Maternal Infection Research Articles

Impact of maternal infection on outcomes in extremely preterm infants.

Infants born less than 29 weeks, or extremely preterm (EPT), experience increased morbidity and mortality. We hypothesized that exposure to maternal infection might contribute to neurodevelopmental impairment (NDI) or death at 2 years of age. We conducted a retrospective cohort study of EPT infants from January 2010 to December 2020. Maternal data extracted included maternal infections, classified as extrauterine or intrauterine. Placental pathologic and infant data were extracted. The primary outcome was NDI or death at 2 years of age. 548 EPT infants were born to 496 pregnant people: 379 (69%) were not exposed to any documented maternal infection prenatally, 124 (23%) to extrauterine infection, and 45 (8%) to intrauterine infection. Neither diagnosis of maternal extrauterine nor intrauterine infection was associated with NDI or death at 2 years of age (p > 0.05). Acute histologic chorioamnionitis was associated with NDI or death at 2 years of age (p = 0.033). Maternal infection was not associated with NDI or death at 2 years of age in EPT infants. However, acute histologic chorioamnionitis was associated with this outcome. Further work should investigate the differential influence of infection and immune response with this pathology as relates to outcomes in EPT infants. Maternal infection was not associated with neurodevelopmental impairment (NDI) or death at 2 years of age in extremely preterm (EPT) infants. This is reassuring support that mechanisms at the maternal-fetal interface largely protect the EPT infant. However, pathologic findings of acute histologic chorioamnionitis were associated with NDI and death at 2 years of age. Further work should investigate the differential influence of infection and immune response with acute histologic chorioamnionitis on pathology as relates to outcomes in EPT infants.

Unveiling the microbiome during post-partum uterine infection: a deep shotgun sequencing approach to characterize the dairy cow uterine microbiome

BackgroundThe goal of this study was to assess the microbial ecology and diversity present in the uterus of post-partum dairy cows with and without metritis from 24 commercial California dairy farms using shotgun metagenomics. A set subset of 95 intrauterine swab samples, taken from a larger selection of 307 individual cow samples previously collected, were examined for α and β diversity and differential abundance associated with metritis. Cows within 21 days post-partum were categorized into one of three clinical groups during sample collection: control (CT, n = 32), defined as cows with either no vaginal discharge or a clear, non-purulent mucus vaginal discharge; metritis (MET, n = 33), defined as a cow with watery, red or brown colored, and fetid vaginal discharge; and purulent discharge cows (PUS, n = 31), defined as a non-fetid purulent or mucopurulent vaginal discharge.ResultsAll three clinical groups (CT, MET, and PUS) were highly diverse, with the top 12 most abundant genera accounting for 10.3%, 8.8%, and 10.1% of mean relative abundance, respectively. The α diversity indices revealed a lower diversity from samples collected from MET and PUS when compared to CT cows. PERMANOVA statistical testing revealed a significant difference (P adjusted < 0.01) in the diversity of genera between CT and MET samples (R2 = 0.112, P = 0.003) and a non-significant difference between MET and PUS samples (R2 = 0.036, P = 0.046). ANCOM-BC analysis revealed that from the top 12 most abundant genera, seven genera were increased in the natural log fold change (LFC) of abundance in MET when compared to CT samples: Bacteroides, Clostridium, Fusobacterium, Phocaeicola, Porphyromonas, Prevotella, and Streptococcus. Two genera, Dietzia and Microbacterium, were decreased in natural LFC of abundance when comparing MET (regardless of treatment) and CT, while no changes in natural LFC of abundance were observed for Escherichia, Histophilus, and Trueperella.ConclusionsThe results presented here, are the current deepest shotgun metagenomic analyses conducted on the bovine uterine microbiome to date (mean of 256,425 genus-level reads per sample). Our findings support that uterine samples from cows without metritis (CT) had increased α-diversity but decreased β-diversity when compared to metritis or PUS cows, characteristic of dysbiosis. In summary, our findings highlight that MET cows have an increased abundance of Bacteroides, Porphyromonas, and Fusobacterium when compared to CT and PUS, and support the need for further studies to better understand their potential causal role in metritis pathogenesis.

