Positive Pregnant Women Research Articles

Prognostic Value of Serum D-dimer in Predicting Outcomes in COVID-19 Positive Pregnant Women

Background: Combined effects of pregnancy induced hypercoagulability and SARS-CoV-2 infection place pregnant women with COVID-19 disease at high risk of severe outcome. COVID-19 severity has also been associated with serum D-dimer, a biomarker reflecting coagulation and fibrin degradation, in general populations. Despite its prognostic value in pregnant women, the prognostic value of this finding particularly in maternal outcomes remains less understood. The aim of this study was to determine whether elevated serum D-dimer levels in pregnant COVID-19 positive women are of prognostic significance for severe maternal outcomes. Methods: This retrospective observational study included 62 third trimester COVID 19 positive pregnant women admitted to the Department of Obstetrics and Gynecology, BSMMU, Dhaka from March 2019 to February 2020. Serum D-dimer were measured at admission and day 7, 14. D-dimer levels were related to clinical outcomes and statistically evaluated using chi square tests and logistic regression at p < 0.05. Results: Significantly associated with higher risk of severe outcomes, all of which included ICU admission, respiratory complications and adverse pregnancy events is elevated D-dimer levels (≥1.5 mg/L). In logistic regression analysis, patients with D-dimer levels of ≥1.5 mg/L had 3.5-fold greater odds of severe outcomes (OR 3.486; 95% CI, 1.184 to 10.263; p = 0.023). D-dimer had a sensitivity of 64.29%, 67.55% specificity in predicting severe outcomes. Conclusion: Serum D-dimer is valuable prognostic marker of disease severity in pregnant COVID-19 positive women and may be used for early risk assessment and clinical decision making. Routine measurement may help identify early high risk cases in order to improve maternal outcomes.

A prospective, multicenter study of hepatitis B birth-dose vaccine with or without hepatitis B immunoglobulin in preventing mother-to-child transmission of hepatitis B virus in Ethiopia

BackgroundHistorically, mother-to-child transmission (MTCT) of hepatitis B virus (HBV) was considered uncommon in Africa, leading to a reluctant attitude to birth-dose HBV vaccination on the continent. As a randomized trial would be unethical, real-life data are needed to assess the effect of HBV birth-dose vaccine in Africa. MethodsA multicenter, prospective, observational study of hepatitis B surface antigen (HBsAg)-positive pregnant women and their infants was carried out in Ethiopia, from January 2019 to May 2021. Pregnant women were screened for HBsAg and HIV as part of routine antenatal care and/or delivery, and HBsAg-positive HIV-negative pregnant women were included in the study. HBV birth-dose vaccine and hepatitis B immunoglobulin (HBIg) were recommended but not all newborns received it as it was not national policy. All infants, however, received the pentavalent HBV vaccine at 6, 10, and 14 weeks of age. Vaccination status was confirmed from delivery ward charts and infant vaccination certificates. Infants were tested for HBsAg at 9 months of age and a positive result was taken as evidence of MTCT. FindingsOf 290 HBsAg-positive pregnant women, 168 mother/infant pairs returned for their 9-month follow-up visit and were included in this analysis. Two of 112 (1.8 %) infants who received birth-dose vaccine with HBIg, and 2 of 23 (8.7 %) who received birth-dose vaccine alone were HBsAg positive at nine months of age, compared to 8 of 33 (24.2 %) who received neither vaccine nor HBIg at birth (p = 0.002). High maternal viral load (>200,000 IU/ml; adjusted odds ratio [AOR] 10.4; 95 % confidence interval [CI] 1.2–92.1) and not receiving HBV birth-dose vaccine nor HBIg (AOR 29.2; 95 % CI 4.0–211.3) were independent predictors of MTCT. InterpretationBirth-dose HBV vaccine with or without HBIg significantly reduced the risk of MTCT of HBV in Ethiopia. Improved coverage of birth-dose HBV vaccine should be an urgent priority.

