Previous Pregnancy Outcomes Research Articles

Distribution of antigens of the HLA-system in married couples with reproductive disorders

Aim: to study the distribution of HLA-antigens in married couples with failed conception and/or carrying of pregnancy, and to assess the occurrence rate and the presence of common alleles of the main histocompatibility complex in couples with infertility and miscarriages. Materials and methods. We conducted HLA-typing of 198 married couples with aggravated obstetric history. The main inclusion criteria were conception failures and unsuccessful outcomes of previous pregnancies. The HLA-class I antigen typing was carried out using a standard micro-lymphocyte-toxic test («Gisans», Russia); for the class II HLA-antigens, real-time polymerase chain reaction («DNA-Technology», Russia) was used. Based on the obstetric and gynecological history, the patients were divided into 2 subgroups: 1st – those with infertility and 2nd– with recurrent miscarriages. The comparison group included 101 married couples with no aggravated obstetric history, no infectious, no endocrine or anatomical abnormalities, and having 2 or more children. The occurrence rates of classes I and II HLA-antigens in women and men from the examined groups were compared with those in healthy individuals living in the same area. Results. In the examined couples with recurrent miscarriages, the HLA-A11 antigen occurred significantly more often in men, and HLA-В35 antigen – less often in women. In women of the infertile couples, HLA-A19 antigen was detected more often than in couples with children. In women with infertility, the HLA-DRB1*08 and HLA-DQA1*0401 alleles were less common than in women without fertility disorders. In the examined couples with infertility and recurrent miscarriages, statistically significant predominance of 3 genes common to the HLA class II system was found. In couples with normal fertility functions, the absence of homologous alleles of the HLA class II system in their genotypes was typical. Conclusion. HLA typing allows for predicting the risk of infertility and reproductive failure.

Previous experiences of pregnancy and early motherhood among women living with HIV: a latent class analysis

ABSTRACTPrevious maternity experiences may influence subsequent reproductive intentions and motherhood experiences. We used latent class analysis to identify patterns of early motherhood experience reported for the most recent live birth of 905 women living with HIV enrolled in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). Four indicators were used: difficulties getting pregnant, feelings when finding out pregnancy, feelings during pregnancy, and feelings during the first year postpartum. Most (70.8%) pregnancies analyzed occurred before HIV diagnosis. A four-class maternity experience model was selected: “overall positive experience” (40%); “positive experience with postpartum challenges” (23%); “overall mixed experience” (14%); and “overall negative experience” (23%). Women represented in the “overall negative experience” class were more likely to be younger at delivery, to not know the HIV status of their pregnancy partner, and to report previous pregnancy termination. Women represented in the “positive experience with postpartum challenges” class were more likely to report previous miscarriage, stillbirth or ectopic pregnancy. We found no associations between timing of HIV diagnosis (before, during or after pregnancy) and experience patterns. Recognition of the different patterns of experiences can help providers offer a more adapted approach to reproductive counseling of women with HIV.

Are there possible predictors of pain during office hysteroscopy among infertile women in Port Harcourt Nigeria?

Context: Invasive office procedures such as office hysteroscopy are usually carried out without analgesia as they are thought to cause minimal or no pain to the patient. Hysteroscopy has been found to be a cause of significant pain in some patients. Aims: To determine factors inherent in infertile patients experiencing pain during office hysteroscopy in Port Harcourt, Nigeria. Settings and Design: A cross-sectional comparative study amongst infertile women undergoing office hysteroscopy. Methods and Material: Assessment of Pain perceptions using a numerical pain scale in 101 women following office hysteroscopy. Demographic, Social, and gynecological factors of these patients were analysed for association with to pain perception. Statistical Analysis Used: Bivariate logistic regression analysis was conducted for associations between pain perception and suspected factors with P≤ 0.05 as statistically significant. Results: The mean age of the patients was 35.95±4.65 years. 53(52.5%) and 48(47.5%) of the patients experienced moderate/severe pain and mild/no pain respectively. Moderate/severe pain in participants was not associated with age, parity, type or period of infertility, dysmenorrhea or previous pregnancy terminations. However, it was associated with education below secondary level (OR=1.82; P value=0.21, 95%CI 0.81-4.11) and over one previous miscarriages (OR=1.11, P value = 0.948.;95% CI 0.51-2.43). Conclusions: Moderate/severe pains at office hysteroscopy occurred in more than one half of the patients increased risk of pain occurred in patients with miscarriages and those with less than secondary education. We recommend analgesia for patients undergoing office hysteroscopy.

