Factors associated with umbilical artery acidemia in term infants with low Apgar scores at 5 min

Objective

To evaluate predictors of umbilical artery acidemia in term neonates with low Apgar score.

Study design

From a cohort of term singleton deliveries over a 13-year period, we selected neonates with 5-min Apgar score <7. Acidemia was defined as umbilical artery pH < 7.00 or base excess (BE) ≤−12 mmol/L. Three pathogenic processes of neonatal acidemia were evaluated: (1) intrauterine vascular disease, defined as preeclampsia, clinical diagnosis of placental abruption, birth weight <10th centile, or histologic evidence of placental infarction or severe vascular pathology, (2) intrauterine infection, defined as clinical chorioamnionitis, histologic chorioamnionitis, or early neonatal sepsis, and (3) acute intrapartum events, which included cases of cord prolapse, amniotic fluid embolism, uterine rupture, sudden and sustained fetal bradycardia or absence of FHR variability with a previously normal pattern, shoulder dystocia or complicated breech extraction. The associations of such processes with umbilical artery evidence of acidemia were tested using χ², Fisher's exact test, Student's t-test, and logistic regression, with P < 0.05 or odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant.

Results

Among the 27,395 neonates in the cohort, an Apgar score at 5 min <7 was recorded in 94 (0.32%) and it was associated with umbilical artery acidemia in 33 cases. Logistic regression analysis showed that intrauterine vascular disease was independently associated with umbilical cord acidemia (P = 0.035, OR = 3.2, 95% CI = 1.1–9.7) whereas intrauterine infection (OR = 1.1, 95% CI 0.4–3.4) and acute intrapartum events (OR = 2.1 95% CI 0.6–7.0) were not.

Conclusions

Umbilical artery evidence of acidemia is present in 38% of term babies with low Apgar score and it is predominantly associated with chronic antepartum vascular disease. Neither intrauterine infection nor acute intrapartum events are significantly associated with umbilical artery acidemia.     

Prevalence of Human Papillomavirus in endometrial cancer: A systematic review and meta-analysis

Objective

HPV is a common sexually transmitted infection and is considered to be a necessary cause of cervical cancer. The anatomical proximity to the cervix has led researchers to investigate whether Human Papillomavirus (HPV) has a role in the etiology of endometrial cancer.

Methods

We conducted a systematic review and meta-analysis to investigate the pooled prevalence of HPV DNA in endometrial cancer. Using meta-regression, we further analyzed whether factors such as geographical region, HPV DNA detection method, publication year and tissue type were associated with HPV prevalence. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for studies providing data on HPV prevalence in cases with endometrial cancer and in controls with normal or hyperplastic endometrial tissue.

Results

We identified 28 papers (29 studies) examining the prevalence of HPV DNA in tumor tissue from endometrial cancer comprising altogether 1026 cases of endometrial cancer. The HPV prevalence varied considerably from 0% to 61.1%. From the random effects meta-analysis, the pooled prevalence of HPV DNA in endometrial cancer was 10.0% (95% CI: 5.2–16.2) with large between-study heterogeneity (I² = 88.2%, p < 0.0001). The meta-regression showed that HPV DNA detection method was statistically significantly associated with HPV prevalence (p = 0.0016): the pooled HPV prevalence was 6.0% (95% CI: 1.5–13.0) using general primers, 18.9% (95% CI: 8.6–32.1) using type-specific primers and 1.0% (95% CI: 0.0–3.6) using non-PCR based methods. None of the other a priori defined variables were statistically significantly associated with HPV prevalence. The pooled OR was 1.43 (95% CI: 0.68–3.00) indicating that the odds of HPV was not increased in cases versus controls.

Conclusions

HPV appears to have a limited or no role in the etiology of endometrial cancer.     

Risk factors for severe perineal lacerations during childbirth

Background

Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life.

Objectives

To identify factors that lead to the occurrence of severe perineal lacerations.

Search strategy

We searched MEDLINE, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies.

Selection criteria

We included prospective and retrospective observational studies.

Data collection and analysis

Predetermined data were collected and analyzed with the Mantel–Haenszel fixed-effects model or the DerSimonian–Laird random-effects model.

Main results

The meta-analysis included 22 studies (n = 651 934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g [95% CI, 139.80–245.96 g]), an episiotomy (OR 3.82 [95% CI, 1.96–7.42]), or an operative vaginal delivery (OR 5.10 [95% CI, 3.33–7.83]). Epidural anesthesia (OR 1.95 [95% CI, 1.63–2.32]), labor induction (OR 1.08 [95% CI, 1.02–1.14]), and labor augmentation (OR 1.95 [95% CI, 1.56–2.44]) were also more common among women with perineal lacerations.

