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Nature Communications May 2023
PubMed: 37160921
DOI: 10.1038/s41467-023-38372-1 -
International Health Jan 2024Anaemia in pregnancy is one of the most frequent complications related to pregnancy and is a public health concern. This article examines the prevalence of anaemia in...
BACKGROUND
Anaemia in pregnancy is one of the most frequent complications related to pregnancy and is a public health concern. This article examines the prevalence of anaemia in the third trimester of pregnancy and the associations between anaemia and adverse perinatal outcomes in Hebei Province, China.
METHODS
We used SPSS software to describe the incidence of anaemia in the third trimester of pregnancy in Hebei Province and analysed the clinical characteristics in anaemic patients and the relationship between anaemia and adverse pregnancy outcomes.
RESULTS
The overall prevalence of anaemia in the third trimester of pregnancy was 35.0% in Hebei Province. The prevalence of anaemia in the population with a high education level was lower than that in the population with a low education level. The incidence rate in rural areas was higher than that in urban areas. After adjustment for confounding factors, anaemia in the third trimester of pregnancy is an independent risk factor in terms of placenta previa, placental abruption, uterine atony, pre-eclampsia, gestational diabetes mellitus, heart disease, postpartum haemorrhage, premature birth, laceration of birth canal, puerperal infection, caesarean section and large for gestational age.
CONCLUSIONS
The prevalence of anaemia in the third trimester of pregnancy is associated with an increased risk of adverse perinatal outcomes. A comprehensive approach to prevent anaemia is needed to improve maternal and child health outcomes.
Topics: Child; Pregnancy; Humans; Female; Pregnancy Trimester, Third; Cesarean Section; Prevalence; Placenta; Pregnancy Outcome; Anemia
PubMed: 37093789
DOI: 10.1093/inthealth/ihad028 -
Nature Communications Apr 2023Life-threatening bacterial infections in women after childbirth, known as puerperal sepsis, resulted in classical epidemics and remain a global health problem. While...
Life-threatening bacterial infections in women after childbirth, known as puerperal sepsis, resulted in classical epidemics and remain a global health problem. While outbreaks of puerperal sepsis have been ascribed to Streptococcus pyogenes, little is known about disease mechanisms. Here, we show that the bacterial R28 protein, which is epidemiologically associated with outbreaks of puerperal sepsis, specifically targets the human receptor CEACAM1. This interaction triggers events that would favor the development of puerperal sepsis, including adhesion to cervical cells, suppression of epithelial wound repair and subversion of innate immune responses. High-resolution structural analysis showed that an R28 domain with IgI3-like fold binds to the N-terminal domain of CEACAM1. Together, these findings demonstrate that a single adhesin-receptor interaction can drive the pathogenesis of bacterial sepsis and provide molecular insights into the pathogenesis of one of the most important infectious diseases in medical history.
Topics: Female; Humans; Pregnancy; Adhesins, Bacterial; Bacterial Proteins; Puerperal Infection; Sepsis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 37080973
DOI: 10.1038/s41467-023-37732-1 -
The Journal of Maternal-fetal &... Dec 2023To identify the clinical characteristics of pregnancy associated group A streptococcus (GAS) infection and predictors for intensive care unit (ICU) admission.
OBJECTIVE
To identify the clinical characteristics of pregnancy associated group A streptococcus (GAS) infection and predictors for intensive care unit (ICU) admission.
METHODS
A retrospective cohort study of culture-proven pregnancy-related GAS infections in tertiary hospital Electronic medical records were reviewed, for cases of cultures positive GAS that were identified between January 2008 and July 2021. A GAS infection was defined by the isolation of the pathogen from a sterile liquid or tissue site. Blood and urine cultures were obtained from all patients with peripartum hyperpyrexia (fever >38 °C). Medical Personnel screening included cultures of the throat, rectum, and skin lesions (if present). In cases of hemodynamic instability patients were transferred ad hoc to ICU, according to the obstetrician and intensivist judgment.
RESULTS
Of the 143,750 who delivered during the study period, 66 (0.04%) were diagnosed as having a pregnancy associated GAS infection. Of these, 57 patients presented postpartum, and represented the study cohort. The most common presenting signs and symptoms among puerperal GAS, were postpartum pyrexia (72%), abdominal pain (33%), and tachycardia (>100 bpm, 22%). 12 women (21.0%) developed streptococcal toxic shock syndrome (STSS. Predictors for STSS and ICU admission were: antibiotic administration >24 h from presentation postpartum, tachycardia, and a C-reactive protein level >200 mg/L. Women that received antibiotic prophylaxis during labor had a significantly lower rate of STSS (0 vs 10, 22.7%; = .04).