Characterization of clinical infection and drug resistance of group B streptococcus in Chengdu, China

ObjectiveTo investigate the clinical infection characteristics and antibiotic resistance of Group B Streptococcus (Streptococcus agalactiae, GBS) in Chengdu, China, from 2019 to 2021, as well as to provide data to support rational clinical drug use. MethodsThis was a retrospective study to collect 203 culture-positive GBS strains isolated from January 2019 to December 2021 in Chengdu, China, all of which were identified by the VITEK 2 Compact automated microbial Bacterial identification instrument. Data were derived using WHONET 5.6 software. The sample type and ward distribution were counted. Pregnant women and newborns were screened from the original data and their pregnancy outcomes were calculated respectively. ResultsGBS strains were mainly concentrated in obstetrics and neonatology departments, accounting for 40.9 % and 33.5 %. The types of specimens were mainly vaginal secretions, amniotic fluid and sputum, accounting for 25.6 %, 26.1 % and 18.7 %, respectively. Chorioamnionitis, premature rupture of membranes and preterm delivery occurred mainly in pregnant women after infection, accounting for 44.4 %, 31.5 % and 24.1 %. Neonates, on the other hand, were mainly diagnosed with neonatal pneumonia, neonatal sepsis, respiratory failure and septic meningitis, accounting for 91.8 %, 61.2 %, 44.9 % and 16.3 % of all positive neonates. 840 pregnant women were screened for GBS colonization from 2019 to 2021, and a total of 108 GBS positive pregnant women were identified, with a GBS colonization rate of 12.9 %. A total of 9 neonates from 108 GBS positive pregnant women developed early-onset disease. The morbidity in neonates was 8.3 %. No strains resistant to penicillin and ampicillin were found, while the resistance rates of tetracycline and clindamycin were higher than 50 %, respectively 60.1 % and 53.2 %. ConclusionGBS infection mainly affected pregnant women and newborns in Chengdu, China, which can lead to adverse maternal and infant outcomes. Attention should be paid to strengthening general screening of GBS in perinatal urogenital secretions and the prevention strategy of IAP (intrapartum antibiotic prophylaxis). Antimicrobial therapy should be administered with appropriate antibiotics. Penicillin was still the first line drug for the treatment of GBS. These initiatives were important to reduce mother-to-child transmission and neonatal infections.

Fetal-hope study: Home monitoring of fetal heart rate in SSA + pregnant women: Rationale and design

IntroductionWorldwide, approximately 0.5–1 % of women of childbearing age are positive for anti-Ro/SSA antibodies and anti-La/SSB. The presence of these antibodies may be responsible for the appearance of Neonatal Lupus. The pathogenesis of this disease is probably mediated by the binding of these antibodies to fetal myocardiocytes. The typical manifestation is atrioventricular block (AVB), which in most cases is complete (CHB). AVB commonly develops between 16 and 26 weeks of gestation and is cause of severe heart failure. CHB appears to be irreversible, but anecdotal reports suggest that treatment of second-degree AVB can restore sinus rhythm. ObjectiveThe aim of the study is to evaluate the reliability of home monitoraing of fetal heart rate by the use of a hand-held device, extablishing the incidence of fetal AVB in pregnant women positive for anti-Ro/SSA autoantibodies and to evaluate whether early treatment can influence the course of the disease. MethodsAnti-Ro/SAA positive pregnant women are currently recruited from 11 Italian centers in a prospective observational study. Patients are instructed to use a portable doppler between 16 and 34 weeks of gestation and to monitor the fetal heart rate (FHR) every 8 h. In case of FHR anomalies patients will contact the reference center which will guarantee an echocardiogram within 8 h and in case of anomalies, adequate treatment. All patients will undergo check-ups at 20, 26 and 32 weeks of gestation, with the collection of information on the course of the maternal disease, on the use of drugs and on instrumental monitoring progress.After birth, data will be collected on the outcome of pregnancy and the methods of delivery. Newborns will also be evaluated for the possible appearance of clinical signs of Neonatal Lupus. ResultsFetal-Hope is actually enrolling Patients from involved Centers. ConclusionsFetal-Hope is the first European study assessing the reliability of home monitoring of fetal heart rate using a handheld device, determining the incidence of fetal atrioventricular block (AVB) in pregnant women positive for anti-Ro/SSA autoantibodies and assessing whether early intervention can alter the disease’s progression.

Shedding Light on the COVID-19 Pandemic: Placental Expression of Cell Biomarkers in Negative, Vaccinated, and Positive Pregnant Women.