Conclusions

Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation.     

Impact of sickle cell disease and thalassemias in infants on birth outcomes

Objective

The contribution of sickle cell disease (SCD) and other common thalassemias in infants to adverse birth outcomes is under-studied. We therefore sought to compare adverse birth outcomes in infants with and without hemoglobinopathy.

Study design

Retrospective cohort study utilizing a population-based dataset from Florida (1998–2007, n = 1,564,038). The primary outcomes were low birthweight (LBW), very low birthweight (VLBW), preterm birth (PTB), very preterm birth (VPTB) and small for gestational age (SGA). We used propensity scores to match infants with hemoglobinopathy to those without hemoglobinopathy on selected variables. To approximate relative risks, we generated adjusted odds ratios (AOR) and 95% confidence intervals (CI) from logistic regression models and accounted for the matched design using generalized estimating equations framework.

Results

Infants with SCD or thalassemia had a heightened risk for LBW (AOR = 1.58, 95% CI: 1.29–1.93), VLBW (AOR = 3.01, 95% CI: 2.12–4.25), PTB (AOR = 1.36, 95% CI: 1.12–1.65), VPTB (AOR = 2.70, 95% CI: 1.93–3.78), and neurological conditions (AOR = 2.04, 95% CI: 1.48–2.81) compared to infants without hemoglobinopathy.

Conclusion

Infants with SCD or thalassemia experience considerably higher risks for multiple infant morbidities. Our findings are potentially important in prenatal counseling, as well as for targeted care of affected pregnancies in the prenatal period.     

Promoters of and barriers to cervical cancer screening in a rural setting in Tanzania

Objective

To investigate promoters and barriers for cervical cancer screening in rural Tanzania.

Methods

We interviewed 300 women of reproductive age living in Kiwangwa village, Tanzania. The odds of attending a free, 2-day screening service were compared with sociodemographic variables, lifestyle factors, and knowledge and attitudes surrounding cervical cancer using multivariable logistic regression.

Results

Compared with women who did not attend the screening service (n = 195), women who attended (n = 105) were older (OR 4.29; 95% CI, 1.61–11.48, age 40–49 years versus 20–29 years), listened regularly to the radio (OR 24.76; 95% CI, 11.49–53.33, listened to radio 1–3 times per week versus not at all), had a poorer quality of life (OR 4.91; CI, 1.96–12.32, lowest versus highest score), had faced cost barriers to obtaining health care in the preceding year (OR 2.24; 95% CI, 1.11–4.53, yes versus no), and held a more positive attitude toward cervical cancer screening (OR 4.64; 95% CI, 1.39–15.55, least versus most averse).

Conclusion

Efforts aimed at improving screening rates in rural Tanzania need to address both structural and individual-level barriers, including knowledge and awareness of cervical cancer prevention, cost barriers to care, and access to health information.     

A preliminary study of the relationship between the long arm of the Y chromosome (Yqh+) and reproductive outcomes in IVF/ICSI-ET

Objective

To compare the reproductive outcomes of Yqh+-carrying and control couples undergoing IVF/ICSI treatments.

Study design

Retrospective analysis of 72 Yqh+ carriers and 986 Yqh+ non-carriers undergoing their first cycle of ART in a single centre between August 2005 and May 2011.

Results

Yqh+ carrying couples had significantly worse reproductive outcomes compared with control couples undergoing IVF treatment. There were a significantly higher cancellation rate (20.69% vs 7.9%; P < 0.05; OR, 3.03; CI, 1.18–7.79) and a significant lower fertilisation rate (50.05% vs 66.01%; P < 0.05; OR, 0.61; CI, 0.49–0.57), implantation rate (8.33% vs 20.87%; P < 0.05; OR, 0.35; CI, 0.14–0.87), good quality embryo ratio (44.70% vs 57.89%; P < 0.05; OR, 0.59; CI, 0.43–0.80) and clinical pregnancy rate (17.39% vs 39.59%; P < 0.05; OR, 0.32; CI, 0.11–0.96) in Yqh+ group compared with control group undergoing IVF treatment. Yqh+ carrying couples had similar reproductive outcomes compared with control couples undergoing ICSI treatment.