PENGARUH PEMBERIAN KONSUMSI TABLET TAMBAH DARAH (Fe) DAN BUAH KURMA TERHADAP PENINGKATAN HB IBU HAMIL ANEMIA DIWILAYAH KERJA PUSKESMAS PANAAN

Anemia in pregnancy is dangerous for the mother or fetus. The consequences that can occur if pregnant women suffer from anemia, namely miscarriage, premature birth, KPD can occur during childbirth with his, old partus. postpartum hemorrhage, puerperal infection, as well as decreased milk production. The purpose of the study was to determine the effect of giving blood-added tablets (Fe) and dates in increasing Hb levels in anemic pregnant women. The research method uses the quasy experimental method with the Pretest-Posttest Control Group Design design. The design of this study was a group divided into 3, intervention group I (Fe tablets and dates), intervention group II (dates) and control group (Fe tablets). Data were analyzed using the Wilcoxon test. The results of the study of 15 respondents of anemic pregnant women after the intervention, all respondents experienced an increase in Hb. The highest increase in Hb was in the intervention group I average value of 1.44 mg / dl and from the results of the Wilcoxon test obtained a p-value of 0.043, intervention group II an average increase in Hb 0.62 mg / dl and obtained a p-value of 0.042, intervention group III an average increase in Hb of 0.46 mg / dl with a p-value of 0.041.

Uji Aktivitas Antibakteri Ekstra Virgin Olive Oil (EVOO) Terhadap Streptococcus Agalactiae

Streptococcus agalactiae is a pathogen known to frequently cause infections in both mothers and children. It can lead to complications such as premature birth, premature rupture of membranes, postpartum infections, pneumonia, meningitis, and sepsis. Current treatment for Streptococcus agalactiae often involves antibiotics, which can contribute to antibiotic resistance. Given the increasing concern about antibiotic resistance, the development of herbal antibacterials is gaining momentum, with extra virgin olive oil (EVOO) being one such area of interest. EVOO contains oleuropein, flavonoids, and essential oils, all of which possess antibacterial properties. The objective of this research is to demonstrate the antibacterial activity of extra virgin olive oil (EVOO). The study employed a true experimental design with a post-test-only control group, using the disc diffusion method to measure bacterial inhibition zones. The results revealed the largest inhibition zone, measuring 15.9 mm, with a 3 ml dose of EVOO. The correlation test indicated a significant value of 0.000, with a coefficient of -726, suggesting that an increase in EVOO dose results in a reduction in the Streptococcus agalactiae bacterial population. Based on these findings, it can be concluded that extra virgin olive oil (EVOO) exhibits potent antibacterial activity against Streptococcus agalactiae.

Prophylactic Antibiotics for Vaginal Delivery: Benefits and Possible Harms

(N Engl J Med. 2023;388:1221–1223) Antiseptic techniques were discovered by Ignaz Semmelweis. Semmelweis was a physician in Hungary in the 1860s. His discovery wasn’t popular at the time he published his work, but it is now a standard practice in today’s modern healthcare facilities with procedures such as basic handwashing being used in everyday life outside of the hospital setting. Although this is now standard practice, maternal death is still often caused by infection. Infection during delivery is the third most leading cause of death among mothers, following hemorrhage and hypertension. It was reported that 810 individuals die during or following delivery every day from diseases that could be prevented by following simple antiseptic techniques. Ninety-four percent of these deaths occur in low and middle-income areas, such as Africa and Asia, with 10.7% of these deaths being directly related to infection or sepsis. The Global Maternal and Neonatal Sepsis Initiative was created by the WHO to reduce the overall rate of maternal mortality by the year 2030.

SARS-CoV-2-Placental effects and association with stillbirth.

SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease which occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to identify quickly such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. While we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. As a placental condition with an infectious aetiology, SARS-CoV-placentitis is unlikely to recur in a subsequent pregnancy and thus a measured approach to subsequent pregnancy management is needed.

