Maternal Infection Research Articles

Epidemiology, antimicrobial resistance profile and management of carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

BackgroundEarly detection and proper management of maternal sepsis caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) can significantly reduce severe complications and maternal mortality. This study aimed to describe the epidemiology, antimicrobial resistance profile, and management of carbapenem-resistant K. pneumoniae among sepsis-suspected maternal cases in Ethiopia.MethodsA prospective cross-sectional study was conducted in five tertiary hospitals from June 2021 to December 2023. Isolation, identification, and antimicrobial susceptibility testing of the isolates were carried out following standard microbiological procedures as stated in the CLSI guidelines. Data on socio-demographics, risk factors, and management strategies were collected with structured questionnaires. Associations between variables were determined using logistic regression analysis in STATA-21. A p-value of less than 0.05 was statistically significant.ResultsOf the 5613 total women suspected of having maternal sepsis, 609 (10.8%) of them were infected with K. pneumoniae. The prevalence rates of MDR, XDR, and PDR K. pneumoniae strains were 93.9%, 24.3%, and 10.9%, respectively. The resistance rates for the last-resort antibiotics; amikacin, tigecycline, carbapenem, and third-generation cephalosporin were 16.4%, 29.1%, 31.9%, and 93.0%, respectively. The combination of carbapenem with tigecycline or amikacin therapy was used to manage maternal sepsis caused by cephalosporin-and carbapenem-resistant strains. Sepsis associated risk factors, including septic abortion [AOR = 5.3; 95%CI:2.2–14.4]; extended hospitalization [AOR = 3.7; 95%CI: 1.6–19.4]; dilatation and curettage [AOR = 2.2; 95%CI:1.3–13.4]; cesarean wound infection [AOR = 4.1; 95%CI:2.0–9.2]; indwelling catheterization [AOR = 2.1;95%CI: 1.4–6.2]; ICU admission [AOR = 4.3; 95%CI:2.4–11.2]; post abortion [AOR = 9.8; 95%CI:5.7–16.3], and recurrent UTI [AOR = 3.3; 95%CI: 1.6–13.2] were significantly associated with maternal sepsis caused by K. pneumoniae.ConclusionsThe prevalence of maternal sepsis caused by carbapenem- resistant K. pneumoniae is high and serious attention needs to be given to combat transmission. Therefore, improving awareness, early diagnosis, IPC, integrated maternal surveillance, improved sanitation and efficient antimicrobial stewardship are crucial to combating bacterial maternal sepsis.

The Negative Impact of Maternal HIV Infection on Birth Outcomes-Myth or Reality?

Human Immunodeficiency Virus (HIV) infection during pregnancy poses significant risks to both maternal and child health, with potential adverse effects on perinatal outcomes. This study aimed to compare perinatal outcomes, including birth weight, length, Apgar scores, and prematurity rates, between HIV-exposed, uninfected (HEU) children and HIV-unexposed, uninfected (HUU) children. A total of 204 neonates were included in the study, comprising 102 born to HIV-positive mothers and 102 born to uninfected mothers. Our findings revealed significant differences in birth weight (p < 0.001), length (p < 0.001), and Apgar scores at both 1 min (p = 0.003) and 5 min (p < 0.001) between HIV-exposed and -unexposed children. The HIV-exposed group exhibited lower birth weights and lengths, along with lower Apgar scores, indicating potential neonatal health challenges. No significant disparities were observed in the prematurity risk between the two groups (OR = 2.58, p = 0.126), but the risk of being born small for gestational age (SGA) in the case of HEU newborns was significantly high (OR = 17.41, p < 0.001). The significant differences in birth weight, length, and Apgar scores underscore the need for tailored healthcare interventions and support for neonates born to HIV-positive mothers. These findings contribute to our understanding of the complex interplay between maternal HIV infection and perinatal outcomes, guiding healthcare professionals in delivering targeted care for this vulnerable population.

Identifying Childhood Risk Factors for Hepatitis B with a Focus on Vertical Transmission.