Regional Influences on Nutritional Iodine Status of Pregnant Women in Pakistan.

Pregnant women are particularly vulnerable to iodine deficiency. Considering the rural-urban disparities in nutritional status in Pakistan, this study aimed to assess regional influences on nutritional iodine status of pregnant women in Pakistan. Data were collected from 1246 pregnant women in all trimesters of pregnancy who visited antenatal clinics for routine checkups in five Khyber Pakhtunkhwa province districts. Information concerning iodized salt intake and knowledge of iodine deficiency disorders (IDD) was obtained through an interview questionnaire. Goiter and urinary iodine concentration (UIC) levels were assessed by the palpation method and Sandell-Kolthoff reaction, respectively. Logistic regression analysis was used to quantify associations between residence (rural-urban), pregnancy trimester, and previous pregnancy outcomes with knowledge about IDD, iodized salt intake, presence of goiter, and UIC <150 μg/L. Among study participants, 87.7% had no knowledge about IDD, and only 21.0% were consuming iodized salt. Goiter was present in 25.5% of the women. The median UIC level was 131 μg/L, and 41.3% of study participants had a UIC ≥150 μg/L. There were no significant differences between pregnant women from rural and urban settings in regions with a solid socioeconomic status with respect to knowledge about IDD, iodized salt intake, iodine deficiency, and goiter prevalence. Urban-rural differences were observed only in socioeconomically disadvantaged districts. Only pregnant women living in the Lakki Marwat district had higher odds of having knowledge of IDD and iodized salt intake than those from rural regions. Trimesters of pregnancy and previous pregnancy outcomes had no significant effect on the outcome measures. Relative to a national nutrition survey conducted in Pakistan in 2011, the results from this study indicate that UIC levels remained stable with mild iodine deficiency, whereas rates of goiter and iodized salt intake remained high and low, respectively, especially in rural areas. Rural-urban disparities were observed only in socioeconomically disadvantaged districts, and these disparities limit the effectiveness of the IDD prevention program in rural areas in Pakistan. Thus, implementation of mandatory salt iodization requires improvement, and program effectiveness should be continuously monitored to prevent adverse health effects of iodine deficiency during pregnancy.

Nausea and vomiting of pregnancy: A study with pregnancy-unique quantification of emesis questionnaire

ObjectivesNausea and vomiting of pregnancy (NVP) is frequent, affecting up to 70–85% of pregnant women. However, severity of NVP especially in clinical practice is often uncertainly assessed and thus both under- and overdiagnosing is probable. Furthermore, risk factors for NVP, although recognized, are not well established. The aim of our study was to evaluate the severity of NVP with a structured questionnaire and evaluate associative risk factors. Study designSample of 2411 women were recruited from maternity health care clinics. Severity of NVP was assessed with pregnancy-unique quantification of emesis (PUQE) questionnaire. Age, previous pregnancies, previous deliveries, previous miscarriages including ectopic pregnancies, previous pregnancy terminations, nationality, pre-pregnancy body mass index, smoking, marital status and employment were used as explanatory factors. ResultsAltogether 88.0% of the women reported some level of NVP, of which 6.4% was severe, 52.2% moderate and 29.4% mild. Daily duration of NVP was ≥ four hours in 12 h in 45.0%. Further, 18.8% of the women had vomiting episodes ≥ three times and 37.4% retching episodes ≥ three times in 12 h. Women with ≥ two previous pregnancies had increased risk for more severe NVP (OR 2.17, 95%CI; 1.34–3.51, p < 0.0001). Older women had increased daily duration of nausea (OR 1.03, 95%CI; 1.00–1.06, p = 0.004) but lower number of vomits (OR 0.93, 95%CI; 0.93–0.97, p < 0.0001) and lower number of retching (OR 0.93, 95%CI; 0.90–0.96, p < 0.0001). Smokers had shorter daily duration of nausea (OR 0.49, 95%CI; 0.33–0.73, p < 0.0001), but higher number of vomiting episodes compared to non-smokers (OR 1.83, 95%CI; 1.26-2.66, p = 0.021). ConclusionsWomen suffered from NVP very frequently. The daily duration of NVP was moderately long, in nearly half of the women four hours or more. In addition, retching was more frequent than vomiting. From studied risk factors, few associations with different aspects of NVP emerged, but only multiparity was associated with the severity of NVP. As NVP affects several women during pregnancy, in future, the impact of NVP on quality of life, future family planning and health costs should be evaluated.

