Uricult trio as a screening test for bacteriuria in pregnancy.

OBJECTIVE: To establish the effectiveness in an indigent urban population of Uricult Trio as a screening test for asymptomatic bacteriuria in pregnancy and in diagnosing urinary tract infections (UTI) in symptomatic pregnant women. Likelihood ratios were established for positive and negative Uricult Trio test results. SUBJECTS: Two populations of patients from the Pretoria region were involved: (i) asymptomatic pregnant women attending the antenatal clinic for the first time or presenting in labour; and (ii) pregnant women with symptoms suggestive of UTI. METHOD: A midstream urine specimen was collected from the two populations of patients, plated onto the Uricult Trio and sent to the laboratory for culture. RESULTS: The prevalence of asymptomatic bacteriuria in this population was 23%, and for women with symptoms suggestive of UTI, 29%. The likelihood ratios for a positive test were 1.8 and 1.5 for asymptomatic and symptomatic patients respectively. The likelihood ratios for a negative test were 0.35 and 0.44 for asymptomatic and symptomatic patients respectively. Escherichia coli was the causative agent in 36% of cases. CONCLUSION: Uricult Trio is not effective as a screening test for asymptomatic bacteriuria in pregnancy or for diagnosing UTIs in women with symptoms suggestive of infection.     

Comparison of point-of-care versus laboratory-based CD4 cell enumeration in HIV-positive pregnant women

Introduction

Early initiation of antiretroviral therapy (ART) in eligible pregnant women is a key intervention for prevention of mother-to-child transmission (PMTCT) of HIV. However, in many settings in sub-Saharan Africa where ART-eligibility is determined by CD4 cell counts, limited access to laboratories presents a significant barrier to rapid ART initiation. Point-of-care (POC) CD4 cell count testing has been suggested as one approach to overcome this challenge, but there are few data on the agreement between POC CD4 cell enumeration and standard laboratory-based testing.

Methods

Working in a large antenatal clinic in Cape Town, South Africa, we compared POC CD4 cell enumeration (using the Alere Pima^TM Analyzer) to laboratory-based flow cytometry in consecutive HIV-positive pregnant women. Bland–Altman methods were used to compare the two methods, including analyses by subgroups of participant gestational age.

Results

Among the 521 women participating, the median gestational age was 23 weeks, and the median CD4 cell count according to POC and laboratory-based methods was 388 and 402 cells/µL, respectively. On average, the Pima POC test underestimated CD4 cell count relative to flow cytometry: the mean difference (laboratory test minus Pima POC) was 22.7 cells/µL (95% CI, 16.1 to 29.2), and the limits of agreement were −129.2 to 174.6 cells/µL. When analysed by gestational age categories, there was a trend towards increasing differences between laboratory and POC testing with increasing gestational age; in women more than 36 weeks’ gestation, the mean difference was 45.0 cells/µL (p=0.04).

Discussion

These data suggest reasonable overall agreement between Pima POC CD4 testing and laboratory-based flow cytometry among HIV-positive pregnant women. The finding for decreasing agreement with increasing gestational age requires further investigation, as does the operational role of POC CD4 testing to increase access to ART within PMTCT programmes.     

妊娠期尿路感染相关因素及临床防治

目的了解妊娠期尿路感染的危险因素、主要病原菌及敏感抗生素,以提高诊治水平。方法选取2008年1月至2014年1月在我院住院的106例妊娠合并尿路感染患者,并选取产科门诊进行产前检查的无尿路感染的孕妇126例进行回顾性研究。结果年龄、孕周、糖尿病、既往尿路感染、泌尿系结石、贫血、流产是妊娠期尿路感染的高危因素,文化程度与妊娠期的尿路感染相关。妊娠期尿路感染病原菌以大肠埃希菌为主（占60．3％）。革兰阴性杆菌对青霉素类及喹诺酮类抗生素耐药率高,对头孢呋辛、头孢唑林、头孢他啶、头孢哌酮、头孢吡肟、亚胺培南、呋哺妥因敏感。革兰阳性球菌对半合成青霉素、喹诺酮类耐药率较高,对头孢呋辛、头孢唑林、头孢他啶、头孢哌酮、头孢吡肟、亚胺培南、呋喃妥因敏感。结论应注意妊娠期尿路感染的高危因素,加强孕期尿液检查及中段尿培养检查,选用敏感、合理的抗菌素治疗。     

