Contribution of the foetal uro-MRI in the prenatal diagnosis of uronephropathies

PurposeTo study the complementary diagnostic value and role in the perinatal management of foetal MRI in the prenatal diagnosis of abnormalities of the urinary tract.Patients and methodsRetrospective monocentric study from November 2002 to June 2011 of foetuses benefiting from an MRI after ultrasound diagnosis of uronephropathy abnormalities. Ultrasound and MRI data were compared with postnatal radiological and/or surgical data or with the foetopathology. The MRI analysis focused on the diagnostic concordance with the ultrasound, the complementary diagnostic contribution and/or a change in perinatal care.ResultsOf the 154 MRI examined, a follow-up was obtained for 108 cases. The indications for MRI were classified into six groups: suspected renal agenesis (n = 20, 18.5%), posterior urethral valve (n = 20, 18.5%), reflux or megaureter (n = 14, 13%), uretropelvic junction syndrome (n = 24, 22.5%), enlarged kidneys (n = 7, 6.5%) and others (n = 23, 21%). The information supplied by ultrasound was confirmed by MRI in 72 patients (67%). MRI provided additional data for 36 patients (33%) and changed the perinatal care for 16 patients (15%).ConclusionFoetal uro-MRI is a useful complementary tool in the prenatal diagnosis of some uropathy abnormalities.     

Maternal outcomes of intimate partner violence during pregnancy: study in Iran

Objectives

To investigate the prevalence of intimate partner violence (IPV) against pregnant women and its relationship with adverse maternal outcomes, including preterm labour, abortion, caesarean section, antenatal hospitalization and vaginal bleeding, in the West Azerbaijan, Iran.

Study design

Cross-sectional design.

Methods

In total, 1300 pregnant women, aged 18–39 years, who were referred to hospitals in the Iranian cities of Miandoab and Mahabad in the province of West Azerbaijan in 2009–2010 were recruited for this study by a convenience sampling method. Participants were asked to share their experiences of IPV during pregnancy and adverse maternal outcomes.

Results

Of these pregnant women, 945 (72.8%) reported that they had experienced IPV during their last pregnancy. A significant association was found between IPV and preterm labour [adjusted odds ratio (adjOR) 1.54, 95% confidence interval (CI) 1.16–2.03], caesarean section (adjOR 11.84, 95% CI 6.37–22.02), antenatal hospitalization (adjOR 6.34, 95% CI 3.82–10.52) and vaginal bleeding (adjOR 1.51, 95% CI 0.9–2.3).

Discussion

This study demonstrated a high prevalence of IPV during pregnancy, and found that IPV was associated with adverse maternal outcomes including preterm labour, caesarean section, antenatal hospitalization and vaginal bleeding. This adds to the existing literature and can be used to inform healthcare practices in developing countries. Medical, health and surgical services for pregnant women should consider screening for IPV, and providers should be aware that IPV victims are at increased risk for adverse outcomes. Services should also develop links with the Battered Women's Movement; such programmes now exist in many countries.     

Socioecological and message framing factors influencing maternal influenza immunization among minority women

Objective

A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination (“gain-frame”), or messages which emphasize negative outcomes of forgoing vaccination (“loss-frame”). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.

Study design

Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.

Results

Neither gain- [OR = 0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR = 0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR = 3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR = 2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR = 3.405, 95% CI: (1.412,8.212)].

Conclusion

Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.     

妊娠孕妇产前超声检查胎儿心脏异常表现与染色体异常的相关性

目的探究妊娠孕妇产前超声检查胎儿心脏异常表现与染色体异常的相关性。方法回顾性分析我院2016年2月-2018年2月产前检查的500例胎儿心脏超声检查及染色体核型分析结果,分析心脏异常与染色体核型分析结果的相关性。结果本研究中共有26例发生胎儿心脏异常,37例存在染色体异常,26例胎儿心脏异常中共有19例发生染色体异常,发生率为73.08%。26例发生心脏异常的胎儿主要为室间隔缺损、卵圆孔未闭、三尖瓣轻度反流、左室功能异常,其中室间隔缺损发生率最高,其染色体异常率占总异常率的18.92%,三尖瓣轻度反流最低,占5.41%。将上述数据代入Spearman检验后发现,胎儿心脏异常表现与染色体异常成正相关(P<0.05)。结论妊娠孕妇产前超声检查胎儿心脏异常表现与染色体异常存在正相关,当胎儿出现心脏结构畸形时,胎儿染色体异常发生率较高,临床在超声检查应尤为注意。     