Despite worldwide vaccination efforts, Hepatitis B virus (HBV) infection remains a significant global health burden, particularly in regions where vertical transmission is prevalent. Given Romania's history as an endemic area for hepatitis B from the 1990s until the early 2000s and the previously high infection rates among children, it is crucial to continually evaluate HBV infection in this population to monitor current trends, assess the long-term impact of vaccination programs, and address any remaining gaps in prevention and treatment efforts. This study aims to identify childhood risk factors associated with HBV acquisition, examining the role of maternal HBV status in child HBV infection, focusing on vertical transmission among a cohort of 654 children, with maternal infection as the independent variable and child infection as the dependent variable. We assessed potential risk factors and vaccination coverage among these children. The cohort included 148 children who tested positive for chronic hepatitis B from those 654 tested for HBsAg. Anamnestic data and vaccination history were analyzed, with particular attention to birth type and surgical interventions. Of the 148 HBV-positive children, 80.4% were delivered naturally. Among these, 130 had received hepatitis B vaccination, and 5 were also given hepatitis B immunoglobulin at birth, 4 of whom were born via cesarean section. In the control group, comprising 418 vaccinated children, a lesser proportion were unvaccinated (2.2%). Documented surgical interventions included general and dental surgeries, as well as a single blood transfusion. The study emphasizes the need for comprehensive vaccination strategies and illuminates potential correlations between birth type and vaccination status with childhood HBV infection. Crucially, it highlights the necessity of diligent monitoring and treatment of pregnant women with HBV to prevent vertical transmission as effectively as possible.

Prevalence of bacterial vaginosis and its associated factors among pregnant women attending antenatal care clinics at public hospitals in West Shoa Zone, Oromia, Ethiopia

Bacterial vaginosis is a polymicrobial syndrome characterized by the decrease of Lactobacilli and an overgrowth of facultative and anaerobic bacteria in vaginal fluid. Though it has received little attention, it has been associated with poor pregnancy outcomes, such as pre-term labor and delivery, premature rupture of membranes, low birth weight, spontaneous abortion, and postpartum infections. This study aimed to determine the prevalence of bacterial vaginosis and its associated factors among pregnant women attending antenatal care clinics from September 15 to December 14, 2021, at public hospitals in West Shoa Zone, Oromia, Ethiopia. An institutional-based cross-sectional study was conducted on 260 pregnant women, and systematic random sampling was employed to recruit the study participants. Data were collected through a structured questionnaire and the vaginal swab was collected using a sterile cotton swab. The gram staining result was interpreted using the Nugent scoring system. Data was entered into an Excel spreadsheet and exported to STATA-14 for analysis. Data were presented using tables and graphs. Binary and multivariable logistic regressions were performed. Variables with a P value ≤ 0.25 at the binary logistic regression were entered into the multivariable logistic regression. Finally, variables with a P value ≤ 0.05 were considered predictors of bacterial vaginosis and interpreted using adjusted Odds Ratios (AOR) with a 95% confidence interval (CI). A total of 260 pregnant women attending antenatal care were included in the study. The prevalence of bacterial vaginosis according to the Nugent scoring system was 22.3% (95% CI 17.4 to 27.9%). Pregnant women with other marital status were at reduced risk of bacterial vaginosis as compared with married pregnant women (AOR = 0.260, 95% CI 0.068 to 0.9995; P = 0.05). Rural residence (AOR = 2.1, 95% CI 1.05 to 4.24; P = 0.036), use of one pant per week (AOR = 2.7, 95% CI 1.04 to 7.2; P = 0.041), and use of two or more pants per week (AOR = 4.96, 95% CI 1.49 to 16.57; P = 0.009) were significantly associated with bacterial vaginosis. In the current study, a high magnitude of bacterial vaginosis was reported. Residence, marital status, and number of pants used per week were found significantly associated among pregnant women. Hence, screening for the disease should be integrated into the recommended basic laboratory investigations during antenatal visits.

Maternal Cytomegalovirus (CMV) Serology: The Diagnostic Limitations of CMV IgM and IgG Avidity in Detecting Congenital CMV Infection.