自然妊娠早孕期孕酮水平及其检测价值的研究

目的探讨自然妊娠早孕期孕酮水平及其检测价值。方法前瞻性收集2015年7月至2015年12月在本医院产科就诊的妇女,排除辅助生育、双胎多胎妊娠、复发性流产、使用孕激素药物的女性。于孕4~10周采血测定血清孕酮水平,并随访妊娠结局。妊娠超过12周、可见胎心搏动为妊娠成功组,其余为妊娠失败组。结果平均采血孕周为(5.9±1.4)周。妊娠成功组137例,早孕期血清孕酮水平呈正态分布,血清孕酮平均值为(77.3±24.4)nmol/L,第5百分位数为37nmol/L,第95百分位数为126.5nmol/L。孕酮水平与孕周、母亲年龄无关。该组15例先兆流产患者的血清孕酮值与无症状者无显著性差异(P0.05)。妊娠失败组14例,血清孕酮平均值为(53.6±16.5)nmol/L,显著低于妊娠成功组(P=0.000,F=12.784)。结论早孕期孕酮水平波动范围大,难以通过单一孕酮水平预测妊娠结局。     

Maternal and fetal outcomes of spontaneous preterm premature rupture of membranes

The authors retrospectively evaluated maternal and fetal outcomes of 73 consecutive singleton pregnancies complicated by preterm premature rupture of amniotic membranes. When preterm labor occurred and fetuses were at a viable gestational age, pregnant patients were managed aggressively with tocolytic therapy, antenatal corticosteroid injections, and antenatal fetal testing. The mean gestational age at the onset of membrane rupture and delivery was 22.1 weeks and 23.8 weeks, respectively. The latency from membrane rupture to delivery ranged from 0 to 83 days with a mean of 8.6 days. Among the 73 pregnant patients, there were 22 (30.1%) stillbirths and 13 (17.8%) neonatal deaths, resulting in a perinatal death rate of 47.9%. The perinatal survival rate based on gestational age at the onset of fetal membrane rupture was 12.1% at less than 23 weeks of gestation, 60% at 23 weeks, and 100% at 24 to 26 weeks. Maternal morbidity was minimal with puerperal endomyometritis in 5 (6.8%) cases, one of which became septic; however, there was no long-term sequela. Eight (15.7%) liveborn infants had pulmonary hypoplasia, 5 (62.5%) of which resulted in neonatal death. In 33 (45.2%) patients, amniotic membranes ruptured before 23 weeks of gestation. At previable gestational age, the risk of neonatal pulmonary hypoplasia appears to be primarily dependent on gestational age at the onset of premature rupture of membrane rather than gestational age at delivery. Pregnancy outcomes remain dismal when the fetal membrane ruptures before 23 weeks of gestation.     

Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study

Introduction

Recent international guidelines call for expanded access to triple-drug antiretroviral therapy (ART) in HIV-positive women during pregnancy and postpartum. However, high levels of non-adherence and/or disengagement from care may attenuate the benefits of ART for HIV transmission and maternal health. We examined the frequency and predictors of disengagement from care among women initiating ART during pregnancy in Cape Town, South Africa.

Methods

We used routine medical records to follow-up pregnant women initiating ART within prevention of mother-to-child transmission of HIV services in Cape Town, South Africa. Outcomes assessed through six months postpartum were (1) disengagement (no attendance within 56 days of a scheduled visit) and (2) missed visits (returning to care 14–56 days late for a scheduled visit).

Results

A total of 358 women (median age, 28 years; median gestational age, 26 weeks) initiated ART during pregnancy. By six months postpartum, 24% of women (n=86) had missed at least one visit and an additional 32% (n=115) had disengaged from care; together, 49% of women had either missed a visit or had disengaged by six months postpartum. Disengagement was more than twice as frequent postpartum compared to in the antenatal period (6.2 vs. 2.4 per 100 woman-months, respectively; p<0.0001). In a proportional hazards model, later gestational age at initiation (HR: 1.04; 95% CI: 1.00–1.07; p=0.030) and being newly diagnosed with HIV (HR: 1.57; 95% CI: 1.07–2.33; p=0.022) were significant predictors of disengagement after adjusting for patient age, starting CD4 cell count and site of ART initiation.

Conclusions

These results demonstrate that missed visits and disengagement from care occur frequently, particularly post-delivery, among HIV-positive women initiating ART during pregnancy. Women who are newly diagnosed with HIV may be particularly vulnerable and there is an urgent need for interventions both to promote retention overall, as well as targeting women newly diagnosed with HIV during pregnancy.     