Maternal Mortality in Women With Previable Premature Rupture of Membranes: An Analysis From the French Confidential Enquiry into Maternal Deaths

(Acta Obstet Gynecol Scand. 2022;101:1395–1402) Previable premature rupture of membranes (PvPROM) is a rare complication of pregnancy (&lt;1% frequency) but can lead to severe maternal adverse outcomes including sepsis and death. Conservative management without fetal extraction is common, but the documented risk of maternal sepsis remains elevated and variable even with prophylactic antibiotic treatment. The data on maternal mortality is lacking, and underreporting is a concern. The aim of this study was to characterize the lethality of PvPROM to inform decision-making as to whether to prolong a ruptured pregnancy or recommend termination.

Exploring the long-term seroprevalence of SARS-CoV-2 antibodies in infants born to women with clinical or laboratory-confirmed COVID-19

IntroductionInfants are at a higher risk of severe illness with COVID-19 infection compared to older children. While COVID-19 vaccination is not recommended for young infants, they can acquire maternally-derived anti-SARS-CoV-2 antibodies passively through the placenta and breastmilk. We described the persistence of infection-induced maternal antibodies in infant circulation at 9–12 months of age. MethodologyThis was a cross-sectional study nested within the INTERCOVID multinational cohort study. For each COVID positive pregnant woman, two unmatched consecutive COVID negative pregnant women were enrolled between April and September 2020. Women with a positive PCR test, radiographic signs consistent with COVID-19, or at least 2 predefined symptoms of COVID-19 were considered as COVID positive. For this nested cross-sectional study, all COVID positive and either one of the COVID negative participants recruited from the Aga Khan University, Pakistan were approached 9–12 months after delivery, and maternal and infant sera were collected for antibody detection. ResultsAltogether, 83 mothers provided consent, of whom 32 (38.6 %) were COVID positive and 51 (61.4 %) were COVID negative during pregnancy. Anti-SARS-CoV-2 antibodies were present in 13 (41 %) infants born to COVID positive and 19 (39 %) infants born to COVID negative mothers (p = 0.87). The presence of reactive antibodies in infants at follow-up was associated with maternal antibodies at follow-up (OR:9.50, 95 % CI:2.03–44.42; p = 0.004). COVID infection occurred in 3 (6 %) infants born to COVID negative mothers while no infant born to a COVID positive mother had a history of infection (p = 0.27). ConclusionThe presence of reactive anti-SARS-CoV-2 antibodies in infants at 9–12 months of age is associated with maternal seropositivity 9–12 months after delivery rather than maternal infection during pregnancy. Further studies are required to validate these findings and assess whether passive immunity in infants is protective against COVID-19 infection.

Ophthalmological impairment in patients with congenital cytomegalovirus infection.

Congenital cytomegalovirus (cCMV) infection is a frequent cause of neurosensory impairment. Ocular abnormalities and visual impairment have been reported in a high percentage of symptomatic infants, whereas they are considered uncommon in asymptomatic ones. The paucity of data has made difficult to reach clear recommendations on the ophthalmological follow-up that should be provided. 250 patients with cCMV infection (123 symptomatic) were enrolled and underwent a series of age-appropriate ophthalmologic, audiologic, and neurodevelopmental examinations from 2002 to 2022. Funduscopic abnormalities were identified at onset in 16/123 (13%) symptomatic infants and in none of the asymptomatic ones (p < 0.001). Chorioretinitis lesions were the most common findings (10/16 cases), while the others showed retinal scars. Lesions were bilateral in 4 patients. No later onset retinal lesions were detected, nor in symptomatic or in asymptomatic children. Five of the 16 (31.5%) symptomatic and none of the asymptomatic subjects showed visual impairment al the last evaluation (p < 0.001). All patients with unfavorable outcome had also neurological impairment. Among symptomatic patients, ocular lesions were associated with central nervous system (CNS) pathological findings in prenatal ultrasonography (p 0.05) and with clinical signs of CNS involvement at birth (p 0.046). No correlation was found with the type of maternal infection and pathological neuroimaging. Chorioretinal lesions are a fairly common finding at birth in neonates with symptomatic cCMV, often associated with long term visual impairment. Asymptomatic infants do not show ophthalmological abnormalities in the short or long term. This information is relevant both to parental counseling and to cost-effective patient management.