CLINICAL CHARACTERYSTYCS OF WOMEN WITH BREECH BIRTHS

The repeated revision of the world obstetric techniques regarding pregnancy with breech presentation and breech births, which does not significantly affect the improvement of perinatal indexes, draws the attention of modern scientists to such prevention aspects as formation and preservation of women’s reproductive health.The aim of the research is to study the state of reproductive health of women with breech deliveries.Materials and methods of the research. A prospective analysis has been conducted which covered 140 primigravidae, primiparae and multiparae having pregnancies with breech presentation (partial and full); the births took place in Odessa regional perinatal centre. The patients were divided into 2 groups: I – the main one (MG) (n=70), women who gave birth with breech presentations II – control group (CG) (n=70), women who gave birth with cephalic presentation.The results of the research and further discussion. The provided data demonstrates that patients from MG have more frequent gynecological anamnesis complications: late menarche – 24 (34.2%), abnormal uterus bleeding – 20 (28.6%), congenital anomalies of their reproductive system – 13 (18.6%), infertility – 14 (20%). The cases of adverse outcomes of previous pregnancies also prevail in MG: spontaneous abortion – 9 (12.8%), missed miscarriage – 14 (20%) and habitual noncarrying of pregnancy – 13 (18.6%). Women with breech presentation were less likely to have natural pregnancies – 58 (82.8%) while surgical deliveries were more frequent – 49 (70%).Conclusions. Infertility treatment using assisted reproductive technologies required more than one attempt for 10 (83.3%) out of 12 (17.1%) women from MG. Premature births also occurred more frequently in this group – 10 (14.3%). In 100% of cases they resulted in surgical deliveries leading to high index of surgical deliveries in MG.

Trial of Vaginal Birth After Caesarean (VBAC): Sharing Experience From a Tertiary Care Center of Eastern Nepal

Background: Rising rates of cesarean section is a matter of great concern and trial of labor in previous cesarean section women is an attractive alternative. Vaginal Birth After Caesarean (VBAC) may be one of the strategy developed to control the rising rate of cesarean deliveries in our country. Analyzing outcome of previous caesarean pregnancies will provide an insight for reducing the caesarean rates and formulating protocols and policies for trial of labor. The purpose of this study is to evaluate the pregnancy outcome in previous caesarean section women with VBAC trial with the hope of avoiding unnecessary repeat caesarean section rates. Methodology: It is a cross-sectional observational institute based study carried out in Nobel Medical College Teaching Hospital from 15th March 2017 to 14th March 2018 after the approval from Institutional Review Committee (IRC). This consists of patient with past history of cesarean section, who delivered in NMCTH during the study period and meeting the Royal College of Obstetrics and Gynecology (RCOG) inclusion criteria for VBAC. Feto-maternal outcomes were analysed. Results: There were 1225 previous cesarean cases, among them, we did VBAC trial in 135(11%) patients, 99 (73.33%) had successful vaginal delivery whereas 36(26.66%) could not do the same after labor trial. Feto-maternal outcome was better in VBAC patients than cesarean group.No maternal and neonatal mortality occurred. Conclusion: In the country like ours where rate of caesarean section is increasing alarmingly we have to try VBAC in appropriate group of patients. National policy and guidelines are necessary after large multicenter prospective studies. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 18-25

Preimplantation genetic diagnosis versus prenatal diagnosis—decision-making among pregnant FMR1 premutation carriers