MICROSCOPIC HAEMATURIA IN PREGNANCY

Objectives to determine (1) the prevalence of microscopic haematuria in pregnancy (2) whether this is a marker for adverse pregnancy outcome, and (3) whether this persists post‐partum. Methods 951 women attending the antenatal clinic were enrolled in a prospective study of urinalysis and urine microscopy in pregnancy. Urinalysis was performed using an automated device on a carefully collected midstream urine sample at each antenatal visit. After initial or de novo dipstick microscopic haematuria was confirmed at a second antenatal visit, urine infection was excluded by urine culture. In the absence of infection women were referred for assessment by one of two nephrologists, including repeat urinalysis, urine microscopy and measurement of antinuclear antibody, serum creatinine and renal ultrasound. Women were followed up at delivery and three months post‐partum. Results 106 (11%) women were referred for haematuria. 56% had only a trace of haematuria and 16% had associated proteinuria. All were normotensive at referral. At nephrologist assessment haematuria persisted in 79% of women, 56% being a trace only and 54% having dysmorphic haematuria. Creatinine was normal (≤ 0.08 mmol/L) in all cases, as was ANA. One ultrasound revealed asymptomatic renal calculi but no other abnormalities were found. To date 30 women have delivered, 4 with hypertensive complications (13%). Conclusion Microscopic haematuria is a common occurrence in pregnancy but is generally mild and does not appear to be associated with an increased incidence of adverse pregnancy outcomes. Further data will determine whether assessment of such women can be left until persistent post‐partum haematuria is documented.     

Laparoscopic appendectomy in pregnancy

BACKGROUND: Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. METHODS: Between January 2001 and August 2004, 1235 patients with clinically suspected appendicitis underwent laparoscopic surgery at our hospital. Eleven patients (0.9%) were pregnant women (mean age, 25 years; age range, 19-37 years; range of gestational age, 4-30 weeks). Clinical data collected retrospectively included demographic information; preoperative, procedural, and postoperative information; and outcome of the pregnancy. RESULTS: All 11 pregnant women underwent laparoscopic surgery without need of conversion. Ten patients underwent LA and were found to have acute appendicitis on histologic analysis. One patient had torsion of the right fallopian tube and a healthy-looking appendix; she underwent detorsion of the fallopian tube and incidental appendectomy. Mean operative time was 50.5 minutes (range, 20-135 minutes). Length of postoperative hospital stay averaged 4.2 days (range, 1-11 days). One patient had a surgical wound infection, which was managed conservatively. Mean follow-up period was 14 months (range, 2-46 months). Seven pregnant women delivered healthy term infants, 2 had planned abortions, and 1 experienced fetal loss due to uterine infection and premature contractions 1 month after LA. Another patient had normal results at prenatal examination. CONCLUSION: Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.     

Operative laparoscopy in pregnancy.

OBJECTIVE: We compared the surgical outcomes of pregnant women undergoing laparotomy in the first 2 trimesters of pregnancy with those undergoing laparoscopy for the management of acute pelvic pain. METHODS: We performed a systematic retrospective chart review of patients whose discharge diagnosis included intrauterine pregnancy with exploratory laparotomy or laparoscopy from August 1, 1993 to October 31, 1999. The following factors were assessed: preoperative diagnosis, postoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complications, and outcome of the pregnancy in both groups. RESULTS: Sixteen pregnant patients underwent surgery during the study period. All but one had abdominopelvic pain, and all patients had an associated adnexal mass. The mean gestation age at the time of surgery was 15+/-6 weeks versus 13+/-4 weeks in the laparoscopic and laparotomy groups, respectively (P=NS). All patients undergoing laparoscopy remained in the hospital for one day compared with a mean of 4.4+/-1.1 days in the laparotomy group (P<0.0001). Pregnancy outcomes were similar and uniformly good. CONCLUSION: Laparotomy can be avoided and pregnant patients managed safely by operative laparoscopy, with shorter hospital stays.     

The posterior pelvic pain provocation test in pregnant women

Summary This study was done to evaluate a new, simple, non-invasive pain provocation test as an aid to differentiate between low-back and posterior pelvic pain in pregnant women. The test was performed on 72 pregnant women at various stages of pregnancy with or without low-back or posterior pelvic pain. The study was conducted by two physiotherapists with special interest in back pain in pregnancy at a normal antenatal clinic. The test was easy to learn, perform and interpret and was applicable throughout pregnancy. There was a strong correlation between a positive test answer and a history of posterior pelvic pain (P < 0.01, chi-square). There were no side-effects. The test was highly specific and had a high positive prediction value for posterior pelvic pain and a high negative prediction value for low-back pain among pregnant women.     