Congenital cytomegalovirus (cCMV) is a common congenital viral infection. Testing for cCMV usually begins with assessing maternal CMV serology, specifically IgM and IgG antibodies. A negative maternal CMV IgM suggests a low risk of recent maternal CMV infection, thereby suggesting a low risk of cCMV in the fetus. Consequently, cCMV is often ruled out when maternal CMV IgM is negative. In our perinatal autopsy and placental pathology database, we identified 5 cases of cCMV despite negative maternal CMV IgM results in the second trimester. In all 5 cases, fetal abnormalities were first detected by ultrasound in the second trimester, prompting maternal CMV testing. Since second trimester maternal CMV IgM was negative in all cases, cCMV was considered unlikely, thus precluding further prenatal CMV testing in 4 of these cases. The diagnosis of cCMV was subsequently made through placental and/or autopsy examinations. Following this diagnosis, retrospective CMV serology and IgG avidity testing was performed on stored frozen first-trimester maternal blood samples in 3 cases. Among these, the first-trimester samples in 2 cases were IgG+, IgM+, and exhibited low IgG avidity, suggesting a primary maternal CMV infection around the time of conception. In the third case, both first and second-trimester maternal blood samples were IgG+, IgM-, and showed high IgG avidity, suggesting a non-primary maternal CMV infection (i.e., reactivation or reinfection of CMV). A negative maternal CMV IgM in the second trimester cannot exclude cCMV infection. While CMV IgG avidity testing and analysis of stored frozen first-trimester maternal blood samples provide valuable insights, they have limitations. CMV PCR performed on amniotic fluid is a useful prenatal diagnostic tool. For cases of unexplained fetal abnormalities or death, autopsy and placental examination are recommended.

LACTIC ACID BACTERIA AS INGREDIENTS OF PROBIOTIC PREPARATIONS

Lactic acid bacteria have a long and extensive application record as probiotic strains. Lately, due to wide-spread use of molecular-genetic, transcirptomic, proteomic, metabolomic etc. studies and the massive accumulation of data on the structure and functions of symbiotic intestinal microbiota, the interest in probiotic microorganisms tends to expand year-by-year. Lactic acid bacteria were the first used probiotic species, are still of sharp market demand and have been recognized as the most thoroughly studied microbes among functional relatives. However, characteristics inherent to probiotic bacteria are strain-specific, as a rule, and for preparations with defined purpose it is essential to select special strains showing a complex of appropriate properties. It accentuates the top relevance of research aimed at selection of lactic acid bacterial strains suitable for diverse probiotic preparations. For several decades we curried out investigations to isolate strains of lactic acid bacteria from various natural sources, to characterize their properties and to derive technologies of producing pro- and prebiotic preparations for farm stock, poultry, veterinary practice, food processing, cosmetic formulas, etc. Enrichment, in addition to bifidobacteria, of probiotic product Poultrybac with lactic acid bacteria showing high antagonistic activity toward pathogen Salmonella typhimurium and producing enzymes capable to hydrolyze feed oligo- and polysaccharides, promotes prevention of salmonellosis cases, normalizes gut microbiocenosis, contributes to assimilation of fodder, accelerates growth of broilers. Bacteria of genera Lacticaseibacillus, Limosilactobacillus, Lactococcus constitute bacterial preparation Bilametrit designed for prophylaxis and complex therapy of endometrites in cows, actively suppress growth of pathogenic microorganisms of the genera Staphylococcus, Streptococcus, Pseudomonas, Salmonella, Escherichia, including isolates from uterus exudate from animals with post-partum endometritis. Owing to the pronounced adhesive ability to protein ligands the selected lactic acid bacteria recover microbiocenosis in reproductive system, especially after antibiotic therapy, facilitate regeneration of endometrium, produce organic acids, antimicrobial peptides, amino acids, enzymes of carbohydrate and protein metabolism. Inclusion, in addition to bifidobacteria, of microorganisms of genus Lactiplantibacillus with a high antagonistic activity against pathogenic and opportunistic microorganisms responsible for inflammation of the mammary gland in animals as component of dry probiotic preparation Bactomast shifts the bias of the mammary gland biocenosis towards lactic acid bacteria, curtails general insemination level 2.4–4.8 times, provides a shield protecting from penetration of pathogenic agents, decreases the ratio of somatic cells in milk. The constituent bacterial strains raise non-specific macro host resistance, display tolerance to a series of antimicrobial compounds (antibiotics of aminoglycoside and cephalosporin groups), allowing to recommend it for comprehensive therapy of mastites in cows. Bactomast is not inferior to veterinary drug iodomastin in therapeutic efficacy (83.3%). A crucial characteristic of the above-mentioned preparations, as well as probiotics Lactimet, Bilavet (liquid form), Bilavet-C (dry product), complex probiotic Synvet, probiotic ingredient Lyobact in whole milk substitutes, dry bacterial concentrate IM-pro fortifying dairy products with probiotics is that they are safe and eco-friendly, i.e. they will not cause adverse effects on the body and reproductive functions of humans, animals, poultry, are not accompanied by health complications, do not deteriorate quality of milk and meat products. Farm products may be consumed without restraints following treatment with biopreparations.