To detect which factors influence decision-making among pregnant FMR1 premutation carriers regarding the preferred mode of genetic diagnosis: IVF-PGT-M (in vitro fertilization with preimplantation genetic testing for monogenic gene diseases), or CVS (chorionic villus sampling), or AC (amniocentesis) after spontaneous conception. In Israel FMR1 premutation preconception genetic screening is offered, free of charge, to every woman in her reproductive years. FMR1 premutation carriers with ≥70 CGG repeats, or a history of FXS offspring, are offered IVF-PGT-M. This is a historical cohort study including all pregnant FMR1 premutation carriers who underwent prenatal diagnosis between the years 2011 and 2016 at a tertiary medical center. Data were collected from electronic charts and through phone interviews. One hundred seventy-five women with high-risk pregnancies who were offered IVF-PGT-M were evaluated. In 37 pregnancies (21%), the women decided to undergo IVF-PGT-M. Using the generalized estimating equations (GEE) statistical method including seven parameters, we found that previous termination of pregnancy due to FXS and advanced woman's age were significantly associated with making the decision to undergo IVF-PGT-M. Previously failed IVF was the most significant parameter in a woman's decision not to undergo IVF-PGT-M. The most dominant factor affecting the decision of FMR1 premutation carriers to choose spontaneous conception with prenatal diagnosis versus IVF-PGT-M is a previous experience of failed IVF treatments. Women whose IVF treatments failed in the past tended to try to conceive naturally and later, during the course of the pregnancy, perform CVS or AC. Conversely, women who previously experienced a termination of pregnancy (TOP) due to an affected fetus, and older women, preferred to undergo IVF-PGT-M procedures.

Correlates of sexual inactivity and met need for contraceptives among young women in Ghana

BackgroundYoung women in sub-Saharan Africa continue to experience unintended pregnancies despite effective contraceptive methods being more readily available than ever. This study sought to determine the correlates of met need for contraceptives and sexual inactivity among young women in Ghana who want to postpone childbearing. We examine this among all women and then separately by marital status.MethodsUsing data from 1532 females aged 15–24 years from the 2014 Ghana Demographic and Health Survey, we conducted descriptive and multinomial logistic regression analyses to assess sociodemographic, economic and obstetric determinants of the type of family planning method (current abstinence, modern contraceptive method) used by married and unmarried young women.ResultsA higher proportion (~ 44%) of the respondents was currently abstinent compared to those with met need (~ 25%). Abstinence was higher among single young women while unmet and met need were higher among the married. Having at least senior high school education was significantly associated with the likelihood of current abstinence (especially among single women) and with met need. Being in the middle and rich categories, on the other hand, was associated with lower likelihood of current abstinence and a met need. Compared with multiparous women, those with one or no surviving child had a lower likelihood of being abstinent and having a met need. Other correlates of both current abstinence and met need are region of residence and ethnicity, while previous pregnancy termination and age were associated with abstinence and contraceptive use, respectively.ConclusionsUnmet need is high among young women but abstinence is an option they are using. As reproductive health programmes target the at-risk groups, the secondary and higher educational levels must be attained by most women as this is associated with use of abstinence and met need.

Primipaternity and birth interval; independent risk factors for preeclampsia

Background: The exact cause of preeclampsia remains unknown. The past decade has seen an ongoing debate on the relative importance of primipaternity versus prolonged birth/pregnancy interval.Aims: The aim of the current study was to analyze these two major potential risk factors in a high risk population in the Northern suburbs of Adelaide; a socioeconomically disadvantaged area characterized by instable relationships and overall poor health and lifestyle.Methods: A retrospective cohort study was performed on all multigravid women birthing at the Lyell McEwin Hospital, Adelaide, from July 2011 to August 2012; 2003 patients were included in this analysis. Basic demographic data, previous pregnancy outcomes, paternity, and birth and pregnancy intervals were recorded.Results: Women with a previously normal pregnancy had a significantly increased risk of developing preeclampsia in subsequent pregnancy with a new paternity (OR: 2.27 [p = .015]). Increasing birth and pregnancy intervals were associated with a significantly increased risk of developing preeclampsia in later pregnancies, with OR 1.39 at 3 years (p = .042) and OR 2.05 at 4 years (p = .002).Conclusions: The results of this study indicate that both prolonged birth interval and primipaternity are independent risk factors for preeclampsia in multigravidae.

Application of individual behavioral models to predict willingness to use modern contraceptives among pastoralist women in Afar region, Northern Ethiopia.