Background: We investigated the expression of inflammation, placental development, and function markers, including cluster of differentiation 44 (CD44), osteopontin (OPN), and cyclooxygenase-2 (COX-2), to shed light on the controversy regarding the impact of the COVID-19 epidemic on fetal development and pregnancy outcomes. Methods: We immunohistochemically analyzed placental tissue from 170 patients (65 COVID-positive and unvaccinated women; 35 Pfeizer-vaccinated and COVID-negative women; and 70 COVID-negative and unvaccinated women, without any other associated pathology) for particularities in the expression of these three molecules. Results: CD44 expression was highest in COVID-negative and unvaccinated women, moderate in COVID-positive cases, and lowest in vaccinated and COVID-negative women. OPN expression was highest in COVID-negative and Pfeizer-vaccinated cases, moderate in COVID-negative and unvaccinated cases, and lowest in COVID-positive cases. COX-2 expression was increased in COVID-negative and unvaccinated women, modestly elevated in COVID-positive and unvaccinated cases, and lowest in vaccinated cases. Conclusions: These findings reflected an alteration in the placental structure and consequent function due to altered expression of the three studied molecules.

Assessment of the Knowledge, Attitude and Practice (KAP) of PMTCT among Healthcare Providers at the University of Ghana Legon

One of the leading causes of morbidity and mortality among communicable diseases is acquired immunodeficiency syndrome (AIDS). A vulnerable group in this setting is HIV exposed infants, (born to women living with HIV). The magnitude of the pandemic of HIV infection in developing countries is such that multiple approaches are required to show its spread and alleviate the burden on the health sector and society in general. Every woman of childbearing age needs to be aware of HIV infection, the risks of Mother-to-Child Transmission and the services available to reduce such risks. Considering these, this study assessed the knowledge, attitude and practice of Prevention of mother-to-child transmission (PMTCT) among healthcare providers at the University of Ghana Legon. A descriptive cross-sectional design was used in this study. The minimum sample size for this study was calculated using the single proportion population formula by Fisher (1978): The study area was the University of Ghana Hospital Legon. The collected data was exported into STATA version 16.0 for cleaning and analysis. Descriptive analysis, such as simple frequencies, percentages, means, and standard deviations, were used to summarize the data. Findings were presented in tables and graphs. Generally, the data accumulated from the research on the knowledge, attitude and practice of PMTCT among healthcare workers indicate that there is unsatisfactory knowledge and practice. In this study, no participants had a total good score above 85%. The relationship between gender, ward and knowledge was investigated using a chi-square. The p-value was higher than the alpha-value, indicating acceptance of the null hypothesis (p-value = 0.79 and 0.053, alpha value = 0.05). Sixteen (16) of the respondents, representing 17.6%, said HIV positive pregnant women should be managed like any other pregnant woman in Labour. The majority of the respondents (56) said at the first week of pregnancy, while only (2) said at week 28. However, their attitude was satisfactory. It must be noted that without further training and an increase in staffing levels, the quality and accessibility of PMTCT will be severely affected. It is therefore recommended that there should be continuous and pre-service training on PMTCT. All new medical officers, midwives and nurses should undergo PMTCT training, and those who are already in service should take refresher courses on new and updated guidelines.

The Prevalence of Chronic Hepatitis B Infection and Associated Factors Among Pregnant Women in Southeast of Iran

Background: Hepatitis B virus (HBV) infection is a significant global public health issue. Although infant immunoprophylaxis effectively reduces viral transmission, mother-to-child transmission during pregnancy, often associated with intrauterine infection, remains a major route of HBV infection. Objectives: The aim of this study was to determine the prevalence of maternal HBV infection, identify its associated factors, and measure viral load in Hepatitis B surface antigen (HBsAg)-positive pregnant women in Zahedan, Iran. Methods: This cross-sectional study included data from pregnant women who were referred to the Central Laboratory of Zahedan, Iran, for routine pregnancy tests between August and December 2019. Data were collected during the first prenatal visit along with HBsAg testing. Hepatitis B surface antigen testing was repeated for HBsAg-positive women at 24 - 28 weeks of gestation. If the patient remained HBsAg-positive, serum viral load was determined. Factors associated with HBV infection were identified using multiple logistic regression models. Results: A total of 1,474 pregnant women participated in this study. Among them, 24 (1.6%, 95% CI: 0.9% - 2.2%) were HBsAg-positive, with 17 (71%) of these patients being unaware of their infection. The mean viral load in infected women was (11.1 ± 3.2) × 107 IU/mL. Only 13.3% of pregnant women were vaccinated against HBV. Maternal tobacco use, family history of HBV infection, previous history of HBV infection, and history of nonalcoholic fatty liver disease were significantly associated with HBV infection (P < 0.05). Conclusions: The prevalence of HBV infection remains high among pregnant women, and vertical transmission poses a major challenge in the elimination of HBV infection in southeastern Iran. In addition to active-passive immunoprophylaxis, universal screening of all pregnant women for HBV infection and the use of peripartum antiviral therapy in HBsAg-positive pregnant women with high viral loads are warranted.