High level of immunoglobulin G targeting mycoplasma or cytomegalovirus in the newborn increases risk of ADHD

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder typically detected in childhood. Although ADHD has been demonstrated to have a strong genetic component, environmental risk factors, such as maternal infections during pregnancy, may also play a role. We therefore measured the immunological response to 5 abundant microorganisms (Toxoplasmosis Gondii, cytomegalovirus (CMV), Herpes Simplex Virus 1, Epstein Barr Virus and mycoplasma pneumoniae) in newborn heel prick samples of 1679 ADHD cases and 2948 matching controls as part of the iPSYCH Danish case-cohort study. We found an association between high anti-CMV (OR 1.30, 95 % CI [1.09,1.55], p = 0.015) and anti-mycoplasma (OR 1.30, 95 % CI [1.07,1.59], p = 0.037) signal and those newborns later being diagnosed with ADHD. The risk estimate remained increased when controlling for ADHD polygenic risk score as well as penicillin prescriptions. We saw a dose–response association with the amount of positive anti-microorganism titers increasing the risk of being diagnosed with ADHD later in life (p = 0.01 for the trend), suggesting that the more activated the immune system is prior to or at birth, the higher the risk is for a later diagnosis with ADHD. If the associations are causal, they emphasize the importance of a healthy life style during pregnancy to reduce the risk of infections when pregnant and the associated risks for the child.

Associations between Fetal Symptoms during Pregnancy and Neonatal Clinical Complications with Toxoplasmosis.

Toxoplasmosis is a parasitism transmitted by Toxoplasma gondii, part of the TORCH complex, the most prevalent parasitism worldwide. It is asymptomatic in immunocompetent individuals but causes severe infections and developmental abnormalities in pregnant women, mainly affecting the central nervous system and the gastrointestinal system. In our prospective study, we analyzed cases of recent maternal Toxoplasma infections confirmed by serological testing between 1996 and 2020 at the Department of Obstetrics and Gynecology, Semmelweis University. Amniocentesis, followed by PCR, was performed in cases of recent infection confirmed by serological testing during pregnancy. After birth, a neonatological, microbiological, pediatric neurological and ophthalmological examination and a follow-up was carried out. During the study period, a total of 238 cases of amniotic fluid Toxoplasma PCR testing due to Toxoplasma recent infection were performed. In terms of pregnancies, there were 219 deliveries and seven abortions. Twelve cases had no data available on the outcome of the pregnancy. In total, 133 cases of ultrasound abnormalities were detected during pregnancy, while in 105 cases, no abnormalities were detected on ultrasound examination. During amniocentesis, eight cases of Toxoplasma infection were revealed in amniotic fluid samples by PCR, and in 230 cases, the result was negative. Neonatal follow-up was performed in 139 cases, with no abnormalities during follow-up in 117 cases, and in 22 cases, there was a detectable complication that was likely to be related to Toxoplasma infection. In all 22 cases, amniotic fluid PCR Toxoplasma testing was negative. The most common ultrasound abnormalities involve the nervous system and the gastrointestinal system. In cases of suspicion, it is recommended to perform amniocentesis Toxoplasma PCR testing besides the indirect methods to help the pregnant woman decide whether to carry the pregnancy to term. During follow-up, a multidisciplinary team experienced in pregnancies complicated by toxoplasmosis must carry out the follow-up, care and subsequent development.

Association Between Maternal Infections in Pregnancy and the Risk of Inflammatory Bowel Disease in the Offspring: Findings From Two Scandinavian Birth Cohorts.