BackgroundUse of modern contraceptive methods reduces the risk of unwanted pregnancy, and is influenced by individual-level factors. Willingness to use modern contraceptive methods maybe a useful metric when considering health outcomes as it could predict health behaviors. Therefore, the current study aimed to assess the willingness of women to use modern contraceptives in Afar pastoralist communities.MethodsA community-based cross-sectional study was conducted from May 1 to 30, 2016. Three hundred forty-five women of childbearing age (15–49 years) were systematically sampled with proportionate allocation from seven randomly selected kebeles (neighborhoods) in Aballa District of Afar Region, Ethiopia. All women meeting the inclusion criteria in each selected household were interviewed at home using a semi-structured questionnaire. Construct validity was assured using factor analysis. A combination of individual behavioral models were applied in order to measure willingness to use modern contraceptive methods. Multiple logistic regressions were utilized to identify factors associated with willingness to use contraceptive at P-value of less than 0.05.ResultsThree hundred twenty-two women participated in the study, for a response rate of 93.3%. The mean age of respondents was 27 (±6) years. About one-third (N = 106, 32.9%) of the participants reported that they were willing to use modern contraceptives. Orthodox Christians (AOR = 4.22, 95% CI 1.94–8.92), women aged 19 or older at first marriage (AOR = 2.89, 95% CI 1.16–7.23), and women who had never experienced a stillbirth (AOR = 3.85, 95%CI 1.37–10.78) were more likely to report being willing to use modern contraceptives. Additionally, perceived severity of an unwanted pregnancy (AOR = 1.71, 95% CI 1.57–1.93) and perceived self-efficacy to use contraceptives (AOR = 1.26, 95% CI 1.17–1.65) were positively associated with the willingness. Women who had never had an abortion were less likely to express willingness to use modern contraceptives (AOR = 0.41, 95% CI 0.19–0.92) and perceived importance of cultural and religious norms (AOR = 0.85, 95% CI 0.62–0.90) was also negatively associated with willingness.ConclusionsThe majority of women in this study were not willing to use modern contraceptive methods. A previous pregnancy outcome of stillbirth was associated with reduced willingness, while a prior abortion was associated with increased willingness. Perceived severity of unwanted pregnancy and higher self-efficacy surrounding contraceptive use were strong predictors of increased willingness to use contraceptives. Religious and cultural norms also appear to influence perception towards modern contraception. Thus, involvement of cultural and religious leaders and consideration of a woman’s reproductive history are recommended when designing health education messages on contraception for Afar pastoralist women.

The duration of gestation at previous pregnancy termination and its impacts on subsequent birth: A nationwide registry-based study

The duration of gestation at previous pregnancy termination and its impacts on subsequent birth: A nationwide registry-based study

Bacterial vaginosis: Prevalence and associated risk factors among non-pregnant women of reproductive age attending a Nigerian tertiary hospital.

To determine the prevalence and risk factors associated with bacterial vaginosis (BV) among non-pregnant women of reproductive age group. A cross-sectional study among non-pregnant asymptomatic women aged 19 to 45 years, attending the gynaecological clinic at University of Ilorin Teaching Hospital, Ilorin, Nigeria. Participants were counselled and an informed consent was obtained. This was followed by vaginal swabs for microscopy, culture and sensitivity. Diagnosis of BV was by Nugent's criteria. Data analysis was by Statistical Package for Social Sciences (SPSS) version 20.0. Chi-square and Yates corrected chi-square were calculated, and p value <0.05 was significant. Among the 212 participants, prevalence of BV was 40.1%; it was common among women aged 25-34 years (50; 58.8%), the married (77; 90.6%) and those with tertiary education (39; 45.9%). The risk factors for BV were common among women with laboratory evidence of the infection, however statistically significant risk factors were the use of intrauterine device (OR 1.61, 95%CI 0.543-4.759; p0.020) and previous voluntary termination of pregnancy (OR 1.04, 95%CI 0.600-1.808; p0.047). There was high prevalence of bacterial vaginosis in the study population. Universal screening and treatment of cases may assist in lowering the associated morbidity.