Differences of Efficacy Between Tenofovir Alafenamide Fumarate and Tenofovir Disoproxil Fumarate in Pregnant Women with Different Hepatitis B Virus DNA Loads

Abstract Tenofovir alafenamide fumarate (TAF) has been endorsed by guidelines for blockade of mother-to-child transmission of hepatitis B virus (HBV), given that its efficacy and safety are comparable to tenofovir disoproxil fumarate (TDF). However, there is a lack of comparative studies regarding the treatment efficacy in patients with diverse viral loads. This study retrospectively analyzed 96 hepatitis B e antigen (HBeAg)-positive pregnant women with HBV DNA levels ≥2 × 105 IU/mL. Based on viral loads (HBV DNA levels), participants in the TAF and TDF groups were stratified into three subgroups, namely the High-G (titer ≥8 log10 IU/mL), Middle-G (7 log10 IU/mL ≤ titer <8 log10 IU/mL) and Low-G (titer <7 log10 IU/mL) subgroups. The primary endpoint was effectiveness of TAF and TDF in patients with varying viral loads, while secondary endpoints were hepatitis B surface antigen (HBsAg) positivity in infants at 7 -12 months and the safety profile for mothers and children. Compared to baseline levels, median HBV DNA levels in mothers were decreased by 4.51 and 4.09 log10 IU/mL in the TAF and TDF groups (P = 0.04) pre-delivery, respectively. In the High-G subgroup, the titers were significantly lower in the TAF group (P = 0.045), a higher proportion of patients experienced a virus decline of ≥4 log10 IU/mLin the TAF group compared with the TDF group, with rates of 78.26% versus 58% (P = 0.034), respectively. Moreover, the median serum phosphate levels significantly decreased from baseline to pre-delivery in the TDF group (P = 0.04). Finally, infants in both cohorts tested negative for HBsAg at 7-12 months after delivery. Overall, our findings indicated that TAF can be considered the preferred option for treatment of HBeAg-positive pregnant women with HBV DNA levels ≥8 log10 IU/mL.

Pregnancy and COVID—Complications and its Challenges: A Case Series from a Tertiary Care Center in the Northeastern Part of India

The objective was to describe the course of management of all the coronavirus disease 2019 (COVID-19)-positive pregnant women, admitted to a 150-bedded tertiary care center in Guwahati, Assam, from March 01, 2021, till June 15, 2021. We collected a case series of 13 COVID-19-positive pregnant women, mostly in their second and third trimesters, admitted to our center between March 01, 2021, and June 15, 2021. All of the cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were confirmed by a positive result on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) tests. We aimed to show the course of management and maternal outcomes in these cases. The Results show that among the 13 infected pregnant women, three presented with severe SARS-CoV-2 pneumonia and were treated in the intensive care unit (ICU) and the rest were treated in wards as the mild category and discharged successfully. Two among them required invasive mechanical ventilation (IMV), and one was managed on non-invasive ventilation (NIV). Of the two mechanically ventilated patients, one succumbed to the illness and the other patient was successfully weaned in 5 days and shifted out after 15 days of the ICU stay. The third patient was on NIV support for 7 days, weaned off to low-flow oxygen therapy via face mask/ nasal prongs, and shifted out after 17 days of the ICU stay. Data on pregnant women with coronavirus infection are scarce and contradictory as the effect of SARS-CoV-2 on pregnancy is not clear. It is highly important to systemically investigate the clinical characteristics and outcomes of pregnant women with COVID-19 to provide strong guidelines for prevention, treatment, and management.