Conclusions

The Y chromosome polymorphic variant Yqh+ most likely plays a role in infertility. Yqh+ couples with poor reproductive outcomes in IVF treatment can be advised to undergo ICSI to improve their reproductive results in the next cycle.     

Pregnancy outcomes of expectant management of stable mild to moderate chronic hypertension as compared with planned delivery

Objective

To compare outcomes between elective delivery at 37 weeks of pregnancy and expectant management among pregnant women with mild to moderate chronic hypertension.

Methods

In a two-center study, 76 women with mild to moderate chronic hypertension were randomly allocated to planned delivery at 37 completed weeks (group A) or expectant management for spontaneous onset of labor or reaching 41 weeks (group B) between April 2012 and October 2013. Differences were compared by t test, χ² test, or Fisher exact test. Odds ratios (ORs) with 95% confidence interval (CIs) were determined.

Results

There were no differences in superimposed pre-eclampsia (SPE), severe hypertension, preterm delivery, placental abruption, oligohydramnios, intrauterine growth restriction, or perinatal mortality between the groups. Group B had higher gestational age at delivery (P = 0.001) and birth weight (P = 0.01), but lower cesarean (OR 3.4; 95% CI, 1.2–10.3; P = 0.03) and neonatal care unit admission (OR 5.4; 95% CI, 1.4–21.0; P = 0.01) rates. More women with SPE were diagnosed before than after 37 weeks in group B (P = 0.01). Overall, patients who developed SPE had more adverse pregnancy outcomes than those who did not.

Conclusion

Mild to moderate chronic hypertension could be managed expectantly up to 41 weeks if SPE did not develop.     

Maternal and neonatal outcomes following additional doses of vaginal prostaglandin E2 for induction of labour: a retrospective cohort study

Objective

To assess maternal and neonatal outcomes following the use of additional doses of vaginal prostaglandins (PGE2) above the recommended dose for induction of labour in post-dates pregnancies.

Study design

Retrospective cohort study set in Aberdeen Maternity Hospital, Aberdeen, UK. A total of 3514 nulliparous women with labour induced with vaginal PGE2 (3 mg tablet or 2 mg gel) for a post-dates singleton pregnancy from January 1994 to December 2009 were included. Women receiving ≤ 2 doses of PGE2 were compared with those receiving > 2 doses (maximum 5 doses). Binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Primary outcomes included mode of delivery, terbutaline use, indication for CS, postpartum haemorrhage, neonatal unit admission, and Apgar score < 7. A further analysis was conducted which stratified for number of doses of PGE2 given.

Results

Of the 3514 women who met inclusion criteria, 605 (17%) received PGE2 that exceeded the licensed dose. They were more likely to deliver by caesarean section (53.4% vs. 31.8%, OR 2.2, 95% CI 1.8–2.6), have a caesarean section for ‘failed’ induction of labour (11.4% vs. 1.9%, OR 4.1, 95% CI 1.3–13.2) or lack of progress in labour (37% vs. 17%, OR 2.8, 95% CI 2.3–3.4), but not for fetal concerns (8.2% vs. 8.8% OR 0.9, 95% CI 0.7–1.3). Terbutaline use and postpartum haemorrhage was no more likely (0.7% vs. 0.9% OR 0.6 95% CI 0.3–1.5 and 19.8% vs. 18.9% OR1.01, 95% CI 0.97–1.06 respectively). Apgar score < 7 (1.1% vs. 1.3% OR 0.9 95% CI 0.8–1.1) and neonatal unit admission (13.7% vs. 10.7% OR 1.2 95% CI 0.8–1.6) were similar in both groups.

Conclusion

The use of additional doses of vaginal PGE2 above the recommended dose for induction of labour was not associated with increased maternal or neonatal morbidity and almost half of these women achieved a vaginal delivery.     

Genetic polymorphisms in DNA repair gene APE1, XRCC1 and XPD and the risk of pre-eclampsia

Objective

Oxidative stress has been postulated as a major contributor to placental hypoperfusion and ischemia in pre-eclampsia (PE). Reactive oxygen species (ROS) generated during placental ischemia can cause oxidative damage to nucleic acids. Base excision repair (BER) and nucleotide excision repair (NER) are major pathways responsible for removing the oxidative DNA damage. Polymorphisms in DNA repair genes may be associated with differences in the repair efficiency of DNA damage.

