Fibrinolytic changes in pregnant women on highly active antiretroviral therapy

Objectives:

To report on the changes in fibrinolytic activity in human immunodeficiency virus (HIV) infected pregnant women who are undergoing highly active antiretroviral therapy (HAART).

Methods:

Blood was collected from 50 HIV positive women on HAART (test subjects), and 50 HIV positive women not on HAART (controls). These women were attending the prevention of mother to child clinic (PMTCT) of the University of Benin Teaching Hospital, Benin City, Nigeria from January to June 2014. Standard manual techniques were used to estimate plasma fibrinogen concentration (PFC), euglobulin lysis time (ELT), packed cell volume (PCV), and plasma viscosity (PV).

Results:

The mean ± standard error of mean (SEM) of PFC was 4.02±0.13g/l and ELT from the test subjects was 378±15 mins was significantly higher (p<0.05) compared with the control subjects (PFC 3.46±0.12g/l and ELT 267±9.0mins). The PCV or hematocrit values in the test subject was 29.1±0.38%, which was significantly lower (p<0.05) compared with the control subject (31.3±0.43%). The PV in the test subject was 1.76±0.02 mPa/s, while the control subjects was higher (1.73±0.02 mPa/s). This increase was not statistically significant (p>0.05). There were differences in the various parameters investigated when the various trimesters were compared. These differences did not, however, follow a particular pattern.

Conclusion:

Highly active antiretroviral therapy can cause changes in fibrinolytic activity that may predispose pregnant women to hyperfibrinogenemia and anemia.During pregnancy the physiology of a woman is temporary changed to accommodate the newly developing fetus.1 Conception occurs during ovulation, which is approximately on the fourteenth day of a regular menstrual cycle. In conception, the ovum is fertilized in the fallopian tube and becomes a zygote, which is then carried into the uterus. There are changes in the coagulation and fibrinolytic system during pregnancy and knowledge of these physiological changes characterized by hemodilution, changes in the concentration of one or more plasma protein fractions, and reduced fibrinolytic activity is necessary to manage 2 of the more serious problems in pregnancy; namely hemorrhage and thrombo-embolic diseases.2 Increased levels of plasma proteins and reduced fibrinolytic activity have been reported in pregnancy,3 while prolonged euglobulin lysis time (ELT) and increased levels of fibrinogen have also been observed in pregnancy.4 While numerous studies have examined optimal methods for prevention of mother to child transmission of human immunodeficiency virus (HIV) and subsequent response to HAART,5 as well as the impact of pregnancy on outcomes of HIV in the pre-HAART era,6 little is known of the impact of pregnancy on response to HAART in Africa. There are several biologically plausible mechanisms that might alter efficacy of several antiretroviral agents including changes in enzyme activity and beta-estradiol levels, pregnancy-related changes in blood volume and body mass index, and factors which may compromise adherence to HAART ante and post-partum, such as nausea/vomiting, labor-associated morbidity, or responsibility for a new infant.7 Human immunodeficiency virus infected patients have been reported to be at risk of cardiovascular diseases, (CVD) mostly due to the use of antiretroviral agents.8,9 Protease inhibitors have been mostly implicated.10 All these are also connected to fat redistribution dyslipidemia and insulin resistance observed in HIV patients;11,12 thus, this study aims to report on the changes in fibrinolytic activity in HIV infected pregnant women who are undergoing HAART.     

福州地区流动人口孕产妇保健服务利用现状调查

目的调查福州地区流动人口孕产妇的保健服务利用情况。方法在福州市流动人口聚集区,对480例流动孕产妇进行问卷调查,应用SPSS 13.0统计软件对数据进行统计分析。结果 92.1%的流动孕产妇接受过产前检查,5次及以上产前检查率为59.4%,建卡率为52.3%,住院分娩率为98.5%,产后访视率为51.3%,32.5%流动孕产妇接受过保健知识指导。流动人口妇女及其配偶的文化程度、月人均收入、生育史和是否接受过孕产期保健知识指导是孕产期保健服务利用的主要影响因素。结论流动人口孕产妇保健服务利用率低,需要加强宣传教育、打击非法接生、健全流动人口孕产妇管理系统,提高流动孕产妇保健服务利用水平。     

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background

Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization''s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.

Methods

A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.

Results

Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.

Conclusions

The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.     

孕妇丙型肝炎病毒感染影响因素的病例对照研究

目的 了解孕妇人群丙型肝炎病毒(hepatitis C virus,HCV)感染的影响因素,为科学制定预防控制策略提供理论依据.方法 采用1:2配比的病例对照的研究方法,对甘肃省妇幼保健院2008-2018年兰州地区227例抗-HCV阳性的孕妇进行研究.采用条件logistic回归模型进行孕妇HCV感染影响因素的单因素...     