Relationship between HBV RNA level and pregnancy outcomes among hepatitis B carriers

Background: This study aims at investigating the relationship HBV RNA level and pregnancy outcomes among hepatitis B carriers. Methods: A total of 562 pregnant women who attended the Affiliated Hospital of Guizhou Medical University (Guizhou, China) from June 2020 to June 2023 were collected, 203 HBV carriers was included in this study. Then we recorded general data and pregnancy outcomes, the levels of HBV DNA, HBV RNA and HBeAg status in HBV carrier were detected. Pregnancy outcomes including intrahepatic cholestasis of pregnancy (ICP), gestational hypertension (GH), pre-eclampsia, gestational diabetes mellitus (GDM), preterm prelabour rupture of membranes (PPROM), mode of delivery , preterm birth, low birth weight (LBW) and macrosomia. Results: 562 pregnancies were analyzed, 203(36.12%) were infected with hepatitis B virus. Compared with HBsAg negative, HBsAg positive pregnant women had a higher risk of ICP. No statistically significant differences were found in the rates of GDM, GH, pre-eclampsia, PPROM, preterm birth, LBW, macrosomia and mode of delivery among women with the two groups. The analysis of risk factors of ICP showed that maternal HBV RNA level (OR = 3.814, 95% CI: 2.036~7.142, P< 0.001) was an important risk factor for ICP in HBsAg positive pregnant women. The receiver operating characteristics (ROC) curve revealed that the areas under the HBV RNA was 0.8652(95% confidence interval 0.7636~0.9669, P< 0.001). Conclusion: HBV RNA level pose significant negative impact to the pregnancy outcomes. It can be used as indicators to guide the prevention of ICP and improve maternal outcomes.

Antenatal depression and its predictors among HIV positive women in Sub-Saharan Africa; a systematic review and meta-analysis.

Antenatal depression in Human Immunodeficiency Virus (HIV) positive pregnant women can have significant adverse effects on both the mother and newborns, yet it is often overlooked in pregnancy care in Sub-Saharan Africa (SSA). Despite this, there is limited data on the combined prevalence of antenatal depression and its predictors among HIV-positive women in the region. To assess the pooled prevalence of antenatal depression and its associated factors among HIV-positive women in SSA. All primary cross-sectional studies published before 1st January/2024, were included. We conducted searches in relevant databases; PubMed, HINARI, Web of Science, PsycINFO, Psychiatry Online, ScienceDirect, and Google Scholar. The Joanna Briggs Institute checklist was used to critically appraise the selected studies. To assess heterogeneity among the studies, we utilized the I2 test. Publication bias was evaluated using a funnel plot and Egger's test. The forest plot was used to present the combined proportion of antenatal depression and odds ratio, along with a 95% confidence interval. The pooled prevalence of antenatal depression among HIV-positive women in Sub-Saharan Africa was found to be 30.6% (95% CI, 19.8%-41.3%). Factors significantly associated with antenatal depression among HIV-positive women in SSA included being unmarried (AOR: 3.09, 95% CI: 1.57 - 6.07), having a previous history of depression (AOR: 2.97, 95% CI: 1.79 - 4.91), experiencing intimate partner violence (IPV) (AOR: 2.11, 95% CI: 1.44 - 3.09), and experiencing stigma (AOR: 1.36, 95% CI: 1.05 - 1.76). High prevalence of antenatal depression among HIV-positive women in SSA underscores the need for prioritizing identification and management. Interventions addressing factors like IPV and stigma, along with training for healthcare providers in recognizing symptoms and providing support, are recommended. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024508236.

Association of gestational hepatitis B virus infection and antiviral therapy with pregnancy outcomes: A retrospective study.

To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes. We retrospectively selected hepatitis B surface antigen (HBsAg)-positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time. Overall, 1115 participants were enrolled and grouped into control (n = 380) and HBsAg-positive groups (n = 735), which were further divided into groups I (n = 407; low viral load), II (n = 207; high viral load without antiviral therapy), and III (n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62-9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49-24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46-17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26-9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes (P < 0.05). Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.

Distribution Characteristics of Rh Phenotype and Feasibility of Compatible Blood Transfusion in Pregnant and Postpartum Women