Thromboprophylaxis and maternal-fetal outcomes of women with serum markers for hereditary thrombophilia and previous obstetric complications

Abstract Objectives: to evaluate the maternalfetal outcomes of thromboprophylaxis with enoxa parin based on scoring system in women with serum markers for hereditary thrombophilia and previous obstetric complications. Methods: a retrospective study was undertaken based on data collected from clinical records. We included 54 pregnant women with serum markers for hereditary thrombophilia undergoing therapeutic intervention with enoxaparin in the period from November 2009 to December 2013. The initial dose of low molecular weight heparin was guided by a scoring system. The maternalfetal outcomes of previous pregnancies and, subsequently, the treatment were compared using the chisquare (χ2) test with the Yates correction and Fisher's Exact Test; p&lt;0.05 was considered significant. Results: we observed significant reduction in fetal/perinatal deaths (p&lt;0.05) and spontaneous abortions (p&lt;0.001) after intervention. The live births at fullterm delivery (p&lt;0.001) and live births at preterm delivery (p&lt;0.05) increased significantly after intervention. Conclusions: the therapeutic intervention with enoxaparin based on scoring system during pregnancy seems to improve the fetal prognosis.

Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta-analysis.

Little is known about the risk of non-recurrent adverse birth outcomes. To evaluate the risk of stillbirth, preterm birth (PTB), and small for gestational age (SGA) as a proxy for fetal growth restriction (FGR) following exposure to one or more of these factors in a previous birth. We searched MEDLINE, EMBASE, Maternity and Infant Care, and Global Health from inception to 30 November 2016. Studies were included if they investigated the association between stillbirth, PTB, or SGA (as a proxy for FGR) in two subsequent births. Meta-analysis and pooled association presented as odds ratios (ORs) and adjusted odds ratios (aORs). Of the 3399 studies identified, 17 met the inclusion criteria. A PTB or SGA (as a proxy for FGR) infant increased the risk of subsequent stillbirth ((pooled OR 1.70; 95% confidence interval, 95% CI, 1.34-2.16) and (pooled OR 1.98; 95% CI 1.70-2.31), respectively). A combination of exposures, such as a preterm SGA (as a proxy for FGR) birth, doubled the risk of subsequent stillbirth (pooled OR 4.47; 95% CI 2.58-7.76). The risk of stillbirth also varied with prematurity, increasing three-fold following PTB <34weeks of gestation (pooled OR 2.98; 95% CI 2.05-4.34) and six-fold following preterm SGA (as a proxy for FGR) <34weeks of gestation (pooled OR 6.00; 95% CI 3.43-10.49). A previous stillbirth increased the risk of PTB (pooled OR 2.82; 95% CI 2.31-3.45), and subsequent SGA (as a proxy for FGR) (pooled OR 1.39; 95% CI 1.10-1.76). The risk of stillbirth, PTB, or SGA (as a proxy for FGR) was moderately elevated in women who previously experienced a single exposure, but increased between two- and three-fold when two prior adverse outcomes were combined. Clinical guidelines should consider the inter-relationship of stillbirth, PTB, and SGA, and that each condition is an independent risk factor for the other conditions. Risk of adverse birth outcomes in next pregnancy increases with the combined number of previous adverse events. Why and how was the study carried out? Each year, around 2.6million babies are stillborn, 15million are born preterm (<37weeks of gestation), and 32million are born small for gestational age (less than tenth percentile for weight, smaller than usually expected for the relevant pregnancy stage). Being born preterm or small for gestational age can increase the chance of long-term health problems. The effect of having a stillbirth, preterm birth, or small-for-gestational-age infant in a previous pregnancy on future pregnancy health has not been summarised. We identified 3399 studies of outcomes of previous pregnancies, and 17 were summarised by our study. What were the main findings? The outcome of the previous pregnancy influenced the risk of poor outcomes in the next pregnancy. Babies born to mothers who had a previous preterm birth or small-for-gestational-age birth were more likely to be stillborn. The smaller and the more preterm the previous baby, the higher the risk of stillbirth in the following pregnancy. The risk of stillbirth in the following pregnancy was doubled if the previous baby was born both preterm and small for gestational age. Babies born to mothers who had a previous stillbirth were more likely to be preterm or small for gestational age. What are the limitations of the work? We included a small number of studies, as there are not enough studies in this area (adverse birth outcomes followed by adverse cross outcomes in the next pregnancy). We found very few studies that compared the risk of small for gestational age after preterm birth or stillbirth. Definitions of stillbirth, preterm birth categories, and small for gestational age differed across studies. We did not know the cause of stillbirth for most studies. What are the implications for patients? Women who have a history of poor pregnancy outcomes are at greater risk of poor outcomes in following pregnancies. Health providers should be aware of this risk when treating patients with a history of poor pregnancy outcomes.