The association of infections and antibiotic use in pregnancy and the risk of inflammatory bowel disease (IBD) development in the offspring have been scarcely investigated. We examined infection and antibiotic use in pregnancy and the risk of IBD in offspring. We followed participants from the All Babies in Southeast Sweden (ABIS) and the Norwegian mother father and child cohort (MoBa) from birth (1997-2009) until 2020-2021. IBD diagnosis was classified as ≥2 records in national registers. Information on infections (any, gastrointestinal, and respiratory), their timing (early or late in pregnancy), and antibiotic use in pregnancy were collected from questionnaires. Cox proportional-hazard regression and meta-analytic methods were used to estimate pooled adjusted hazard ratios (aHRs) for IBD and its subtypes, adjusted for parental IBD, maternal smoking, and education. Sensitivity analyses accounted for exposure to antibiotics and infections 0-12 months of age. We followed 117 493 children for 2 024 299 person-years (follow-up 22.3 years in ABIS and 16.4 years in MoBa), including 451 IBD cases. The aHRs for any infection and respiratory infections in pregnancy and offspring IBD were close to one (aHR = 0.99 [95% CI = 0.73-1.33] and aHR = 1.00 [95% CI = 0.81-1.23], respectively). However, any versus no infection in early pregnancy was associated with IBD development (aHR = 1.26 [95% CI = 1.02-1.55]), particularly Crohn's disease (CD; aHR = 1.40 [95% CI = 1.01-1.93]). Any versus no gastrointestinal infection in late pregnancy was associated with offspring CD (aHR = 1.95 [95% CI = 1.34-2.84]). Antibiotic use in pregnancy was not associated with IBD in the child (aHR = 1.15 [95% CI = 0.93-1.44]). In this binational birth cohort study, the risk of offspring IBD varied by infection type and timing but not with maternal antibiotic use in pregnancy.

Correlation of Doppler Indices Within the Umbilical Vein Compared With Gestational Age and Fetal Weight in a Normal Pregnancy

Objective: Given the sophistication of ultrasonography, it is possible to explore and better comprehend the link between gestational age (GA), fetal weight (FW), and the diameter of the umbilical vein (UV). Therefore, the aim of this study was to determine whether a correlation exists between the Doppler indices, within the UV, compared with GA and FW, in a normal pregnancy. Materials and Methods: The design of this work was a cross-sectional analytical study. The sample size was calculated to include a sample size of 61, for statistical significance. A convenient sampling technique was used to collect the data. The inclusion criteria were to recruit pregnant women between the ages of 18 and 45 years, in the second and third trimester of pregnancy. In this cohort, the exclusion criteria were to be no co-existing maternal medical conditions chronic hypertension, gestational diabetes, cardiovascular problems, infections, hypercoagulability, and endocrine disorders. Results: A total of 61 pregnant women participated in this study, with a mean age of 25.21 ± 2.79 years. The mean GA was 32.4 ± 6.5 weeks. GA demonstrated a strong positive correlation with UV diameter ( r = .772, P &lt; .001), UV velocity ( r = .687, P &lt; .001), and UV volume ( r = .732, P &lt; .001). UV diameter showed a strong positive correlation with UV velocity ( r = .593, P &lt; .001) and an even stronger positive correlation with UV volume ( r = .928, P &lt; .001). UV velocity showed a strong positive correlation with UV volume ( r = .754, P &lt; .001). These findings may suggest that as GA increases, there are corresponding increases in UV diameter, velocity, and volume. Conclusion: In this cohort, the data collected demonstrated significant correlations between UV Doppler indices, GA, and FW, in normal pregnancies.

A Few Year Review of Still Birth at The Prince Abubakar Audu University Teaching Hospital Anyigba, North Central Nigeria