Measles seroprevalence in pregnant women in Soweto,South Africa: a nested cohort study

ObjectivesMeasles infection causes particularly severe disease in young children who, prior to vaccination, are dependent on maternal antibodies for protection against infection. Measles vaccination was introduced into the South African public immunization programme in 1983 and became widely available in 1992. The aim of this study was to determine measles-specific immunoglobulin G (IgG) levels in pregnant women living with and without HIV born before and after measles vaccine introduction in South Africa.MethodsMeasles IgG antibody level from blood obtained at the time of delivery was compared between women who were born before 1983 (n = 349) and since 1992 (n = 349). Serum samples were tested for measles IgG antibody using an enzyme-linked immunosorbent assay. Geometric mean titres (GMTs) and the proportion with seronegative (<200 mIU/mL) or seropositive titres (≥275 mIU/mL) were compared.ResultsWomen born since 1992 had lower GMTs [379.7 mIU/mL (95% CI 352.7–448.6)] and fewer were seropositive (55.9%, 195/349) than women born before 1983 [905.8 mIU/mL (95% CI 784.7–1045.5); 76.8%, 268/349], for both comparisons p < 0.001.ConclusionsWe found an association between measles vaccine implementation into the public immunization program in South Africa and peri-partum maternal measles immunity, where women born before vaccine introduction had higher measles IgG antibody titres and were more likely to be seropositive. These findings suggest a need to reconsider the infant measles immunization schedule in settings where women have derived immunity mainly from measles vaccine rather than wild-type virus exposure.     

2011年深圳市梅毒母婴垂直传播影响因素分析

目的掌握梅毒在深圳市孕产妇中的感染现状和流行病学特点,为阻断梅毒母婴垂直传播提供参考。方法采用快速血浆反应素环状卡片试验法（RPR）对2011年1-12月深圳市某区的孕产妇进行梅毒检测的初筛。所有阳性血清送往当地疾病预防控制中心进行梅毒螺旋体明胶凝集试验法（TPPA）确诊试验;对阳性孕产妇进行问卷调查和随访分析,并对阳性孕产妇新生儿出生1个月和6个月后进行2次梅毒检测。结果深圳市某区2011年度共有孕产妇16153例,其中普通孕产妇15798例,特殊孕产妇355例,共有15788例接受梅毒血清学检测,检测覆盖率为97．77％,其中普通孕产妇15433（检测覆盖率为97．63％）和特殊孕产妇355例（检测覆盖率为100．00％）。共检测出56例梅毒阳性的孕产妇,其中普通孕产妇中50例,特殊孕产妇中有6例,阳性率为0．35％;共检测出17例先天梅毒新生儿,阳性率为0．11％：多因素Logistic回归分析结果显示：职业和文化程度与孕产妇梅毒感染关系密切。结论深圳市孕产妇梅毒初筛覆盖率较高,孕产妇的职业和文化程度与母婴梅毒垂直传播关系密切。     

Multicentre surveillance of prevalence of the 23S rRNA A2058G and A2059G point mutations and molecular subtypes of Treponema pallidum in Taiwan, 2009–2013

Resistance mutations A2058G and A2059G, within the 23S rRNA gene of Treponema pallidum, have been reported to cause treatment failures in patients receiving azithromycin for syphilis. Genotyping of T. pallidum strains sequentially isolated from patients with recurrent syphilis is rarely performed. From September 2009 to August 2013, we collected 658 clinical specimens from 375 patients who presented with syphilis for genotyping to examine the number of 60-bp repeats in the acidic repeat protein (arp) gene, T. pallidum repeat (tpr) polymorphism, and tp0548 gene, and to detect A2058G and A2059G point mutations by restriction fragment length polymorphism. Treponemal DNA was identified in 45.2% (n = 298) of the specimens that were collected from 216 (57.6%) patients; 268 (40.7%) specimens tested positive for the 23S rRNA gene, and were examined for macrolide resistance. Two isolates (0.7%) harboured the A2058G mutation, and no A2059G mutation was identified. A total of 14 strains of T. pallidum were identified, with 14f/f (57.5%) and 14b/c (10.0%) being the two predominant strains. Forty patients who presented with recurrent episodes of syphilis had T. pallidum DNA identified from the initial and subsequent episodes, with five cases showing strain discrepancies. One patient had two strains identified from different clinical specimens collected in the same episode. Our findings show that 14f/f is the most common T. pallidum strain in Taiwan, where the prevalence of T. pallidum strains that show A2058G or A2059G mutation remains low. Different genotypes of T. pallidum can be identified in patients with recurrent episodes of syphilis.     