基于问卷调查的孕妇孕期护肤美容知识认知需求情况分析

通过对我院产科门诊产检及住院的孕妇孕期护肤美容知识掌握情况进行调查，为提高 育龄期妇女孕期护肤美容保健知识提供借鉴。方法 使用预先设计好的自填式问卷，对2023年2月-7月 我院产科门诊及产科病房的200例妊娠期女性进行问卷调查。结果 本研究显示孕妇关于孕期护肤美容 知识知晓率低，孕期存在容貌焦虑的孕妇比例极高，认为护肤品对母儿健康可能存在影响的有169例 （84.50%），认为化妆品对母儿健康有可能存在影响的有191例（95.50%），158例孕妇（79.00%）在孕 期将护肤品更换成孕期可用的护肤品，101例孕妇（50.50%）表示孕期不使用化妆品，有166例孕妇表示 对孕期美容知识有需求，这些孕妇最希望得到以科普视频和文章的形式指导。结论 育龄期女性的孕期 护肤知识知晓程度有待提高，应加强对相关知识的宣传，首选的科普途径是互联网媒体，有助于积极缓 解孕期焦虑，加强孕期心理保健。     

孕前站立时间对妊娠并发症影响的调查研究

目的调查研究孕早期的职业站立时间以及长时间站立对妊娠并发症的影响。方法分别对我市妇幼保健院2010年1月-2013年5月间建卡并分娩的460例妊娠妇女怀孕早期、中期和晚期进行相关问卷调查并进行统计学分析。结果（1）孕妇在孕早期的持续站立和坐着的时间均较孕前显著降低，其人群分布在不同年龄、文化程度和经济收入方面具有明显差异（P〈0．05）。（2）孕妇文化程度高是妊娠期高血压的保护因素；孕妇文化程度和家庭经济收入是妊娠贫血的保护因素；年龄较大是妊娠糖尿病的危险因素。（3）妊娠高血压和贫血的发病率与孕妇久坐久站呈正相关。结论孕前久站久坐可增加孕妇病发高血压、糖尿病和贫血的危险。     

Incidence of nevirapine-associated hepatitis in an antenatal clinic.

OBJECTIVE: To describe the incidence, clinical presentation and management of nevirapine-associated hepatitis among antiretroviral-na?ve pregnant women treated with nevirapine-based antiretroviral therapy at a dedicated antenatal antiretroviral clinic. METHODS: Retrospective analysis of pregnant women initiated on nevirapine-based highly active antiretroviral therapy at a dedicated antenatal antiretroviral clinic between July 2004 and December 2006. RESULTS: Three hundred and ninety women were included in the analysis. Median age was 29 (interquartile range (IQR) 26-32) years and median pre-treatment CD4 cell counts was 157 (IQR 104-193) cells/microl. Baseline alanine transaminase (ALT) was elevated in 2.8% of women (11/390). After initiation of nevirapine-based ART 8% (31/390) experienced an ALT elevation. Three of these patients developed clinical hepatitis with jaundice (0.8%, 3/390). The mean and median time to clinical presentation was 5 weeks. Hepatitis resolved following discontinuation of ART. Non-nevirapine regimens were initiated following biochemical and symptomatic improvement; symptoms did not recur. CONCLUSIONS: Among pregnant women, nevirapine-containing ART has a favourable safety profile, with a low incidence of serious hepatic events.     

Sex and the pregnant kidney: does renal allograft gender influence gestational renal adaptation in renal transplant recipients?