CONCLUSION
Deferral of medical intervention >24 h from the first registered abnormal sign had the most important impact on deterioration of women with invasive puerperal GAS. Antibiotic prophylaxis during labor in women with GAS may reduce associated complications.
Topics: Pregnancy; Humans; Female; Retrospective Studies; Streptococcal Infections; Pregnancy Complications, Infectious; Puerperal Infection; Streptococcus pyogenes; Anti-Bacterial Agents
PubMed: 36997169
DOI: 10.1080/14767058.2023.2196363 -
Revista Brasileira de Ginecologia E... Feb 2023To evaluate the seroprevalence of toxoplasmosis among puerperal women cared for at a tertiary university hospital and the level of understanding of these puerperal...
OBJECTIVE
To evaluate the seroprevalence of toxoplasmosis among puerperal women cared for at a tertiary university hospital and the level of understanding of these puerperal women about toxoplasmosis, vertical transmission, and its prophylaxis.
METHODS
For this cross-sectional study, we evaluated 225 patients using presential interviews, prenatal documentation, and electronic medical records. Data were stored using Research Electronic Data Capture (REDCap) software. Prevalence rates were estimated by the presence of reactive IgG antibodies against . Data analysis was performed using the chi-square test and calculation of the odds ratio (OR). Seroreactivity to and exposure variables (age, educational level, and parity) were analyzed using a confidence interval (95%CI) and a significance level of 5% (p < 0.05).
RESULTS
The seropositivity rate for was 40%. There was no association between seroprevalence and age. Primiparity was a protective factor against seropositivity and low education was a risk factor.
CONCLUSION
Knowledge of infection and its transmission forms was significantly limited, presenting a risk for acute maternal toxoplasmosis and vertical transmission of this protozoan. Increasing the education level regarding the risk of toxoplasmosis during pregnancy could reduce the rates of infection and vertical transmission of this parasite.
Topics: Female; Humans; Pregnancy; Antibodies, Protozoan; Cross-Sectional Studies; Immunoglobulin M; Risk Factors; Seroepidemiologic Studies; Tertiary Care Centers; Toxoplasma; Toxoplasmosis
PubMed: 36977402
DOI: 10.1055/s-0043-1764495 -
BMC Pregnancy and Childbirth Mar 2023Group B Streptococcus (GBS), also referred as Streptococcus agalactiae, is one of the leading causes of life-threatening invasive diseases such as bacteremia,...
BACKGROUND
Group B Streptococcus (GBS), also referred as Streptococcus agalactiae, is one of the leading causes of life-threatening invasive diseases such as bacteremia, meningitis, pneumonia and urinary tract infection in pregnant women and neonates. Rates of GBS colonization vary by regions, but large-sample studies on maternal GBS status are limited in southern China. As a result, the prevalence of GBS among pregnant women and its associated risk factors and the efficacy of intrapartum antibiotic prophylaxis (IAP) intervention in preventing adverse pregnancy and neonatal outcomes remain poorly understood in southern China.
METHODS
To fill this gap, we retrospectively analyzed demographic and obstetrical data of pregnant women who have undergone GBS screening and delivered between 2016 and 2018 in Xiamen, China. A total of 43,822 pregnant women were enrolled and only a few GBS-positive women did not receive IAP administration. Possible risk factors for GBS colonization were assayed by univariate and multivariate logistic regression analysis. Generalized linear regression model was applicated to analyze whether IAP is one of the impact factors of the hospital length of stay of the target women.
RESULTS
The overall GBS colonization rate was 13.47% (5902/43,822). Although women > 35 years old (P = 0.0363) and women with diabetes mellitus (DM, P = 0.001) had a higher prevalence of GBS colonization, the interaction between ages and GBS colonization was not statistically significant in Logistic Regression analysis (adjusted OR = 1.0014; 95% CI, 0.9950, 1.0077). The rate of multiple births was significantly dropped in GBS-positive group than that of GBS-negative group (P = 0.0145), with no significant difference in the rate of fetal reduction (P = 0.3304). Additionally, the modes of delivery and the incidences of abortion, premature delivery, premature rupture of membranes, abnormal amniotic fluid and puerperal infection were not significantly different between the two groups. The hospitalization stays of the subjects were not influenced by GBS infection. As for neonatal outcomes, the cases of fetal death in maternal GBS-positive group did not statistically differ from that in maternal GBS-negative group.
