as to whether it is a more common cause of miscarriage in humans compared to other infective agents, especially with the finding of antibrucella activity in human amniotic fluid. Brucellosis in humans is a treatable disease and risk factors for transmission are prevalent in Zaria. Objective : The objective of this study was to determine the seroprevalence of brucellosis among women with miscarriage. Materials and Methods : This was a descriptive cross‑sectional study involving 121 women aged between 15 and 49 years with miscarriage who presented to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria from August 2014 to May 2015. Information on socio‑demographic characteristics, reproductive profile, and risk factors for contracting Brucella infection were obtained using a questionnaire. Blood samples were obtained and analysed for Brucella IgG and IgM using indirect enzyme‑linked immunosorbent assay kits. The data was analysed with SPSS, version 20.0. Results : The mean age of the participating women was 29.07 years [standard deviation (SD) ±6.74]. The seroprevalence of brucellosis was 19.0%; 17.4% of the women had a recent infection, and 1.7% had a chronic infection. Age, history of previous miscarriage, consumption of milk products and consumption of roasted meat/barbecue had positive relationships with recent Brucella infection (χ 2 = 9.706, P = 0.046; χ 2 = 7.300, P = 0.026; χ 2 = 3.169, P = 0.049; χ 2 = 3.012, P = 0.050, respectively). Chronic Brucella infection had a positive relationship with number of pregnancies (χ 2 = 8.036, P = 0.018). Regression analyses showed that age, history of previous miscarriage and history of recent miscarriage in animals reared were positively correlated with Brucella seropositivity and miscarriage (χ 2 = 13.200, P = 0.022; χ 2 = 9.795, P = 0.007; χ 2 = 7.890, P = 0.005, respectively). Conclusion : There is a high prevalence of brucellosis among women with miscarriage in Zaria. The burden of the disease should be appreciated and routinely tested to prevent reoccurrence. Key words : Brucellosis ; miscarriage; prevalence.

Evidence-based interventions of threatened miscarriage

Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS) and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Bed rest is the commonest advice, but there is little evidence of its value. Other options include progesterone, human chorionic gonadotropin (HCG) and muscle relaxants. The complementary and alternative medicine (CAM) therapies such as acupuncture and Chinese herbs have also been tried. There is some evidence from clinical studies indicating that CAM therapies may reduce the rate of miscarriage, but the quality of studies is poor. Thus, further double-blind, randomized-controlled trials are necessary to confirm its effectiveness, especially acupuncture and Chinese herbs.

Prevalence and Patterns of Sexual Activity during Pregnancy in Kano, Northern Nigeria.

Very little has been documented on sexual activity during pregnancy in northern Nigeria. We examined prevalence and factors associated with vaginal intercourse during pregnancy in Kano, Nigeria. A cross section of 336 pregnant women attending antenatal care at Aminu Kano Teaching Hospital was interviewed using pre-tested structured questionnaire. Nearly all respondents (96.4%; n=324) reported vaginal intercourse during the index pregnancy. By trimester, 88.4%, 90.7% and 97.4% women had coitus during the first, second and third trimesters respectively, (P>0.05). Relative to pre-pregnancy behavior, 55.4%, 16.3% and 28.3% women reported decreased, increased and unchanged coital frequency, respectively. Ninety six (29.6%) of the sexually active women reported having problems. These included vaginal soreness/pain, abdominal discomfort, bleeding, rupture of the membranes, urinary incontinence and vaginal dryness and itching. History of previous miscarriages and higher pre-pregnancy coital frequency were significantly associated with sexual activity during pregnancy (P <0.05). Vaginal intercourse is nearly universal among pregnant women attending this center with little variation between the trimesters. Health providers should counsel couples on safe coital activity during pregnancy and clear any misconceptions.

Prediction of stillbirth from maternal demographic and pregnancy characteristics.