BACKGROUND: Animal work indicates that ovarian hormones are important in initiating and maintaining enhanced renal function in pregnant rats and that a renal response resembling pregnancy can be provoked in male rats exposed to pregnancy hormones. Women becoming pregnant following renal transplantation provide an opportunity to compare the functional response of male and female allografts to the gestational endocrine environment. METHODS: This retrospective observational study included 20 renal allograft recipients (age 29.7 +/- 2.4 yrs) (mean +/- SE) who had 22 pregnancies beyond 24 weeks (gestation at delivery 35.5 +/- 0.6 weeks). Donor characteristics, transplant details, renal follow-up data, and information about pregnancy and allograft function were obtained from hospital notes. RESULTS: Thirteen women received male allografts (donor age 30.0 +/- 3.9 years) (mean +/- SEM) and 7 women, female allografts (donor age 45.1 +/- 6.0 years) (P = .04). There were no significant differences between the two groups in maternal recipient age, transplant to pregnancy interval, antenatal complications, pregnancy outcome, or postnatal graft function. Compared to prepregnancy values serum creatinine (SCr) decrements and augmented 24-hour creatinine clearance (CrCl) were observed over the first trimester in both male and female allografts: Delta CrCl from 106.8 +/- 13.2 mL/min to 114.4 +/- 11.4 mL/min (35.6% increase) and 71.8 +/- 7.4 to 89.5 +/- 11.3 mL/min (24.7% increase), respectively, and Delta SCr from 90.1 +/- 5.4 micromol/L to 73.6 +/- 6.6 micromol/L (17.8% decrease) and 99.8 +/- 9.7 micromol/L to 78.0 +/- 5.7 micromol/L (13.5% decrease), respectively. Differences between the two groups did not reach statistical significance. CONCLUSIONS: Donor gender and/or age do not appear to influence the gestational renal response in kidney transplant recipients.     

Effect of bed rest during pregnancy on bone turnover markers in pregnant and postpartum women

OBJECTIVE: The aims of our study were to evaluate the changes in bone turnover markers during pregnancy and puerperium as a longitudinal study and to elucidate the effect of bed rest during pregnancy on bone turnover markers in pregnant and postpartum women. METHODS: The study population comprised 27 Japanese pregnant women aged 23-40 years. All women were recruited for the longitudinal study from the outpatients clinic of the Department of Obstetrics and Gynecology, Tokushima University Hospital. Concentrations of serum bone-specific alkaline phosphatase (BAP), urinary cross-linked type I collagen N-telopeptides (NTx), serum NTx and urinary C-terminal telopeptide of type I collagen (CTx) were measured at 10, 26, 30 and 36 weeks of pregnancy and at 4 days and 1 month postpartum. In addition, we recruited 15 pregnant women (aged 25-35 years) who were treated by bed rest before 30 weeks of pregnancy for threatened premature delivery and compared bone turnover markers in these women with those in 22 normal pregnant women (aged 22-39 years). Concentrations of serum BAP, serum NTx, urinary NTx and urinary CTx were measured at 30 and 34 weeks of pregnancy and at 4 days and 1 month postpartum. RESULTS: In the longitudinal study, serum BAP concentration at 1 month postpartum was significantly higher than that at any stage of pregnancy and that at 4 days postpartum. Urinary concentration of NTx increased gradually during pregnancy and showed a peak at 36 weeks of pregnancy, followed by a decrease in the postpartum period. Serum NTx concentration and urinary CTx concentration showed the same patterns of change as that of urinary NTx concentration. In the comparison study, urinary concentrations of NTx and CTx at 30 and 34 weeks of pregnancy in women with bed rest were significantly (p<0.0001 and p<0.001, respectively) higher than those in normal pregnant women. Serum NTx concentration at 34 weeks of pregnancy in women with bed rest was also significantly (p=0.0029) higher than that in normal pregnant women. Serum BAP concentration at 34 weeks of pregnancy in women with bed rest was significantly (p=0.0038) higher than that in normal pregnant women, and these high levels were maintained during puerperium. Serum BAP concentration at 34 weeks of pregnancy was significantly correlated with duration of bed rest (r=0.767, p=0.0041). CONCLUSION: Immobilization due to bed rest during pregnancy is associated with increases in bone turnover markers in pregnant and postpartum women. Concentrations of bone resorption markers increased rapidly at the start of bed rest, while the concentration of a bone formation marker gradually increased toward puerperium.     

Syphilis in pregnant black women

Serological tests for syphilis (with rapid plasma reagin) were performed in 2 767 women attending the antenatal clinic of King Edward VIII Hospital, Durban, for their first, booking visit. The test was repeated at the 36th week of pregnancy. A total of 152 women (5,5%) were assumed to have syphilis. In addition, 4 (11,8%) of 34 patients who were seronegative at less than 32 weeks of pregnancy had a positive serological test result at 36 weeks.     