Study design

In order to investigate the possible association between DNA repair genes and PE susceptibility, we analyzed genotype and allele distributions of APE1-148, XRCC1-194, XRCC1-399 and XPD-751 genes in 101 patients with PE and 107 healthy women. Differences in genotype distributions and allele frequencies in the cases and the controls were compared for statistical significance using the χ²-test. Haplotype frequencies were estimated using a contingency χ²-test. One-way ANOVA and Mann–Whitney U-test were used for the statistics of the clinical and biochemical parameters.

Results

No significant association between PE and the variant alleles of APE1 codon 148 (OR: 0.77, 95% CI = 0.51–1.15), XRCC1 codon 194 (OR: 0.64, 95% CI = 0.30–1.37), XRCC1 codon 399 (OR: 1.16, 95% CI = 0.78–1.74) and XPD codon 751 (OR: 1.21, 95% CI = 0.81–1.80) was observed. Results of our haplotype analysis demonstrated that there is a high linkage disequilibrium (D′: 1.0, r² = 0.042) between the haplotypes of XRCC1 codon 194 and codon 399 markers.

Conclusions

These preliminary results suggest that the polymorphic variants of APE1-148, XRCC1-194, XRCC1-399, and XPD-751 genes are not significant risk factors for PE development.     

Predictors of palliative care consultation on an inpatient gynecologic oncology service: Are we following ASCO recommendations?

Objective

Determine predictors of inpatient palliative care (PC) consultation and characterize PC referral patterns with respect to recommendations from the American Society of Clinical Oncology (ASCO).

Methods

Women with a gynecologic malignancy admitted to the gynecologic oncology service 3/2012–8/2012 were identified. Demographic information, disease and treatment details and date of death were abstracted from medical records. Student's t-test, Fischer's exact test or χ²-test was used for univariate analysis. Binomial logistic regression was used for multivariate analysis.

Results

Of 340 patients analyzed, 82 (24%) had PC consultation. Univariate predictors of PC consultation included race, cancer type and stage, recurrent disease, admission frequency, admission for symptom management or malignant bowel obstruction (MBO), discharge to skilled nursing facility (SNF) and number of lines of chemotherapy. On multivariate analysis, significant predictors of PC consultation were recurrent disease (OR 2.4, 95% CI 1.1–5.3), number of admissions (≥ 3, OR 10.9, 95% CI 3.4–34.9), admission for symptom management (OR 19.4, 95% CI 7.5–50.1), discharge to SNF (OR 5, 95% CI 1.9–13.5) and death within 6 months (OR 16.5, 95% CI 6.9–39.5). Of patients considered to meet ASCO guidelines, 53% (63/118) had PC referral. Of patients referred to PC, 51.2% (42/82) died within 6 months of last admission.

Conclusions

Patients referred to inpatient PC have high disease and symptom burden and poor prognosis. High-risk patients, including those meeting ASCO recommendations, are not captured comprehensively. We continue to use PC referrals primarily for patients near the end of life, rather than utilizing early integration as recommended by ASCO.     

Risk factors for preterm premature rupture of membranes in Chinese women from urban cities

Objective

To investigate the prevalence of preterm premature rupture of membranes (PPROM) in urban areas in China and examine the associated risk factors.

Methods

A population-based, prospective study was undertaken in 14 cities in China between January 1, 2011, and January 31, 2012. Women were recruited at their first prenatal-care visit, when maternal characteristics were recorded. Risk factors were analyzed by one-way analysis of variance.

Results

Of 112 439 women included in analyses, 3077 (2.7%) had PPROM. Univariate analysis showed an increased risk of PPROM before 28 weeks of pregnancy in migrant women (odds ratio [OR] 2.25; 95% confidence interval [CI] 1.53–3.30; P < 0.001), in those with a history of recurrent induced abortions (OR 2.75; 95% CI 1.66–4.56; P < 0.001), and in those with a history of preterm birth (OR 3.90; 95% CI 0.77–19.61; P < 0.001). The associations were maintained in multivariate analysis (P < 0.001).

Conclusion

Migration as a result of urbanization, high rates of induced abortion, and preterm birth are potential risk factors for PPROM in Chinese women.     

Weekly fluconazole therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis

Objective

To investigate the efficacy, compared to placebo, of fluconazole 150 mg weekly, given for six months as prophylaxis against recurrent vulvovaginal candidiasis (RVVC).

Study design

A quantitative systematic review was performed, and randomized controlled trials were included. We conducted searches at Medline, EMBASE, Lilacs, Cochrane Library and ICI Web of Science from 1980 to March 2012. We used the odds ratio (OR) with confidence intervals (CI) of 95% using a random effects model of Mantel-Haenszel. The software used was Review Manager version 5.0.