CONCLUSION
Our data identified that pregnant women with DM are at high risk of GBS infection and IAP is highly effective in prevention of adverse pregnancy and neonatal outcomes. This stressed the necessity of universal screening of maternal GBS status and IAP administration to the target population in China, and women with DM should be considered as priorities.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Adult; Antibiotic Prophylaxis; Retrospective Studies; Streptococcus agalactiae; Infectious Disease Transmission, Vertical; Anti-Bacterial Agents; Pregnancy Complications, Infectious; Risk Factors; Pregnancy, Multiple; Streptococcal Infections; Premature Birth
PubMed: 36973793
DOI: 10.1186/s12884-023-05478-9 -
BMC Women's Health Mar 2023Despite interventions improving maternal and newborn morbidity and mortality, progress has been sluggish, especially in hard-to-reach indigenous communities....
Sociocultural practices and beliefs during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in Manyara, Tanzania: a descriptive qualitative study.
BACKGROUND
Despite interventions improving maternal and newborn morbidity and mortality, progress has been sluggish, especially in hard-to-reach indigenous communities. Sociocultural beliefs in these communities more often influence the adoption of particular behaviors throughout pregnancy, childbirth, and postpartum. Therefore, this study identified sociocultural beliefs and practices during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in the Manyara region, Tanzania.
METHODS
The study was a descriptive qualitative design. We used purposive sampling to select twelve participants among community members who were indigenous women of Manyara who had ever experienced pregnancy. In-depth interviews were audio-recorded and transcribed verbatim, and organized manually. We used manual coding and inductive-deductive thematic analysis.
RESULTS
The study's findings showed that sociocultural beliefs and practices are widespread, covering antenatal through childbirth to the postnatal period. Both harmful and harmless practices were identified. For example, the use of herbal preparations to augment labor was reported. Previously, most women preferred home delivery; however, the practice is changing because of increased knowledge of home delivery complications and the accessibility of the facilities. Nevertheless, women still practice hazardous behaviors like applying strange things in the birth canal after delivery, increasing the risk of puerperal infection.
CONCLUSIONS
Sociocultural practices are predominant and widely applied throughout the peripartum period. These beliefs encourage adopting specific behaviors, most harmful to both mother and fetus. These sociocultural practices tend to affect the utilization of some essential maternal and child health practices. Eliminating unsafe peripartum practices will increase the use of medical services and ultimately improve outcomes for both mothers and their newborns. Public health interventions must recognize the cultural context informing these cultural practices in marginalized indigenous communities. Healthcare providers should routinely take the history of commonly traditional practices during the peripartum period to guide them in providing quality care to women by correcting all harmful practices.
Topics: Child; Female; Pregnancy; Humans; Infant, Newborn; Tanzania; Parturition; Qualitative Research; Mothers; Postpartum Period; Maternal Health Services
PubMed: 36959588
DOI: 10.1186/s12905-023-02277-4 -
Cureus Feb 2023A 32-year-old puerperal patient developed acute onset breathlessness and fever on the third postoperative day. On evaluation, the patient was diagnosed to have scrub...
A 32-year-old puerperal patient developed acute onset breathlessness and fever on the third postoperative day. On evaluation, the patient was diagnosed to have scrub typhus pneumonia without any characteristic eschar. The condition was associated with pleural effusion, and it was drained. Azithromycin was used as the drug of choice due to the peripartum status of this patient. The patient improved due to early detection and multidisciplinary timely care. The safe outcome of this near-miss case suggests that fever profile workup, especially in scrub typhus endemic areas, should include scrub typhus testing even if classical signs are absent in the peripartum period.
PubMed: 36949983
DOI: 10.7759/cureus.35142 -
Cureus Feb 2023Introduction Pregnancy is an altered immunological state and not necessarily an immune-compromised state. These immune changes subject pregnant women to increased...
Pregnancy Outcomes in Women With SARS-CoV-2 Infection During the First and Second Waves of the COVID-19 Pandemic in a Tertiary Care Hospital in Ayodhya, Uttar Pradesh, India: A Comparative Study.