Introduction: An estimated 2.6 million still birth occur annually in the world in 2015. Nigeria then accounted for about 12.2% of this being the second highest still birth rate. Still birth is death of the fetus at or after 28 weeks of gestation. In some clime it is death of a fetus at or after 22 weeks. Aim: The study aim is to review still birth, determine the rate and characteristics of stillbirth at the Prince Abubakar Audu University teaching hospital, Anyigba, North Central Nigeria. Methods: This was a retrospective study conducted at Prince Abubakar Audu University Teaching Hospital in Anyigba, Nigeria between September and December 2023. We reviewed deliveries over a 5 year period; between January, 2018 and December 2022. A tool was used to extract data on pregnancies, live births, still births and other relevant related information about the parturients. Data was analyzed (descriptive analysis) using statistical package for social sciences (SPSS) version 20. Results: The institutional stillbirth rate is 3.8% (38 per 1000 deliveries). Majority of Women that had stillbirth were in the age range 21 to 39 years (82%), 29 (56.8%) booked while 18 (38.3%) were unbooked. 25(49%) were multiparae followed by 17 (33%) who were primigravidae and 9(18%) grand multiparae. 55 % (28) of the stillbirths were macerated at delivery while 45 % (23) were fresh still births. Preeclampsia/eclampsia (19.6%) was the most identified risk factor followed by prolonged obstructed labour (11.8%), ruptured uterus (9.8), PPROM (9.8%) and Preterm delivery (9.8%). The others are abruption placentae (5.9%), maternal infection (3.9%) and congenital abnormality (2%). Conclusion: The still birth rate of 38/1000 total births is unacceptably high leaving a lot of women with muted grief after childbirth. We need more effort to eliminate or reduce the incidence of still births.

Serological Outcome in the First Months of Life of Children Born to Mothers with SARS-CoV-2 Infection during Pregnancy.

The objective of this study is to analyze the transplacental transmission of SARS-CoV-2 antibodies, their persistence in newborns, the factors that may influence this transmission, and the protection these antibodies confer over time. This prospective cohort was conducted in a tertiary pediatric hospital in the Barcelona Metropolitan Region, Spain. It included neonates born to mothers who had SARS-CoV-2 infection during pregnancy or delivery between August 2020 and January 2022. We followed the recruited children for at least six months, and blood tests were performed to determine the presence of SARS-CoV-2 antibodies. A total of 101 children were recruited. Among the serologies performed on children under three months of age, 44/82 were positive (53.7%). Newborns whose mothers presented more severe disease exhibited higher seropositivity odds (coefficient 9.747; p = 0.002). There were increased preterm deliveries when maternal infection occurred closer to the time of delivery. No severe SARS-CoV-2 infections were detected in children during the follow-up. Slightly more than half of the SARS-CoV-2 serologies performed in the first three months were positive. This appears to confer protection during early childhood. The severity of maternal infection is the most significant factor influencing the transmission of antibodies in children born to unvaccinated mothers.

SARS-CoV-2 replicates in the placenta after maternal infection during pregnancy.

Pregnant women are at increased risk for severe SARS-CoV-2 infection and adverse neonatal outcome, primarily preterm birth and stillbirth. Our study aimed to investigate to which extent SARS-CoV-2 affects placental tissue and if viral replication within the placenta is evident, thus if there is a correlation between placental damage and adverse pregnancy outcome such as stillbirth. We prospectively collected placentas from 61 SARS-CoV-2 infected pregnant women and 10 controls. Histopathological, immunohistochemical, and in situ hybridization studies were performed on all placentas with antibodies for SARS-CoV-2 proteins, ACE2, various immune cells, and inflammatory markers or probes for SARS-CoV-2 genes and an antisense strand. The measured scores of SARS-CoV-2 glycoprotein, nucleocapsid, and antisense strand indicating replication correlated with both the severity of maternal symptoms and presence of stillbirth. Specifically, 15/61 placentas exhibited replication, while the three cases with stillbirth had high or maximal replication scores. ACE2-H-score was significantly higher in COVID-19 patients, while the expression of various immune cells did not differ statistically. In multivariate analysis, presence of maternal comorbidities correlated with presence of severe COVID-19 infection. We report evidence of active in vivo SARS-CoV-2 replication in the placenta after maternal infection in pregnancy in a case-control setting in a large population. Intensity of placental viral replication as well as viral levels were higher in women with severe or critical COVID-19 disease, supporting the rationale that severity of maternal SARS-CoV-2 infection could correlate with the severity of placentitis. Replication was maximal in cases of stillbirth, which suggests direct placental involvement in the pathophysiology of this dramatic outcome. Continuing to advocate for preventive measures against COVID-19 during pregnancy, including (re)vaccination, as well as appropriately counseling women with diagnosed infection, are of utter importance.