To develop a model for prediction of stillbirth based on maternal characteristics and components of medical history and to evaluate the performance of screening with this model for all stillbirths and those due to impaired placentation and to unexplained causes. This was a prospective screening study of 113 415 singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation and at 19 + 0 to 24 + 6 weeks. The study population included 113 019 live births and 396 (0.35%) antepartum stillbirths; 230 (58%) were secondary to impaired placentation and 166 (42%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to determine the factors from maternal characteristics and medical history which provided a significant contribution to the prediction of stillbirth. The risk for stillbirth increased with maternal weight (odds ratio (OR), 1.01 per kg above 69 kg), was higher in women of Afro-Caribbean racial origin (OR, 2.01), those with assisted conception (OR, 1.79), cigarette smokers (OR, 1.71), and in those with a history of chronic hypertension (OR, 2.62), systemic lupus erythematosus/antiphospholipid syndrome (OR, 3.61) or diabetes mellitus (OR, 2.55) and was increased in women with a history of previous stillbirth (OR, 4.81). Screening with the model predicted 26% of unexplained stillbirths and 31% of those due to impaired placentation, at a false-positive rate of 10%; within the impaired-placentation group the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (38% vs 28%). A model based on maternal characteristics and medical history recorded in early pregnancy can potentially predict one-third of subsequent stillbirths. The extent to which such stillbirths could be prevented remains to be determined. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

PP.24.01] SERIAL AMBULATORY BLOOD PRESSURE MONITORING, INTENSITY OF ANTIHYPERTENSIVE DRUG TREATMENT, AND PREGNANCY OUTCOMES IN WOMEN WITH HYPERTENSION FOUND EARLY DURING PREGNANCY

Objective: Few data are available on serial ambulatory blood pressure monitoring (ABPM) throughout pregnancy and antihypertensive drug treatment required for good blood pressure (BP) control in hypertensive pregnant women. Our aim was to evaluate BP control, antihypertensive drug treatment intensity, and pregnancy outcomes in patients with hypertension (HTN) found early during pregnancy. Design and method: We studied 49 consecutive pregnant patients (mean age 33.4 ± 4.8 years, BMI before pregnancy 24.5 ± 3.7 kg/m2) referred for office HTN found early during pregnancy (mostly before 5 weeks) who gave birth to 50 children (1 twin pregnancy) in 2011–2015. Gestational HTN was previously diagnosed in 39 women, and 9 women had a history of previous miscarriage or stillbirth, with multiple previous pregnancies lost in some patients. ABPM was repeated at 5–10–15–20–25–30–33–35–37 weeks of pregnancy. We calculated overall antihypertensive treatment intensity in standard daily drug doses per patient (standard doses: labetalol 200 mg, methyldopa 750 mg, metoprolol 50 mg, nifedipine 20 mg, verapamil 120 mg). Statistical analysis was performed using ANOVA. Results: All children were born alive (24 vaginal delivery, 26 cesarean section) and are well at follow-up. Gestational age was 38.0 ± 2.5 (range 29–40) weeks, and birth weight was 3215 ± 653 g (range 955–4200). Preeclampsia/eclampsia occurred in 10/3 patients. Four patients had normal BP values by ABPM throughout pregnancy and did not receive antihypertensive drugs. Most patients were treated with labetalol (100–600 mg) and methyldopa (500–2000 mg). Throughout pregnancy, BP remained well controlled (24 h mean SBP/DBP 120.3–126.0/75.3–77.1 mmHg), the number of treated patients increased from 25 at 5 weeks to 42 at 25–35 weeks, and the average number of daily antihypertensive drug doses in treated pts increased from 1.82 at 5 weeks to 2.98 at 37 weeks (p < 0.001).Conclusions: Serial ABPM-guided antihypertensive drug treatment started early during pregnancy was associated with favorable outcomes. The number of patients requiring treatment and the treatment intensity to maintain good BP control increased throughout the pregnancy. No physiological BP fall at the end of 1st trimester was observed. Our findings help estimate the expected treatment intensity required in pregnant patients with preexisting hypertension.