Safety and Efficacy of Cervical Ripening and Induction of Labor Using Prostaglandin E1 in Primiparas, Multiparas and Grand Multiparas.

To compare the efficacy and safety of cervical ripening and induction of labor with prostaglandin E1 among primiparas, multiparas and grand multiparas. This was a retrospective cohort study. Between January and December 2017, 1713 women underwent cervical ripening and induction of labor with prostaglandin E1: 523 were primiparas, 656 were multiparas, and 534 were grand multiparas. Four hundred and seventy-nine (91.6%) primiparas delivered vaginally as did 640 (97.6%) multiparas and 521 (97.6%) grand multiparas. Forty-four (8.4%) primiparas underwent cesarean delivery compared to 16 (2.4%) multiparas and 13(2.4%) grand multiparas. Induction to delivery interval was significantly longer in primiparas (29.7 ± 22.8h). There were no cases of uterine rupture, and the rates of postpartum hemorrhage and endometritis were similar among the three groups. Neonatal outcomes including Apgar score < 7 and umbilical artery pH < 7.1 were not significantly different between the groups. Using prostaglandin E1 for cervical ripening and labor induction is efficient and safe in primiparas, multiparas and grand multiparas.

Prevalence of Tuberculosis in HIV- or Tuberculosis-exposed neonates at the University Teaching Hospital in Lusaka over a period of six months

Background: Tuberculosis (TB) is the leading cause of mortality globally and represents a major health problem. The burden of TB in Zambia is among the highest in the African region with a national prevalence estimated at 455/100 000 for all age groups. A large proportion of people with TB are in the reproductive age group as such may either be pregnant or have young children. As at 2014 the prevalence of TB among women attending antenatal care in Zambia was estimated to be 1.5% in HIV infected women and 1.4% in uninfected women. There is a close association between maternal TB and HIV infection and postpartum infant morbidity and mortality. TB in neonates is very rare but a tenfold increase in the risk of acquiring TB in infants born to HIV infected mothers has been documented. Methods: A cross sectional study was conducted to establish the prevalence of tuberculosis in neonates exposed to either HIV or TB, or to both TB and HIV. The study included neonates aged 28 days and below that were admitted to the intensive care unit (NICU) and nurseries on general pediatric wards at the University teaching hospital. Mothers to neonates that had a positive rapid HIV test were approached, made aware of the study and invited to participate by giving consent to have their baby included in the study. When consent was granted, basic demographic details and medical information were collected. One gastric lavage sample was collected before the first feed of the day and analysed using Xpert MTB- RIF test. Results: One hundred forty-nine consecutive neonates that met the inclusion criteria were enrolled in the study. The average age of the neonates was nine days, 49 % had mean birth weight of 2.50kg (0.85 SD), 86 full term delivery and 73 (49%) were male. One hundred, ten (110) were born to multiparous (74%) vs 38 primiparous (26%) mothers. All the neonates enrolled in the study were HIV exposed and only one neonate was exposed to both TB and HIV. Mycobacterium tuberculosis was detected in 2 out 149 samples analysed using the Xpert MTB-RIF test. None were positive for rifampicin resistance Conclusion: The prevalence of TB using Xpert MTB-RIF test performed on gastric aspirates of HIV exposed neonates admitted to the University teaching hospital is 1.3 %.