Prevalence and outcome of puerperal sepsis among mothers in Nigeria: A five-year retrospective study

BackgroundPuerperal sepsis is one of the leading causes of maternal illness and mortality in low- and middle-income countries, despite advances in diagnosis, antimicrobial therapy, and medical management. AimThis study aimed to assess the prevalence and outcomes of puerperal sepsis in tertiary hospitals in Ondo State, Nigeria. MethodsThis retrospective cross-sectional study was conducted at a tertiary hospital in Ondo State. Total enumerative sampling was used to select patients diagnosed with puerperal sepsis between 2016 and 2020. An adapted structured checklist was used to retrieve data from patients’ medical records. Data analysis was performed using SPSS version 25. Descriptive and inferential statistics were used to analyze the results. FindingsOut of 7980 obstetric cases managed during the study period, 156 patients had puerperal sepsis with a prevalence rate of 2%. The majority of patients were unregistered and were referred from other health facilities (94.2%). Other significant risk factors identified were postpartum hemorrhage (60.9%), prolonged labor (14.1%), premature rupture of membranes (19.9%), and lacerations (5.1%). Of the 156 patients diagnosed with puerperal sepsis, 151 (96.8%) were treated and discharged, while five (3.2%) died due to complications. Furthermore, a strong correlation was found between the mode of delivery and outcomes of puerperal sepsis (P ​= ​0.03). ConclusionsPuerperal sepsis remains a major public health concern. Therefore, there is a need to promote prenatal care and ensure continuous supervision and monitoring of birthplaces/delivery centers in Nigeria.

Maternal sepsis: Clinical pearls for diagnosis and management

Sepsis is a leading cause of maternal morbidity and mortality worldwide. Early recognition and treatment improve outcomes. Multiple sepsis diagnostic screening tools are available and may be used in clinical practice; however, early thorough bedside evaluation of the patient is fundamental. Obstetricians should be able to recognize sepsis and promptly initiate potentially life-saving treatments, such as fluid resuscitation, vasopressors, broad-spectrum antibiotics, and early source control. It is recommended that obstetrical care, including delivery timing, not be altered solely due to the diagnosis of sepsis.

Implementing an obstetric sepsis bundle in a large academic hospital system

For the purposes of this review, obstetric sepsis refers to sepsis (from all causes, including non-obstetric such as pneumonia) in pregnant or postpartum patients, which was previously described as maternal sepsis. Obstetric sepsis poses a significant threat to pregnant, birthing, and postpartum individuals, contributing prominently to maternal mortality and morbidity despite being largely preventable1. In response to identified gaps in sepsis management, particularly the lack of specific protocols tailored to obstetric populations, New York-Presbyterian undertook a system-wide initiative to implement a comprehensive sepsis bundle. This initiative included the development of new criteria for identifying sepsis in obstetric patients, the creation of electronic medical record (EMR) alerts aligned with obstetric-specific indicators, and the establishment of a structured sepsis management algorithm.The project involved collaboration across eight hospital campuses within the New York-Presbyterian system, aiming to standardize and improve the early recognition and treatment of sepsis in maternal care. Key components included rigorous data analysis to select appropriate sepsis criteria, simulation-based training to familiarize clinical teams with the new algorithm, and continuous refinement of alert systems to mitigate alarm fatigue and enhance responsiveness.Post-implementation evaluation revealed a significant reduction in preventable morbidity related to sepsis, accompanied by the identification of additional gaps in fever and chorioamnionitis management. These findings prompted the development of new clinical guidelines to further enhance patient safety. Challenges encountered included adapting sepsis criteria to balance sensitivity and specificity, as well as integrating trauma-informed care principles into clinical practice.This project underscores the effectiveness of tailored quality improvement efforts in maternal health, emphasizing the critical role of proactive interventions in enhancing patient outcomes and safety within obstetric settings. Ongoing efforts focus on monitoring process metrics through a dedicated sepsis dashboard and advancing education on trauma-informed care principles, highlighting the continued commitment to sustained improvement in maternal health outcomes.

Maternal HIV infection and various HIV antiretroviral regimens differentially affect placental System L-amino acid transporters

Maternal HIV infection and various HIV antiretroviral regimens differentially affect placental System L-amino acid transporters

Association Between Self-Reported Infections and Seropositivity Among Pregnant Women With Gastroschisis: A Case Control Study, With Emphasis on Chlamydia trachomatis.