Magnitude of the Cytomegalovirus infection among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania

BackgroundDespite, Cytomegalovirus (CMV) infection being associated with a potential risk to the fetus, there is limited data from Tanzania and many other developing countries regarding the epidemiology and the impact of CMV infections. This cross-sectional study was conducted between December 2014 and June 2015 among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania to investigate the magnitude and associated factors of CMV infection.MethodsThe specific CMV IgM and IgG antibodies were detected using indirect enzyme linked immunosorbent assay (ELISA). Demographic and clinical data were collected using pre-tested data collection tool. Data were analysed using STATA version 13.ResultsA total of 261 pregnant women with median age of 20 (IQR 19–25) years and mean gestation age of 17 ± 7.8 weeks were enrolled. The seroprevalence of CMV IgG antibodies was 193(73.9%; 95% CI 67.2–79.6) while that of CMV IgM antibodies was 0.4%. As the age increased by one unit the IgG seroprevalence was found to increase by 0.3% (95% CI 0.13–0.47, p = 0.001) whereas the risk of being IgG positive increased by 24%. On multivariable logistic regression analysis only urban residence (OR 6.329, 95% CI 2.885–13.887, p < 0.001) was found to independently predict CMV IgG seropositivity. Regarding the outcomes of previous pregnancies the history of miscarriage independently predicted IgG seropositivity (OR 5.6, 95% CI 1.29–24.178, p = 0.021). The IgM seropositive woman had fatal outcome of the term delivery of the baby with microcephaly and spinal-bifida.ConclusionCytomegalovirus seroprevalence among pregnant women residing in urban areas of Mwanza city, Tanzania is high and is associated with poor pregnancy outcomes. There is a need to emphasize routine screening of CMV in order to establish the impact of CMV during pregnancy.

Removal of Retained Multiple Fetal Bones by Hysteroscopy

A 28-year-old woman with a history of a previous pregnancy termination at 14 weeks gestational age 8 years earlier presented with secondary infertility. She reported regular periods that were painful despite normal flow, but no other complaints. An infertility evaluation was notable for ultrasonography demonstrating hyperechoic areas in the uterine cavity suspicious for fetal bones (Fig. 1), presumably from the previous pregnancy. On hysteroscopy, multiple fetal bones were seen in uterine cavity, some buried in myometrium (Fig. 2). A total of 17 fetal bones were removed via hysteroscopic graspers (Fig. 3) without incident.Fig. 2Hysteroscopy image.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Final image of the specimen.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Retained fetal bones may be asymptomatic, making them difficult to identify. These fragments may act like an intrauterine contraceptive device to prevent pregnancy. Hysteroscopy should be performed for accurate diagnosis and treatment.

Maternal residential proximity to unconventional gas development and perinatal outcomes among a diverse urban population in Texas.

ObjectiveTo assess associations between unconventional natural gas development (UGD) and perinatal outcomes.MethodsWe conducted a retrospective birth cohort study among 158,894 women with a birth or fetal death from November 30, 2010-November 29, 2012 in the Barnett Shale, in North Texas. We constructed three UGD-activity metrics by calculating the inverse distance-weighted sum of active wells within three separate geographic buffers surrounding the maternal residence: ≤½, 2, or 10-miles. We excluded women if the nearest well to her residence was >20 miles. Metrics were categorized by tertiles among women with ≥1 well within the respective buffer; women with zero wells ≤10 miles (the largest buffer) served as a common referent group. We used logistic or linear regression with generalized estimating equations to assess associations between UGD-activity and preterm birth, small-for-gestational age (SGA), fetal death, or birthweight. Adjusted models of fetal death and birthweight included: maternal age, race/ethnicity, education, pre-pregnancy body mass index, parity, smoking, adequacy of prenatal care, previous poor pregnancy outcome, and infant sex. Preterm birth models included all of the above except parity; SGA models included all of the above except previous poor pregnancy outcome.ResultsWe found increased adjusted odds of preterm birth associated with UGD-activity in the highest tertiles of the ½- (odds ratio (OR) = 1.14; 95% confidence interval 1.03, 1.25), 2- (1.14; 1.07, 1.22), and 10-mile (1.15; 1.08, 1.22) metrics. Increased adjusted odds of fetal death were found in the second tertile of the 2-mile metric (1.56; 1.16, 2.11) and the highest tertile of the 10-mile metric (1.34; 1.04–1.72). We found little indication of an association with SGA or term birthweight.ConclusionsOur results are suggestive of an association between maternal residential proximity to UGD-activity and preterm birth and fetal death. Quantifying chemical and non-chemical stressors among residents near UGD should be prioritized.