某三甲医院孕妇网络健康信息搜寻行为调查

用在线问卷调查法调查了孕妇这一用户群体的网络健康信息搜寻行为,用SPSS 24.0进行统计分析的结果显示,93%的孕妇会主动通过互联网获取健康信息,主要目的是丰富孕期知识,主要内容是营养膳食信息,主要途径是手机APP、网站和微信公众号,主要评价依据为发布信息的平台和发布信息的目的。互联网已经成为孕妇健康消费最流行的信息来源之一,因此政府机关和主流媒体要分别做好信息发布平台的监管与引导工作,卫生行政部门和医疗机构应发挥网络健康信息传播的优势,医疗行业专家要成为互联网医疗的活跃用户,孕妇自身也要提高网络健康信息素养。     

Prevention,control, and management of HBV infection among pregnant women in China: from a life-cycle perspective

<正>Hepatitis B virus (HBV) infection is a global public health problem, causing a high disease burden worldwide.[1] As a country previously with a high burden of hepatitis, about 70 million people in Chi     

2010年商洛市401名孕产妇艾滋病、梅毒、丙肝检测结果分析

目的了解孕产妇艾滋病防治知识知晓情况、艾滋病、梅毒、丙肝感染情况,为制订艾滋病母婴阻断等相关干预措施提供依据。方法 2010年4～7月对商洛市妇保院、中医院准备分娩进行孕产期保健的401名孕妇进行问卷调查,进行HIV(艾滋病病毒)、HCV(丙型肝炎病毒)、梅毒抗体检测。结果商洛市孕产妇艾滋病防治知识知晓率为83.29%,不同年龄组和文化层次知晓率无统计学差异;未检出HIV,检出HCV抗体阳性2例,感染率为0.50%;梅毒抗体阳性11例,感染率为2.73%。结论商洛市孕产妇艾滋病防治知识知晓率较高,为83.29%,艾滋病感染率较低,应加强对孕产妇艾滋病、性病防治知识的普及,加大筛查检测力度。     

海南省2010—2015年孕产妇艾滋病哨点监测结果

目的 分析海南省2010—2015年孕产妇艾滋病哨点监测数据,为全省艾滋病综合防治提供依据。 方法 按照《全国艾滋病哨点监测实施方案操作手册》要求,采用连续采样监测对准备分娩进行孕产期保健的孕妇进行问卷调查和血清学检测。 结果 2010—2015年共监测孕产妇9 699人,20~29岁年龄组占68.00%,在婚占94.32%,初中及以下文化程度占44.91%;各年度孕产妇艾滋病知识知晓率分别为57.20%、68.99%、81.52%、71.26%、82.88%和82.51%,呈上升趋势（P<0.05);不同年龄和文化程度孕产妇艾滋病知识知晓率差异有统计学意义（P<0.05)。有丈夫以外性伴比例为0.58%,本人患过性病比例为0.44%。孕产妇艾滋病病毒（HIV）、梅毒和丙型病毒性肝炎（HCV）抗体总阳性率分别为0.01%、0.23%和0.13%,各年度HIV和梅毒抗体阳性率差异均无统计学意义(P>0.05),HCV抗体阳性率差异有统计学意义（P<0.05）。 结论 海南省孕产妇人群艾滋病知识知晓率逐年提高,但仍低于其他省份知晓水平;尽管各年度HIV、梅毒和HCV抗体阳性率均处在较低水平,但部分孕产妇存在有多性伴且患性病比例较高等感染艾滋病的风险。     

Toxoplasmosis among pregnant women: High seroprevalence and risk factors in Kinshasa,Democratic Republic of Congo

Objective

To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo.

Methods

Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity.

Results

A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed.

Conclusion

In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy.     

初产妇孕龄、文化程度、家庭支持对心理健康的影响

①目的 对影响孕妇不同孕周、不同文化程度、不同家庭支持的心理健康因子（SCL-90）的指标进行分析，并对孕妇与常模妇女各项指标比较。②方法 对250例初产妇采用症状自评量表（SCL-90），分别在孕28周前及孕38周后进行调查测试。③结果 孕妇心理变化与常模妇女各项指标均有明显差异（P〈0．01），孕28周后强迫、抑郁、焦虑症状高于常模组，孕28周前低于常模组。孕28周前与临产前38周心理变化中躯体、强迫、焦虑症状3个单项因子及总分、总均分有统计学差异（P〈0．05）。④结论 孕妇与正常妇女相比，心理抗压能力明显减低，不同的心理状况对分娩方式的选择可能会有明显的影响。应加强孕妇的产前健康教育，开展分娩镇痛技术，加强家庭支持，改变产时服务意识，提高孕妇心理抗压力，帮助其平安渡过孕产期。     

Low-intensity anticoagulation therapy in the pregnant women with mechanical heart valves:a report with 56 cases

<正>Objective To evaluate the method of low-intensity anticoagulation therapy in the pregnant women who had received mechanical heart valve replacemant,and the effects of warfarin on the pregnant women and their fetus. Methods This retrospective study involved 56 pregnant women (61 pregnancies) who had received mechanical heart valve replacement. Their pregnant status,delivery, and anticoagulation therapy were observed and