Laparoscopic appendectomy in pregnancy

BACKGROUND: Acute appendicitis is the most common cause of an acute abdomen in pregnancy. However, due to the potential fetal risk associated with the CO2-pneumoperitoneum and various operative technical reasons there is still controversy about the role of laparoscopic appendectomy in pregnant women. PATIENTS AND METHODS: Between January 2000 and November 2005, 283 women between 17 and 45 years with suspected appendicitis underwent laparoscopic appendectomy at our institution. Fifteen of these patients (5.3 %) were pregnant at the time of surgery (mean age, 28 years; range, 18-40 years; mean gestational age, 21.9 weeks; range, 14-34 weeks). Perioperative obstetric monitoring included fetal ultrasound, including Doppler sonography and cardiotocography. Clinical data were collected prospectively. Complete follow-up data were available in 14 patients. RESULTS: All 15 patients underwent successful laparoscopic appendectomy. Mean operation time was 53 minutes (range, 30-100 minutes). The histologic appendicitis / appendectomy ratio was 73 %. One patient showed a postoperative pyelonephritis, another a cystitis. Average length of hospital stay was 5.5 days (range, 3-10 days). All fourteen pregnancies with complete follow-up resulted in delivery of healthy infants. The mean gestational age at delivery was 39.6 weeks (range, 35-42 weeks). Two patients (14.3 %) had a preterm delivery at 35 weeks with uncomplicated outcome. One patient underwent caesarean section at 41 weeks after chorioamnionitis. CONCLUSIONS: Laparoscopic appendectomy is a safe and effective method to treat acute appendicitis in pregnant women regardless of the trimester. For the best outcome the operation should be performed in a center where surgeons, perinatologist, obstetricians and anesthesiologists work together as a part of an interdisciplinary team.     

Non-Gynecologic Laparoscopy in Second and Third Trimester Pregnancy: Obstetric Implications

Purpose:

To review the effect of non-gynecologic laparoscopic procedures performed during the second and third trimesters of pregnancy on pregnancy outcome.

Materials and Methods:

A review of the patient log for the antenatal obstetrical unit was used to identify the patients in this series from January 1, 1997 to December 31, 1997. Medical records were then analyzed to identify estimated gestational age at surgery and delivery, type of delivery, use of tocolysis, and complications from surgery.

Results:

Nine patients were identified as having non-gynecologic laparoscopic surgery (without conversion to laparotomy) during the second or third trimester of pregnancy. The median estimated gestational age at surgery was 25 weeks (mean 24 weeks). The most common procedure performed was laparoscopic cholecystectomy (6 patients). Five patients received tocolysis after the initial procedure. All patients delivered at greater than or equal to 37 weeks estimated gestational age (median 38 weeks). No infants were admitted to the neonatal intensive care unit.

Conclusions:

Laparoscopic procedures appear safe in second and third trimester pregnancy. In this study, laparoscopic cholecystectomies were performed as late as 34 weeks estimated gestational age without any adverse effects on pregnancy outcome.     

Acceptability of woman‐delivered HIV self‐testing to the male partner,and additional interventions: a qualitative study of antenatal care participants in Malawi

Introduction : In the era of ambitious HIV targets, novel HIV testing models are required for hard‐to‐reach groups such as men, who remain underserved by existing services. Pregnancy presents a unique opportunity for partners to test for HIV, as many pregnant women will attend antenatal care (ANC). We describe the views of pregnant women and their male partners on HIV self‐test kits that are woman‐delivered, alone or with an additional intervention. Methods : A formative qualitative study to inform the design of a multi‐arm multi‐stage cluster‐randomized trial, comprised of six focus group discussions and 20 in‐depth interviews, was conducted. ANC attendees were purposively sampled on the day of initial clinic visit, while men were recruited after obtaining their contact information from their female partners. Data were analysed using content analysis, and our interpretation is hypothetical as participants were not offered self‐test kits. Results : Providing HIV self‐test kits to pregnant women to deliver to their male partners was highly acceptable to both women and men. Men preferred this approach compared with standard facility‐based testing, as self‐testing fits into their lifestyles which were characterized by extreme day‐to‐day economic pressures, including the need to raise money for food for their household daily. Men and women emphasized the need for careful communication before and after collection of the self‐test kits in order to minimize the potential for intimate partner violence although physical violence was perceived as less likely to occur. Most men stated a preference to first self‐test alone, followed by testing as a couple. Regarding interventions for optimizing linkage following self‐testing, both men and women felt that a fixed financial incentive of approximately USD$2 would increase linkage. However, there were concerns that financial incentives of greater value may lead to multiple pregnancies and lack of child spacing. In this low‐income setting, a lottery incentive was considered overly disappointing for those who receive nothing. Phone call reminders were preferred to short messaging service. Conclusions : Woman‐delivered HIV self‐testing through ANC was acceptable to pregnant women and their male partners. Feedback on additional linkage enablers will be used to alter pre‐planned trial arms.