A multicenter prospective trial to asses a new real-time polymerase chain reaction for detection of Treponema pallidum,herpes simplex-1/2 and Haemophilus ducreyi in genital,anal and oropharyngeal ulcers

Treponema pallidum, herpes simplex virus types 1 or 2 (HSV-1/2) and Haemophilus ducreyi are sexually transmitted pathogens that can cause genital, anal and oropharyngeal ulcers. Laboratory evaluation of these pathogens in ulcers requires different types of specimens and tests, increasing the risk of improper specimen handling and time lapse until analysis. We sought to develop a new real-time PCR (TP-HD-HSV1/2 PCR) to facilitate the detection of T. pallidum, HSV-1/2 and H. ducreyi in ulcers. The TP-HD-HSV1/2 PCR was tested (i) in a retrospective study on 193 specimens of various clinical origin and (ii) in a prospective study on 36 patients with genital, anal or oropharyngeal ulcers (ClinicalTrials.gov # NCT01688258). The results of the TP-HD-HSV1/2 PCR were compared with standard diagnostic methods (T. pallidum: serology, dark field microscopy; HSV-1/2: PCR; H. ducreyi: cultivation). Sensitivity and specificity of the TP-HD-HSV1/2 PCR for T. pallidum were both 100%, for HSV-1 100% and 98%, and for HSV-2 100% and 98%, respectively. T. pallidum and HSV-1/2 were detected in 53% and 22% of patients in the prospective study; H. ducreyi was not detected. In the prospective study, 5/19 (26%) specimens were true positive for T. pallidum in the TP-HD-HSV1/2 PCR but non-reactive in the VDRL. The TP-HD-HSV1/2 PCR is sensitive and specific for the detection of T. pallidum and HSV-1/2 in routine clinical practice and it appears superior to serology in early T. pallidum infections.     

秦皇岛市5739名孕产妇乙肝五项定量检测结果分析

目的 讨论2013年本院建卡孕产妇的乙肝流行情况,以及各个年龄组乙肝表面抗体的含量,及时接种乙肝疫苗,为孕产妇的乙肝防护提供数据支持.方法 采集孕产妇空腹静脉血,采用荧光免疫分析法（TRFIA）进行乙肝五项定量检测.结果 乙肝表面抗体的阳性率为51.93％,高免疫应答阳性率平均为30.49％,低免疫应答阳性率平均为21.43％.结论 在孕妇中存在着一定比例的HBV感染者和易感者,进行乙肝定量检测能够更好地反应机体乙肝感染动态免疫情况,预防HBV感染,阻断母婴传播,对优生优育、提高人口素质有重要意义.     

A Three Year Retrospective Study on Seroprevalence of Syphilis among Pregnant Women at Gondar University Teaching Hospital,Ethiopia

Background

Sexually transmitted infections (STIs) are a serious public health problem in low income countries, including Ethiopia. Syphilis caused by Treponema pallidum remains a major cause of reproductive morbidity and poor pregnancy outcomes in low income countries. Stillbirth, perinatal death, serious neonatal infection and low-birth weight babies are common among seropositive mothers.

Objective

To assess the seroprevalence of syphilis and risk factor correlates of this infection at Gondar University Teaching Hospital, Ethiopia.

Methods

The study was done on 2385 pregnant women attending the antenatal care clinic (ANC) from January 2009 to December 2011. Data was abstracted from the antenatal care clinic medical database. Chi-square test was used, using SPSS version 16 and significance level was chosen at 0.05 level with a two-tailed test.

Results

Of the total, 69(2. 9%) of pregnant women were confirmed as seropositive for syphilis. Pregnant women with an age group of 21–25 years of old were the most seropositive (3.4%), followed by 26–30 years of old (3.1%). The prevalence of syphilis infection was 3.2% in urban and 2.2% in rural pregnant women. Relatively high prevalence of syphilis infection were identified among students (4.2%) followed by governmental employees (3.8%).

Conclusion

The seroprevalence of syphilis among pregnant women attending ANC is declining. However, syphilis is more prevalent in the young and urban pregnant women. Emphasis on education to young people on STI risk behavioral change and partner follow up and notification for exposure to syphilis and treatment should be given.