Perinatal Outcome in High-Risk &amp; Severe-Risk Pregnancy- A Study in a Tertiary Care Hospital

Introduction: High-risk &amp; severe-risk pregnancies are characterized by increased risks of complications for both the mother and the fetus, which can result from several factors such as maternal age, medical situations, lifestyle habits, and previous pregnancies. These complications are a major concern, mostly in developing countries like Bangladesh, where maternal and infant mortality rates remain high. Maternal complications associated with high-risk and severe-risk pregnancies may include maternal death, severe bleeding, sepsis, and hypertensive disorders, while fetal complications may include preterm delivery, fetal growth restriction, and stillbirth. The objective of this study was to investigate the perinatal outcomes of high-risk and severe-risk pregnancies. Methods: This prospective purposive study was carried out on the admitted patients in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2007 to December 2007. Total hundreds of risk groups pregnant women (N=100) were enrolled in the study among them eighty-five (n=85) scoring 3-6 included as high risk pregnancy and fifteen (n=15) scoring 7 or more included as severe-risk pregnancy. All relevant data were recorded for each individual study subject on predesigned data collection sheet. All collected data were compiled and analyzed by computer-based statistical software (Instat). Chi-square tests were performed to compare the prevalence of study variables where, p &lt; 0.05 considered the level of significance with 95%CI. Ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: In the high-risk group (n=85), around one-fourth of the patients (22,25.9%) and in a severe- risk group (n=15), one patient (1,6.7%) underwent vaginal delivery, Caesarean section was done in sixty-three patients (63,74.1%) in high-risk pregnant women and fourteen patients (14,93.3%) in severe-risk pregnant women respectively. The distribution of risk group and mode of delivery is statistically highly significant (P &lt;0.001). Out of sixty-three patients (n1=63), nineteen (19, 30.2%) were required to be delivered by caesarean section for fetal distress and fifteen (15, 30.16%) were malpresentation. Out of forty-one patients (n2=14), the most common indications were a history of previous caesarean section with multiple risk factors in eight patients (8, 57.1%). Birth asphyxia was present in nine neonates (9, 13.6%) in a high-risk group (n = 65) and a severe- risk group (n2=14), and birth asphyxia was present in five neonates (5, 35.7%). Based on the outcome, in high-risk pregnancy (n=85), four neonates (4, 4.5%) died and in severe-risk pregnancy (n=15), one (1, 6.3%) died. Conclusion: The study found various obstetric complications and outcomes associated with high-risk and severe-risk pregnancies. The results indicated a significantly higher proportion of caesarean sections performed in severe-risk pregnancies compared to high-risk pregnancies. Moreover, the overall outcome was favorable, with only five neonatal deaths reported among the one hundred maternal risk groups.

Assistance to postpartum mothers using the Home Care method on Personal Hygiene and Breast Care in Kebun Hamlet and Congaban Hamlet, Samiran Village, Proppo Subdistrict, Pamekasan Regency

Postpartum infections are one of the leading causes of maternal mortality in developing countries. Personal hygiene in postpartum mothers is very important so that they are not vulnerable to infection. This service activity has a direction to improve skills in maintaining personal hygiene and performing breast self-care in postpartum women with the target of activities being a group of postpartum women in the garden hamlet and congaban hamlet of Samiran village, Proppo sub-district, Pamekasan district. The method used is by providing assistance to postpartum women door to door about personal hygiene and breast care. The results obtained are that after home care assistance, postpartum women understand the causes, signs and symptoms and prevention of postpartum infections through good personal hygiene and proper breast care. From counseling activities on personal hygiene and breast care in postpartum mothers, it is very useful, especially for mothers who have children for the first time (primipara). The delivery of material and demonstrating breast care is very influential in improving midwifery care services for postpartum women. Counseling on personal hygiene and breast care by health workers is very useful to increase the knowledge and skills of postpartum women in performing personal hygiene and breast care independently after childbirth.