Results

Through the search strategies we identified 249 articles, of which only two were part of the meta-analysis. Fluconazole was more effective than placebo in reducing symptomatic episodes of VVC, immediately after treatment (OR 0.10, 95% CI 0.03–0.34), 3 months after treatment (OR 0.23, 95% CI 0.07–0.74) and 6 months after treatment (OR 0.39, 95% CI 0.24–0.64).

Conclusion

Weekly treatment with fluconazole (150 mg) for six months is effective against RVVC.     

Factors associated with the use of prenatal corticosteroids in the management of preterm delivery in Chinese hospitals

Objective

To assess the prevalence of the use of prenatal corticosteroids (PCS) in the management of preterm delivery and the factors associated with PCS administration.

Methods

A secondary analysis was performed of a cross-sectional study conducted in 21 Chinese healthcare facilities between November 2010 and January 2011. The medical records of women who delivered preterm were reviewed. Associations between PCS administration and individual and organizational-level factors were determined.

Results

The study population comprised 659 women who delivered at 20 facilities. PCS were given to 158 (68.1%) of 232 women delivering after 27–34 weeks of pregnancy and 119 (27.9%) of 427 delivering after 35–36 weeks. Teenaged girls were less likely to receive PCS after 27–34 weeks than were women aged 20–35 years (odds ratio [OR] 0.22; 95% confidence interval [CI] 0.07–0.70). Among women who delivered after 35–36 weeks, the odds of receiving PCS were lower in urban hospitals than in periurban or rural hospitals (OR 0.04; 95% CI 0.00–0.44), and there was significant hospital-level variance with regard to the administration of PCS (P < 0.05).

Conclusion

Generally, PCS were underprescribed to women at risk of preterm delivery and many women received the treatment after 35–36 weeks of pregnancy, when it might not have been effective.     

A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles

Objective(s)

To compare the clinical pregnancy rates between intrauterine insemination (IUI) simultaneously or 34–36 h following hCG injection in gonadotropin-stimulated IUI cycles.

Study design

Randomized, prospective, controlled, study conducted in a university infertility clinic. Of 923 infertile couples, 220 couples with unexplained infertility or mild male factor infertility were included to the study. Before ovarian stimulation patients were randomized into two groups: IUI at 34–36 h after hCG injection (group I) (n = 106) and IUI simultaneously with hCG administration (group II) (n = 98). The primary outcome was clinical pregnancy rates.

Results

There was no significant difference between the groups according to baseline patient and cycle characteristics. Clinical pregnancy rates were 9.4% and 12.2% in group I and group II, respectively (p = 0.523). Although group II had better outcomes there was no statistically significant difference in clinical pregnancy rates between the different timing methods: IUI simultaneously with hCG versus IUI at 34–36 h after hCG (odds ratio (OR) = 1.35, 95% CI 0.53–3.42).

Conclusion(s)

There is no difference in simultaneous use of hCG injection compared to cycles in which IUI is performed after 34–36 h following hCG injection. Prospective randomized trials with larger sample sizes or meta-analyses are required.     

Predictors of unknown HIV serostatus at the time of labor and delivery in Kampala,Uganda

Objective

To determine factors associated with an unknown HIV serostatus among pregnant women admitted in labor to Mulago Hospital, Kampala, Uganda.

Methods

In total, 665 pregnant women admitted to Mulago Hospital were interviewed about their sociodemographic characteristics, obstetric history, access to prenatal care, fears regarding HIV testing, and knowledge about modes of mother-to-child-transmission (MTCT). Knowledge of the HIV serostatus was assessed by self-report and verified by prenatal card review.

Results

The prevalence of unknown HIV serostatus at the time of labor was 27.1%. Factors associated with an unknown HIV serostatus included high parity (odds ratio [OR] 1.9; 95% confidence interval [CI], 1.16–3.14), preterm delivery (OR 2.60; 95% CI, 1.06–6.34), prenatal care at a private clinic (OR 12.87; 95% CI, 5.68–29.14), residence more than 5 km from the nearest prenatal clinic (OR 2.86; 95% CI, 1.18–17.9), high knowledge about MTCT (OR 0.25; 95% CI, 0.07–0.86), and fears related to disclosing the test result to the partner (OR 3.60; 95% CI, 1.84–7.06).