To analyze the distribution characteristics of Rh phenotype in pregnant and postpartum women in Chongqing area, and to explore the clinical significance of Rh phenotype in pregnant and postpartum women and the feasibility of Rh phenotype compatible blood transfusion. The ABO blood group and Rh phenotype of 65 161 pregnant and postpartum women were detected by microcolumn gel method, and 48 122 males in the same period were taken as controls. The data were analyzed by Chi-square test. There were 112 870 cases (99.64%) of RhD+ in 113 283 samples. In RhD+ cases, CCDee (48.39%) and CcDEe (32.88%) were the main phenotypes. The first case of D-- phenotype in Chongqing area was detected. 413 cases (0.36%) of RhD- were detected, with ccdee (52.78%) and Ccdee (33.41%) as the main phenotypes. Compared with RhD- group, RhD+ group showed statistically significant difference in Rh phenotype distribution (P < 0.01). Among 65 161 maternal samples, the positive rate of 5 antigens of Rh blood group from high to low was D > e > C > c > E, and there was no significant difference compared with male samples (P >0.05). There was no significant difference in the distribution of Rh phenotype between males and pregnant/postpartum women, as well as between pregnant/postpartum women with different ABO blood groups (P >0.05). In pregnant and postpartum women, there was no significant difference in distribution of Rh phenotype among the normal pregnancy population, the population with adverse pregnancy history, the population using human assisted reproductive technology (ART) and the population with infertility (P >0.05). There was no significant difference in the distribution of Rh phenotype between the 4 populations mentioned above and the inpatients in the local general Grade A hospitals and the blood donors (P >0.05). In RhD positive pregnant and postpartum women, the probability of finding compatible blood for CcDEe phenotype was 100%, the probability of finding compatible blood for CCDee, CcDee and CCDEe phenotypes was 45%-60%, the probability of finding compatible blood for ccDEE, ccDEe and CcDEE phenotypes was 5%-10%, and the probability of finding compatible blood for other phenotypes was lower than 0.5%. The supply of blood with CCDee and ccDEE phenotypes can meet the compatible transfusions requirements of 7 Rh phenotypes in more than 99% of patients. Rh phenotype detection should be carried out for pregnant and postpartum women, and it is feasible to carry out Rh phenotype-matched or compatible blood transfusion for pregnant and postpartum women who need blood transfusion.

Maternal and fetal outcome in COVID 19 positive pregnant women with thyroid dysfunction

Background: Normally functioning thyroid glands are able to meet the increasing need for hormones during pregnancy and keep thyroid hormone levels within normal limits. However thyroid dysfunction in pregnancy can cause adverse maternal and fetal outcomes like pre-eclampsia and gestational hypertension, antepartum hemorrhage, anemia, preterm delivery, low birth weight and addition of SARS-CoV-19 infection can worsen the perinatal outcome. In present ambispective study, obstetric outcomes of 32 cases of COVID 19 positive pregnant women with thyroid dysfunction (Group A) were compared with 32 cases of COVID 19 negative pregnant women with thyroid dysfunction (Group B). Results: Pregnancy induced hypertension (PIH) was the most common antepartum complication noted in both the groups (28.1% vs 12.5%). Group-A had 40.6% LSCS rate whereas it was 37.5% in group-B. Average period of gestation at delivery was 38 weeks in both the groups. The most common neonatal complication was low birth weight (9.4%) in both the groups. Group A was also associated with meconium aspiration syndrome (MAS) (9.4%), neonatal sepsis (6.2%) and transient tachypnoea of newborn (TTN) (3.1%). NICU admissions were 37.5% in group A while only 6.25% in group B. (p value &lt;0.01). Most common indication for NICU admission was MAS (9.4%) in group A. It was observed that incidence of pregnancy induced hypertension (PIH) and neonatal complications including NICU admissions were increased in presence of both COVID 19 and thyroid disorder as compared to only thyroid disorder in pregnancy. Multi-disciplinary approach with more vigilant monitoring can help reduce perinatal morbidity and mortality.

A RETROSPECTIVE STUDY OF FETOMATERNAL OUTCOME IN HIV POSITIVE PREGNANT WOMEN

Background: In present scenario Acquired immunodeficiency syndrome is one of the worst global health concerns. HIV has a dramatic impact on the health of mother and children. Parent to child transmission of HIV is a major route of new infection in children Methods: A retrospective study was conducted in Jklon hospital, kota from May 2021 to April 2022. All HIV positive pregnant women who were on ART or not and delivered in our hospital were selected. Maternal and fetal outcome variables were analysed. Results: Total deliveries during the study period were 9046. Out Of these HIV positive pregnant women were 36, prevalence being 0.3%. Primigravida were found to be 41.66% during the study period from may 2021 to April 2022. 47.22% were diagnosed HIV positive during pregnancy, vaginal deliveries were 77.77%% and caesarean section was 22.22%. birth weight &lt;2kg in 8.3% and IUFD were 8.3%. Nevirapine prophylaxis were given to 91.66% of neonate Conclusions: our result suggest that Early diagnosis and initiation of therapy will prevent transmission to their children and better fetomaternal outcome. In patients who are on ART education and counselling can alter maternal and neonatal outcome. Awareness and information is important to increase access to PPTCT services. Team approach involving an experienced obstetrician, neonatologist and physician gives hope of having a healthy uninfected baby for HIV infected mothers.