Managing Maternal Sepsis after Delivering an Advanced Abdominal Pregnancy in Low Resource Setting Health Facility

Background: Abdominal pregnancy is a rare form of ectopic pregnancy with a higher misdiagnosis rate. Sepsis is a life-threatening complication associated with this type of ectopic pregnancy. Various techniques for managing septic advanced abdominal pregnancy have been discussed in the literature. In this article, we report a case of managing septic abdominal pregnancy in which a macerated baby was delivered, and the necrotic placenta was left in situ. Case presentation: We report a 34-year-old African woman, para 5 living 4, who was three days post laparotomy due to abdominal pregnancy. A re-laparotomy was done due to maternal sepsis. The peritoneum had foul-smelling pus, with a necrotized placenta which was still attached to various parts of the abdomen. The placenta was left in situ and the abdomen was left open. Pus swab revealed methicillin-resistant staphylococcus aureus which was sensitive to Vancomycin. She was managed with a ten-day Vancomycin regime. Dressing with normal saline and honey twice or thrice a day for eight weeks was done. Secondary suturing was done and the patient was discharged home later in good health. Conclusion: Advanced abdominal pregnancy is a rare condition, and its management is very challenging. Once it complicates into maternal sepsis the life of the mother becomes endangered. Identifying and treating the source of infection with daily dressing using normal saline and honey is simple and cheap, it saves life.

Gastroschisis Associated Intestinal Dysmotility: What Can We Do?

The cause of gastroschisis is not fully known, but risk factors like prenatal tobacco exposure, maternal infection and maternal drug use are often associated. When gastroschisis occurs with intestinal dysmotility, the enteric interstitial cells of Cajal (ICC) implicate the dysmotility and may ultimately impact the growth of an infant. Furthermore, neonates experience growth weight failure when not taking any enteral feedings secondary to dysmotility. We had a case of an infant with gastroschisis and intestinal atresia who had a prolonged course of feeding intolerance and abdominal distention after his bowel resection. His growth was preserved because of careful management of total parenteral nutrition (TPN) via a judicious nutrition plan.

Risk Factors, Trends, and Outcomes Associated With Postpartum Sepsis Readmissions.

To evaluate the prevalence, timing, clinical risk factors, and adverse outcomes associated with postpartum readmissions for maternal sepsis. We conducted a retrospective cohort study of delivery hospitalizations and 60-day postpartum readmissions for females aged 15-54 years with and without sepsis using the 2016-2020 Nationwide Readmissions Database. Temporal trends in sepsis diagnoses during delivery hospitalizations and 60-day postpartum readmissions were analyzed with the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% CIs. Logistic regression models were fit to determine whether delivery hospitalization characteristics were associated with postpartum sepsis readmissions, and unadjusted and adjusted odds ratios with 95% CIs were reported. Adverse outcomes associated with sepsis during delivery hospitalization and readmission were described, including death, severe morbidity, a critical care composite, and renal failure. Overall, 15,268,190 delivery hospitalizations and 256,216 associated 60-day readmissions were included after population weighting, of which 16,399 (1.1/1,000 delivery hospitalizations) had an associated diagnosis of sepsis at delivery, and 20,130 (1.3/1,000 delivery hospitalizations) had an associated diagnosis of sepsis with postpartum readmission. A sepsis diagnosis was present in 7.9% of all postpartum readmissions. Characteristics associated with postpartum sepsis readmission included younger age at delivery, Medicaid insurance, lowest median ZIP code income quartile, and chronic medical conditions such as obesity, pregestational diabetes, and chronic hypertension. Postpartum sepsis readmissions were associated with infection during the delivery hospitalization, including intra-amniotic infection or endometritis, wound infection, and delivery sepsis. Sepsis diagnoses were associated with 24.4% of maternal deaths at delivery and 38.4% postpartum, 2.2% cases of nontransfusion severe morbidity excluding sepsis at delivery and 13.6% postpartum, 15.6% of critical care composite diagnoses at delivery and 30.1% postpartum, and 11.1% of acute renal failure diagnoses at delivery and 36.4% postpartum. Sepsis accounts for a significant proportion of postpartum readmissions and is a major contributor to adverse outcomes during delivery hospitalizations and postpartum readmissions.