Gastroschisis is a birth defect with the greatest risk among women <20 years of age. Pregnant women attending the University of Utah's Maternal-Fetal Medicine Diagnostic Center between 2011 and 2017 for either their routine diagnostic ultrasound or referral were recruited (cases: pregnant women with fetal gastroschisis, n = 53 participated/57, 93%; controls: pregnant women without fetal abnormalities, n = 102 participated/120, 85%). A clinic coordinator consented and interviewed women and obtained a blood sample and prenatal medical records. We evaluated self-reported maternal characteristics, risk factors, and infections. To assess pathogen seropositivity we used Serimmune's Serum Epitope Repertoire Analysis validated 35 pathogen panels and Chlamydia trachomatis and compared seropositivity to self-report and prenatal medical record screening to assess sensitivity. Cases were more likely to report a younger age at sexual debut (p = <0.01), more sexual partners (p = 0.02), being unmarried (p < 0.01), changing partners between pregnancies (p = <0.01), smoking cigarettes (<0.01), and a recent sexually transmitted infection (STI) (p = 0.02). No differences were observed for self-report of illicit drug use or periconceptional urinary tract infections. Cases had a higher seropositivity for cytomegalovirus (p = 0.01). No differences were observed for herpes simplex I, II, or Epstein-Barr. Though based on small numbers, C. trachomatis seropositivity was highest in cases (17%) compared to controls (8.8%) with the highest proportion observed in case women <20 years of age (cases 33%; controls 0%). Any STI (self-report or seropositivity) was also highest among cases <20 years of age (cases 47%; controls 0%). Among C. trachomatis seropositive women, self-report and prenatal medical record sensitivity was 27.8% and 3%, respectively. Cases were more likely to engage in behaviors that can increase their risk of exposure to sexually transmitted pathogens. Case women <20 years of age had the highest proportion of C. trachomatis seropositivity and any STI. Prenatal medical records and self-report were inadequate to identify a recent chlamydial infection whereas, the SERA assay is a novel approach for evaluating subclinical infections that may impact the developing embryo.

Cesarean Scar Defect (Niche) Risk Factors: A Prospective Study on Indonesian Women

Introduction: Niche or cesarean scar defect is a complication of a cesarean section that has long-term implications for both obstetrics and gynecology. The rate of niche is believed to be increasing with the high number of cesarean sections. This study assesses the risk factors for niche development after cesarean section. Methods: A prospective cohort study was conducted on women who underwent cesarean section at the Haji Adam Malik General Hospital Medan between August 2020 and August 2022. Niche was assessed six weeks after cesarean section using transvaginal ultrasonography. The primary outcome was the presence of a niche. The antepartum, intrapartum and postpartum risk factors were analyzed for niche development. A logistic regression model was used to assess independent risk factors from the bivariate analysis. Results: There were 280 patients enrolled in this study. The prevalence of niche was 44.3% by using transvaginal ultrasound. There was no significant relationship between maternal age, gestational age, parity, nutritional status based on upper arm circumference, hypertension in pregnancy, anemia status, surgical indications, duration of surgery, volume blood loss, and puerperal infection to niche development (P &gt; 0.05). The independent risk factors for niche development were Cervical dilatation &gt; 4 cm (P = 0.035; RR = 1.75), locking suture technique (P = 0.015; RR = 13.81), non-closure vesicouterine folds (P = 0.04; RR = 0.14) and a retroflexed uterus (P = 0.001; RR = 0.039). Conclusion: Cervical dilatation &gt; 4 cm, locking suture technique, non-closure vesicouterine folds, and a retroflexed uterus are risk factors for niche development after CS.

Maternal Sepsis.

Sepsis is the second leading cause of pregnancy-related mortality in the United States. Early recognition, treatment, and escalation of care for the obstetric patient affected by sepsis mitigate the risk of mortality and improve patient outcomes. In this article, we provide an overview of maternal sepsis and address topics of maternal pathophysiology, early warning signs, diagnostic criteria, early goal-directed therapy, and contemporary critical care practices. We also present an overview of common etiologies of maternal sepsis and suggested treatment approaches.