Prevalence of pregnancy-relevant infections in a rural setting of Ghana

BackgroundAlthough infectious diseases still account for a high burden of morbidity and mortality in sub-Saharan Africa, simultaneous investigations on multiple infections affecting maternal and child health are missing.MethodsWe conducted a cross-sectional, single-centre pilot study in a rural area of Ghana to assess the infectiological profile during pregnancy. Screening of 180 expectant mothers was done by vaginal swabs and serology to detect the most common pregnancy-relevant infections. They were also interviewed for potential risk factors, outcome of previous pregnancies, and socio-economic aspects.ResultsWe found a high prevalence of infections caused by hepatitis B virus (16.7% HBs antigen positive). In contrast, infections caused by hepatitis C virus (1.1% anti-HCV) and HIV (0.6%) were rare. Maternal malaria was frequent (10.6%), despite increasing acceptance of intermittent preventive treatment during pregnancy (IPTp). Group B streptococci were present in 10.6% of all pregnant women. Absence of antibodies against varicella zoster virus in 43.2%, Toxoplasma gondii in 26.8%, parvovirus B19 in 20.0%, and rubella virus in 15.7% makes a significant proportion of pregnant women susceptible for acquiring primary infections. Whereas all study participants had specific IgG antibodies against human cytomegalovirus, infections with Listeria, Brucella, or Neisseria gonorrhoeae as well as active syphilis were absent.ConclusionsOur pilot study in a rural community in Ghana indicates an urgent need for action in dealing at least with high-prevalent pregnancy-relevant infections, such as hepatitis B, malaria and those caused by group B streptococci. In addition, the resulting prevalence rates of various other infections may offer guidance for health officials to prioritize possible future intervention schemes.

Pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Practical messages from the EULAR guidelines.

Over the last few decades, reproductive medicine has observed an improvement in the management and outcome of pregnancy in connective tissue diseases, such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). However, pregnancy and related issues remain a challenge in these patients. In routine clinical practice, health professionals dealing with SLE and APS need to consider the numerous aspects of the reproductive life of their patients, such as pregnancy, family planning, fertility, contraception, cancer surveillance, and menopause. The new European League Against Rheumatism recommendations for women's health and family planning reflect the need for a novel approach to communication in the patient-physician relationship. Preconception counseling is essential to ensure optimal pregnancy outcomes through a careful risk stratification involving disease activity, organ involvement, autoantibody profile, use of drugs, and previous pregnancy outcomes, as well as to ensure better preventive and therapeutic strategies to limit complications. In patients with stable/inactive disease and low risk of thrombosis, adequate hormonal contraception and menopausal replacement therapy should be recommended. Assisted reproductive techniques can be safely used in these patients, but anticoagulation or low-dose aspirin (or both) should be added in those with positive antiphospholipid antibody titers. All menstruating women should be counseled on the possibility to preserve fertility with gonadotropin- ‑releasing hormone analogues if receiving alkylating agents. Strict clinical, serological, laboratory, and multidisciplinary monitoring during pregnancy is mandatory to early recognize and effectively treat disease flares or obstetric complications. Doppler ultrasonography and fetal biometry should be regularly performed, especially in the second and third trimesters. Physicians should recommend screening for cervical dysplasia related to human papillomavirus (HPV) infection, especially during immunosuppressive therapy, and HPV immunization can be used in women with stable/inactive disease.