Effect of mentorship and a mHealth application in updating provider skills and knowledge in maternal and newborn care in two informal settlements of Nairobi

BackgroundChildren and women in urban informal settlements have fewer choices to access quality maternal and newborn health care. Many facilities serving these communities are under-resourced and staffed by fewer providers with limited access to skills updates. We sought to increase provider capacity by equipping them with skills to provide general and emergency obstetric and newborn care in 24 facilities serving two informal settlements in Nairobi. We present evidence of the combined effect of mentorship using facility-based mentors who demonstrate skills, support skills drills training, and provide practical feedback to mentees and a self-guided online learning platform with easily accessible EmONC information on providers’ smart phones.MethodsWe used mixed methods research with before and after cross-sectional provider surveys conducted at baseline and end line. During end line, 18 in-depth interviews were conducted with mentors and mentees who were exposed, and providers not exposed to the intervention to explore effectiveness and experience of the intervention on quality maternal health services.ResultsResults illustrated marked improvement from ability to identify antepartum hemorrhage (APH), postpartum hemorrhage (PPH), manage retained placenta, ability to identify and manage obstructed labour, Pre-Eclampsia and Eclampsia (PE/E), puerperal sepsis, and actions taken to manage conditions when they present. Overall, out of 95 elements examined there were statistically significant improvements of both individual scores and overall scores from 29/95 at baseline (30.5%) to 44.3/95 (46.6%) during end line representing a 16- percentage point increase (p > 0.001). These improvements were evident in public health facilities representing a 17.3% point increase (from 30.9% at baseline to 48.2% at end line, p > 0.001). Similarly, providers working in private facilities exhibited a 15.8% point increase in knowledge from 29.7% at baseline to 45.5% at end line (p = 0.0001).ConclusionThis study adds to the literature on building capacity of providers delivering Maternal and Newborn Health (MNH) services to women in informal settlements. The complex challenges of delivering MNH services in informal urban settings where communities have limited access require a comprehensive approach including ensuring access to supplies and basic equipment. Nevertheless, the combined effects of the self-guided online platform and mentorship reinforces EmONC knowledge and skills. This combined approach is more likely to improve provider competency, and skills as well as improving maternal and newborn health outcomes.

Two-Dose Ceftiofur Treatment Increases Cephamycinase Gene Quantities and Fecal Microbiome Diversity in Dairy Cows Diagnosed with Metritis.

Antimicrobial resistance is a significant concern worldwide; meanwhile, the impact of 3rd generation cephalosporin (3GC) antibiotics on the microbial communities of cattle and resistance within these communities is largely unknown. The objectives of this study were to determine the effects of two-dose ceftiofur crystalline-free acid (2-CCFA) treatment on the fecal microbiota and on the quantities of second-and third-generation cephalosporin, fluoroquinolone, and macrolide resistance genes in Holstein-Friesian dairy cows in the southwestern United States. Across three dairy farms, 124 matched pairs of cows were enrolled in a longitudinal study. Following the product label regimen, CCFA was administered on days 0 and 3 to cows diagnosed with postpartum metritis. Healthy cows were pair-matched based on lactation number and calving date. Fecal samples were collected on days 0, 6, and 16 and pooled in groups of 4 (n = 192) by farm, day, and treatment group for community DNA extraction. The characterization of community DNA included real-time PCR (qPCR) to quantify the following antibiotic resistance genes: blaCMY-2, blaCTX-M, mphA, qnrB19, and the highly conserved 16S rRNA back-calculated to gene copies per gram of feces. Additionally, 16S rRNA amplicon sequencing and metagenomics analyses were used to determine differences in bacterial community composition by treatment, day, and farm. Overall, blaCMY-2 gene copies per gram of feces increased significantly (p ≤ 0.05) in the treated group compared to the untreated group on day 6 and remained elevated on day 16. However, blaCTX-M, mphA, and qnrB19 gene quantities did not differ significantly (p ≥ 0.05) between treatment groups, days, or farms, suggesting a cephamycinase-specific enhancement in cows on these farms. Perhaps unexpectedly, 16S rRNA amplicon metagenomic analyses showed that the fecal bacterial communities from treated animals on day 6 had significantly greater (p ≤ 0.05) alpha and beta diversity than the untreated group. Two-dose ceftiofur treatment in dairy cows with metritis elevates cephamycinase gene quantities among all fecal bacteria while paradoxically increasing microbial diversity.