Conclusion

The high prevalence of unknown HIV serostatus among women in labor highlights the need to improve accessibility to HIV testing services early during pregnancy to be able to take advantage of antiretroviral therapy.     

Vaginal progesterone supplementation has no effect on ongoing pregnancy rate in hCG-induced natural frozen–thawed embryo transfer cycles

Objective

The purpose of this study is to assess the effect of luteal phase supplementation (LPS) on pregnancy rates in human chorionic gonadotropin (hCG)-induced natural frozen–thawed (FET) cycles.

Study design

All performed hCG-induced natural FET cycles from January 2006 until August 2007 were retrospectively identified. The study group consisted of 452 cycles: 243 supplemented with progesterone administration (600 mg natural micronized progesterone in three separate doses) and 209 without progesterone. Analysis was limited to cycles where embryos were cryopreserved on day 3. Final oocyte maturation was achieved by hCG when endometrial thickness of ≥7 mm and a follicle of 17 mm were present on ultrasound.

Results

No statistically significant differences were observed in ongoing pregnancy rate between the two groups (22% versus 21%, p = 0.8; difference +1%; 95% confidence interval (CI): −6.5 to +8.7). The non-significant effect of the presence or not of luteal support on pregnancy rate was confirmed by logistic regression (odds ratio (OR): 0.9, 95% CI: 0.54–1.47, P = 0.64). A previous pregnancy following fresh embryo transfer (OR: 6.04, 95% CI: 3.63–10.02, P = 0.001) and increased endometrial thickness (OR: 1.25, 95% CI: 1.11–1.41, P = 0.001) significantly affected the achievement of ongoing pregnancy, whereas the association between embryo score and achievement of pregnancy was marginally significant (OR:0.28, 95% CI: 0.08–0.97, P = 0.05).

Conclusion

There is no convincing evidence to support the use of LPS in hCG-induced natural FET cycles, since there is no luteal phase defect. Further prospective randomized studies are necessary to confirm these findings.     

Association between delivery of a small-for-gestational-age neonate and long-term maternal cardiovascular morbidity

Objective

To investigate whether delivering a small-for-gestational-age (SGA) newborn is a risk factor for subsequent long-term maternal cardiovascular morbidity.

Methods

Data were analyzed from consecutive pregnant women who delivered at Soroka University Medical Center, Beer-Sheva, Israel, between 1988 and 1999, and were followed-up retrospectively until 2010. Long-term cardiovascular morbidity was compared among women with and without SGA neonates.

Results

During the study period, 47 612 deliveries met the inclusion criteria, and 4411 (9.3%) women delivered an SGA neonate. Delivery of an SGA neonate was a risk factor for long-term complex cardiovascular events, including congestive heart failure, hypertensive heart and kidney disease, and acute cor pulmonale (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3–4.4; P = 0.006); and long-term cardiovascular mortality (OR, 3.4; 95% CI, 1.5–7.6; P = 0.006). Women who delivered an SGA neonate had a significantly higher risk for cardiovascular mortality during the follow-up period (Kaplan–Meier survival analysis, P = 0.002). Delivery of an SGA neonate remained an independent risk factor for long-term maternal cardiovascular mortality (Cox multivariable regression: adjusted hazard ratio, 3.5; 95% CI, 1.5–8.2; P = 0.004).

Conclusion

Delivery of an SGA neonate is an independent risk factor for long-term cardiovascular morbidity in a follow-up period of more than 10 years.     

Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study

Objective

To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies.

Study design

A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n = 320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women's hospital (n = 170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared.

Results

Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group.

Conclusions

The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group.     

HIV or human papillomavirus co-infection among Brazilian individuals infected with hepatitis B and/or hepatitis C

Objective

To investigate the incidence of co-infection with HIV and human papillomavirus (HPV) among Brazilian individuals with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.

Methods

A prospective study was conducted that enrolled 103 individuals from the Ceará region of Brazil between January 4, 2010, and August 9, 2012. Eligible participants were men (n = 45) or women (n = 58) infected with HBV and/or HCV. Pap smears were collected from female patients. Material from male (urethra) and female (cervix) patients was then collected via DNA-HPV test and visual inspection with acetic acid.

Results

In all, 48 participants tested positive for HBV and 55 tested positive for HCV; 2 had dual infection with HBV and HCV. Co-infection with HIV was detected among 15 participants, whereas 20 participants were found to be co-infected with HPV.

Conclusion

A high prevalence of co-infection with HIV and HPV was detected among Brazilian individuals with HBV and/or HCV.