Placental inflammation and perinatal outcome

Objective: To examine the role of placental inflammation in adverse obstetrical outcome (AOO). Methods: Analysis of perinatal data of 701 randomly selected mothers of singleton infants, Mombasa, Kenya. Results: There were 661 (94.3%) live infants and 40 (5.7%) stillbirths. Out of the live born infants, 78 (12.4%) had a low birth weight (LBW \u3c 2500 g); 33 of them were preterm and 41 small for gestational age (SGA). The incidence of neonatal sepsis and post partum endometritis was 3.6 and 19.8%, respectively. The perinatal death rate was estimated to be 7.3% (51/701). The prevalence of acute placental inflammation was 19.6%. Acute placental inflammation was independently associated with preterm low birth weight (ARR=3.8, 95% CI=1.7–8.9, P\u3c0.01), stillbirth (ARR=2.3, 95% CI=1.1–5.0, P=0.03) and perinatal death (ARR=2.8, 95% CI=1.4–5.4, P\u3c0.01). Women with acute placental inflammation had a two-fold higher risk for AOO (32.6 versus 15.2%, respectively, ARR=2.5, 95% CI=1.3–4.8, P\u3c0.01). Other risk factors for AOO were bad obstetrical history, low haemoglobin level and leucocytosis. Conclusions: The incidence of adverse obstetrical outcome defined as low birth weight, low Apgar score, perinatal mortality and post partum endometritis, was high in this population. Acute placental inflammation was associated with preterm birth, stillbirth and perinatal death. More research is needed to study the role of infection in adverse obstetrical outcome, and to design interventions to decrease infectious morbidity and mortality in pregnancy

Placental malaria and perinatal transmission of human immunodeficiency virus type 1

Prevalence of placental malaria in human immunodeficiency virus (HIV) type 1–infected and –uninfected women and the effect of placental malaria on genital shedding and perinatal transmission of HIV-1 were examined. Genital samples for HIV-1 DNA RNA were collected during labor. Infants were tested for HIV-1 at 1 day and 6 weeks postpartum. Placental malaria was diagnosed by histopathological examination: 372 placentas of HIV-1–infected women and 277 of HIV-1–uninfected women were processed. A higher prevalence of placental malaria was seen in HIV-1–infected women. No association was found between placental malaria and either maternal virus load, genital HIV-1 DNA, or HIV-1 RNA. Placental malaria did not correlate with in utero or peripartal transmission of HIV-

Placental malaria and perinatal transmission of human immunodeficiency virus type 1

Prevalence of placental malaria in human immunodeficiency virus (HIV) type 1–infected and –uninfected women and the effect of placental malaria on genital shedding and perinatal transmission of HIV-1 were examined. Genital samples for HIV-1 DNA RNA were collected during labor. Infants were tested for HIV-1 at 1 day and 6 weeks postpartum. Placental malaria was diagnosed by histopathological examination: 372 placentas of HIV-1–infected women and 277 of HIV-1–uninfected women were processed. A higher prevalence of placental malaria was seen in HIV-1–infected women. No association was found between placental malaria and either maternal virus load, genital HIV-1 DNA, or HIV-1 RNA. Placental malaria did not correlate with in utero or peripartal transmission of HIV-

Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field?

Untreated maternal syphilis during pregnancy will cause adverse pregnancy outcomes in more than 60% of the infected women. In Nairobi, Kenya, the prevalence of syphilis in pregnant women of 2.9% in 1989, showed a rise to 6.5% in 1993, parallel to an increase of HIV-1 prevalence rates. Since the early 1990s, decentralized STD/HIV prevention and control programmes, including a specific syphilis control programme, were developed in the public health facilities of Nairobi. Since 1992 the prevalence of syphilis in pregnant women has been monitored. This paper reports the findings of 81,311 pregnant women between 1994 and 1997. A total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7–7.7) in 1994, 7.3% (95% CI: 6.9–7.7) in 1995, 4.5% (95% CI: 4.3–4.8) in 1996 and 3.8% (95% CI: 3.6–4.0) in 1997. In conclusion, a marked decline in syphilis seroprevalence in pregnant women in Nairobi was observed since 1995–96 (P \u3c 0.0001, Chi-square test for trend) in contrast to upward trends reported between 1990 and 1994–95 in the same population