Abstract 12660: Outcomes of Pregnancy-Associated Myocardial Infarction: A Systematic Review and Meta-Analysis

Background: Cardiovascular disease is the leading cause of maternal mortality worldwide. The aim of this systematic review and meta-analysis was to investigate complications associated with Pregnancy-associated myocardial infarction (PAMI), which has been linked to various obstetric and fetal complications. Methods: We included a total of 11 studies which reported complications in women who had myocardial infarction (MI) during pregnancy. Our outcomes included maternal mortality, postpartum hemorrhage, postpartum infection, preterm labor, eclampsia and pre-eclampsia. Analysis was performed to calculate the pooled proportions. Data was pooled as mean differences or risk ratio and 95% confidence interval (CI) was used. Results: Mortality was reported in 7.6% of women who had MI with effect estimate 0.189, 95% CI [0.113, 0.266] (Fig 1a). Incidence of postpartum hemorrhage was reported in 13% of women with effect estimate 0.143, 95% CI [0.060, 0.226] (Fig 1b) and postpartum infection was reported in 15.1% with effect estimate 0.269, 95% CI [0.030, 0.507]. Incidence of eclampsia and pre-eclampsia was reported in 10.98% with effect estimate 0.213, 95% CI [0.125, 0.301] (Fig 2a). Incidence of pre-term labor was reported in 12.87% with effect estimate 0.313, 95% CI [0.116, 0.510] (Fig 2b). Conclusion: Our study demonstrated that PAMI was associated with higher rates of major obstetric complications including maternal mortality, postpartum hemorrhage, pre-term labor, pre-eclampsia, eclampsia and postpartum infection.

Abstract 12699: Impact of Mode of Delivery on Maternal and Fetal Outcomes in Pregnant Patients With Heart Failure or Pulmonary Hypertension

Introduction: Despite the existing guidelines, data on maternal, fetal, and obstetric outcomes associated with various modes of delivery in pregnant patients with heart failure (HF) or severe pulmonary hypertension (pHTN) is limited. Methods: This retrospective population based cohort study used Nationwide Readmission Database to identify all hospitalized pregnant patients who were primarily admitted for vaginal or cesarean delivery from 2011 to 2019. Pregnant patients with HF or pHTN were identified. Primary outcomes were inhospital maternal and fetal mortality. Result: 23,359 hospitalized pregnant patients with HF or pHTN were identified. Cesarean deliveries were performed more than vaginal deliveries (66.2% vs. 33.8%). Patients undergoing cesarean delivery had lower odds of fetal mortality [OR: 0.18 (0.07-0.45), p&lt;0.001] and postpartum hemorrhage than vaginal delivery. However, the odds of in-hospital maternal mortality [OR: 2.0 (1.07-3.77), p=0.03], ACS, and puerperal sepsis were higher in cesarean group than in vaginal delivery group. There were no differences in the odds of in-hospital stroke and DVT/PE between two groups. We found that 167 pregnant women would have to undergo cesarean delivery to have one inhospital maternal mortality (NNH=167), and 164 pregnant women would have to undergo cesarean delivery to prevent one fetal mortality (NNT=164). There were increased odds of all-cause readmissions within 6 months in patients who had cesarean delivery compared with those who had vaginal deliveries. There was no difference in risk of acute exacerbation of HF, readmission mortality, ACS, stroke, and DVT/PE between two groups at 6 months. Conclusion: In this retrospective multicentric cohort study, cesarean delivery was associated with lower fetal mortality but higher inhospital maternal mortality. Thus, unique features of each patient case should be considered via a multidisciplinary discussion before determining a preferred delivery method.