Predictors of placental malaria in HIV-positive and HIV- negative pregnant women in Enugu, South-Eastern Nigeria

Background: Placental malaria has long been recognized as a complication of malaria in pregnancy with serious adverse outcome. Recognition of possible predictors is an effort in the right direction. Aim of the study: The study determined and compared the Predictors of placental malaria in HIV-positive and HIV- negative pregnant women attending antenatal clinics in Poly General Hospital, South-Eastern Nigeria. Material and method: A cross-sectional descriptive study, carried out on 200 HIV positive and 200 HIV negative pregnant women attending antenatal clinics in Poly General Hospital, Enugu, selected using simple random sampling technique between May to December 2023. Placenta blood samples were collected and thick blood films were examined for malaria parasite using Giemsa expert microscopy. A structured self-administered questionnaire was used for data collection and the data analysed using SPSS version 23. Results: The prevalence of malaria in HIV positive and negative pregnant women were 83.5% (167/200) and 75.5%(151/200) respectively (P &lt; 0.001). The HIV positive and HIV negative participants were between 16-45 years of age with majority in the age range of 31-35 years. Mean gestational age of HIV positive and HIV negative participants were 24.3±1.1 and 24.4±1.3 weeks respectively. Placental malaria was significantly associated with rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN) ((P&lt;0.001)). Conclusion: The study showed that Placental malaria was significantly associated with rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN). Recognition of these significant predictors will enhance review and implementation of strategies for the prevention of malaria in pregnancy.

The cost-effectiveness of syphilis screening in pregnant women: a systematic literature review.

The cost-effectiveness study of syphilis screening in pregnant women has not been synthesized. This study aimed to synthesize the economic evidence on the cost-effectiveness of syphilis screening in pregnant women that might contribute to making recommendations on the future direction of syphilis screening approaches. We systematically searched MEDLINE, PubMed, and Web of Science databases for relevant studies published before 19 January 2023 and identified the cost-effectiveness analyses for syphilis screening in pregnant women. The methodological design quality was appraised by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. In total, 17 literature met the eligibility criteria for a full review. Of the 17 studies, four evaluated interventions using different screening methods, seven assessed a combination of syphilis testing and treatment interventions, three focused on repeat screening intervention, and four evaluated the interventions that integrated syphilis and HIV testing. The most cost-effective strategy appeared to be rapid syphilis testing with high treatment rates in pregnant women who were positive. The cost-effectiveness of syphilis screening for pregnancy has been widely demonstrated. It is very essential to improve the compliance with maternal screening and the treatment rates for positive pregnant women while implementing screening.

HUBUNGAN TINGKAT PENGETAHUAN IBU HAMIL TENTANG HIV/AIDS DENGAN SIKAP TERHADAP PROVIDER INITIATED TEST AND COUNSELLING (PITC) DI PUSKESMAS SLEMAN YOGYAKARTA

Human Immunodeficiency Virus is a virus that attacks the human immune system. Whereas, Acquired Immunodeficiency Syndrome is a number of symptoms of a disease that results in a decrease in the immune system. HIV and AIDS is a global public health problem, if it is not immediately treated, it will have complications such as tuberculosis, cryptococcal meningitis, bacterial infections, lymphomas, Kaposi's sarcoma and even death. HIV infection in pregnant women can spread to their babies. Primary Health Center of Sleman Yogyakarta had 2 HIV positive pregnant women registered as patients in 2018 which were detected from the results of the PITC test. This study aimed to determine the relationship between the level of knowledge of pregnant women and attitudes towards PITC at Primary Health Center of Sleman Yogyakarta. The research was a quantitative research with Cross Sectional approach. The population was 312 pregnant women and 76 of them were taken as respondents who had given the PITC examination. The sampling technique was done by Quota Sampling on all pregnant women. Data were analysed through bivariate analysis using Kendall Tau. The results showed that there was a significant relationship between the level of knowledge of pregnant women about HIV / AIDS and attitudes toward PITC at Sleman Primary Health Center of Yogyakarta with p value (0.001) and r correlation coefficient of 0.360 which indicated a low closeness relationship. Most of respondents had a good level of knowledge about HIV / AIDS and had a good attitude towards PITC. Midwives are expected to be able to convince pregnant women to undergo HIV / AIDS screening and increase promotion of HIV / AIDS.