Introduction Pregnancy is an altered immunological state and not necessarily an immune-compromised state. These immune changes subject pregnant women to increased susceptibility to infection. During the coronavirus disease 2019 (COVID-19) pandemic, pregnant women were more susceptible to serious illness for reasons other than their immune response. The purpose of this study was to compare the feto-maternal outcome (morbidity and mortality) in relation to pre-existing maternal co-morbidities, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-related disease severity, and its impact on the mode of delivery and long-term sequelae in pregnant women in the first and second waves of the COVID-19 pandemic. Materials and methods This was a hospital-based comparative study carried out on 101 pregnant patients during the first wave (April 2020 to December 2020) and 22 patients in the second wave (March 2021 to July 2021) of the COVID-19 pandemic, in Rajashri Dashrath Autonomous State Medical College, Ayodhya, India. All pregnant women with COVID-19 in the first and second waves were included. Non-pregnant patients with COVID-19 infection, pregnant patients lost to follow-up, pregnant patients without COVID-19 infection, and patients in the puerperal period were excluded. Results Seventy-three (72.27%) patients in the first wave and 12 (54.54%) in the second wave were asymptomatic. Those with mild disease numbered 20 (25.74%) in the first wave and six (27.27%) in the second wave. Disease severity was more in the second wave, that is four (18.18%) as compared to one (0.99%) in the first wave. Severe anemia was the most common co-morbidity associated with both first (n=4, 3.96%) and second (n=5, 22.72%) waves. Four (6.45%) spontaneous abortions occurred in the first wave as compared to three (20%) in the second wave. Intensive care unit (ICU) admission was more in the second wave (n=4, 26.66%) as compared to the first wave (n=1, 1.61%). Two (13.33%) maternal deaths occurred in the second wave and none in the first wave. Cesarean sections in both the first and second waves were performed for obstetric indications only. No newborns tested positive in the COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) in the first and second waves at the time of birth; however, three (4.83%) tested positive on day five of birth in the first wave. Fever was the most common presentation in newborns; seven (11.26%) in the first wave and three (20%) in the second wave. No neonatal death occurred in the first or second waves. No congenital anomalies were noted in the first or second waves of COVID-19. Conclusion In this study, we found that the maximum number of COVID-19-positive pregnant patients in both the first and second waves of COVID-19 were either asymptomatic or had mild infections. Second-wave infection was more lethal as compared to the first wave in terms of adverse maternal as well as fetal outcomes. No gestational age was an exception to the severity of disease and its adverse feto-maternal outcome. In our study, maternal co-morbidities did not impact the overall outcome. All cesarean sections were performed for indications other than COVID-19 infection. Long-term sequelae associated with COVID-19 were seen in both groups but more so in the second wave. No long-term sequelae like congenital anomalies in the babies were associated with COVID-19 either in the first or second wave.
PubMed: 36938274
DOI: 10.7759/cureus.34969 -
BMJ Open Mar 2023Delivering women and neonates are at a great risk of acquiring infections due to a lack of adherence to infection prevention and control (IPC), a low level of immunity...
Healthcare workers' level of adherence to infection prevention and control and its impact on puerperal and neonatal sepsis among delivering women and neonates in Central Tanzania: a protocol for a prospective cohort study.
INTRODUCTION
Delivering women and neonates are at a great risk of acquiring infections due to a lack of adherence to infection prevention and control (IPC), a low level of immunity and extended exposure to care procedures that can lead to infections. This prospective cohort study aims to assess the level of adherence to IPC among healthcare workers and its impact on puerperal and neonatal sepsis in the Dodoma region.
METHODS AND ANALYSIS
The level of adherence to IPC is examined cross-sectionally among healthcare workers (HCWs) in contact with delivering women and their neonates. A prospective cohort approach is used to assess the level of exposure of 294 delivering women and their neonates to poor hygienic practices of HCWs through an observation checklist. Outcomes, including the incidence of puerperal and neonatal sepsis, are evaluated clinically 2 days later before discharge. Laboratory culture and sensitivity confirmatory tests of blood samples are done on positive cases. Data analysis for level of adherence to IPC practices, incidence of puerperal and neonatal sepsis, and relative risk among the exposed women and neonates will be performed.
ETHICS AND DISSEMINATION
The University of Dodoma Research Ethics Committee approved this study (ref no. MA.84/261/'A'/25). Findings of this study will be published in international peer-reviewed journals and disseminated at international conferences to the participating hospitals, the University of Dodoma and the Tanzanian Ministry of Health for informing practice and policy.
Topics: Infant, Newborn; Humans; Female; Neonatal Sepsis; Tanzania; Prospective Studies; Health Personnel; Infection Control
PubMed: 36918240
DOI: 10.1136/bmjopen-2022-066701