Effects of SARS-Cov-2 mRNA vaccine on placental histopathology: Comparison of a population of uncomplicated COVID-19 positive pregnant women

1. IntroductionThis study investigates the impact of SARS-CoV-2 infection on placental histopathology in pregnant women, comparing outcomes between vaccinated and non-vaccinated individuals. Despite known adverse pregnancy outcomes linked to SARS-CoV-2 infection, the specific effects on the placenta remain unclear. Although vaccination has demonstrated a substantial reduction in infection severity, its impact on placental health requires more insight. 2. MethodsBetween March 2021 and July 2022, 387 COVID-19-positive women were admitted for delivery. Of these, 98 with non-severe symptoms were analyzed: 35 vaccinated during pregnancy, and 63 non-vaccinated. Two independent pathologists evaluated all placental specimens. 3. ResultsThe only differing obstetrical characteristic between groups was the mode of delivery (p 0.047), lacking clinical implications. Over 85% of placentas exhibited microscopic abnormalities, predominantly maternal vascular supply disorders (vaccinated 89.1%; unvaccinated 85.5%).Comparing vaccinated and unvaccinated groups revealed statistically significant differences, notably in increased focal perivillous fibrin deposits (IFPFD) [17.1% vs. 33.3% (p 0.04)] and avascular fibrotic villi (AFV) [0% vs. 11.1% (p 0.04)]. Binomial logistic regression confirmed the vaccine's protective role against IFPFD (aOR 0.36; 95%CI 013–0.99) and AVF (aOR 0.06, 95% CI 0.003–0.98). A sub-analysis in vaccinated women showed a positive correlation between the timing of the first dose and IFPFD presence (p 0.018). 4. DiscussionThe lower incidence of maternal and fetal vascular malperfusion placental features in vaccinated women, coupled with the timing correlation, supports the vaccine's protective effect on placental tissue in COVID-19-infected pregnant patients. Notably, no side effects were reported post-vaccination, emphasizing the vaccine's safety and advocating for its secure administration in pregnant populations.

Intrauterine Transmission of Hepatitis B Cannot Be Ruled Out by A Single Negative Hepatitis B e Antigen (HBeAg) Result among Hepatitis B Surface Antigen (HBsAg) - Positive Pregnant Women

BACKGROUND: The risk factors for intrauterine transmission of hepatitis B virus (HBV) in hepatitis B surface antigen (HBsAg)-positive pregnant women are poorly understood. Numerous factors are considered to be involved, including placental barrier, obstetric environment, high viral load, and positivity of hepatitis B e antigen (HBeAg). This study was conducted to investigate the role of placenta barrier, clinical, and viral factors in intrauterine transmission of HBV.METHODS: A cross-sectional study was conducted involving 1,353 pregnant women who underwent HBsAg screening. Eighty-four (6.2%) women were detected as HBsAg positive and were examined for HBsAg level, anti-HBs, anti-HBc, HBeAg/hepatitis B e antibody (anti-HBe) status, and HBV DNA presence in cord blood. Quantitative HBV DNA was analyzed using real-time polymerase chain reaction (PCR).RESULTS: Eighty-four of 1,353 subjects were HBsAg-positive. HBV DNA was positive in 28/84 (33.7%) maternal sera, 19/79 (24.05%) placental specimens, and 9/83 (10.84%) in cord blood. There were significant associations between HBV DNA in maternal serum (p=0.000) and placental tissue (p=0.000) with HBV DNA in the cord blood. No clinical factors were associated with HBV DNA transmission in cord blood. Sixty percent of viral load &gt;5.3 log10 copies/mL were found in the cord blood, of which 43.8% HBeAg positive and 3.1% HBeAg negative.CONCLUSION: Reduced transmission via compartments established the placenta’s barrier function in mother-to-child transmission. A high maternal viral load and positive HBeAg were risk factors for intrauterine transmission, while negative HBeAg still has the possibility of transmission.KEYWORDS: mother-to-child transmission, hepatitis B virus, intrauterine