Dengue Infection and Miscarriage: A Prospective Case Control Study

Dengue is the most prevalent mosquito-borne infection with two billion of the world's population at risk and 100 million infections every year. Dengue is increasingly important due to expansion in the vector's range, increased population density in endemic areas from urbanisation, social and environment change. Miscarriage and stillbirth is associated with dengue when the illness is severe. Dengue can also be transmitted directly from the ill mother through the placenta to the fetus in later pregnancy with variable effect to the fetus. However, dengue infection is asymptomatic to mild only in almost 90% of cases and up to 20% of pregnancies miscarry. Little is known if dengue infection in early pregnancy particularly when it is asymptomatic or mild has an effect on miscarriage. Our study explored the relationship between dengue and miscarriage by looking at recent infection rates amongst women who had miscarried and those whose pregnancies were healthy in an area were dengue is common. Our study finds a positive association between recent dengue infection and miscarriage. This finding may be important in explaining some of the miscarriages in areas where dengue is common. It is also relevant to newly pregnant women from non-dengue travelling to dengue endemic areas

Obstetric Emergencies

<p>Life Saving, The obstetric patient is unique in medicine as two or more lives are involved with the challenge of needing to balance the sometimes conflicting interests of the mother and her fetus within a pregnant physiology.</p

Obstetric Emergencies

<p>Life Saving, The obstetric patient is unique in medicine as two or more lives are involved with the challenge of needing to balance the sometimes conflicting interests of the mother and her fetus within a pregnant physiology.</p

Dengue Infection and Miscarriage: A Prospective Case Control Study

<p>Abstract<br>Background: Dengue is the most prevalent mosquito borne infection worldwide. Vertical transmissions after maternal<br>dengue infection to the fetus and pregnancy losses in relation to dengue illness have been reported. The relationship of<br>dengue to miscarriage is not known.<br>Method: We aimed to establish the relationship of recent dengue infection and miscarriage. Women who presented with<br>miscarriage (up to 22 weeks gestation) to our hospital were approached to participate in the study. For each case of<br>miscarriage, we recruited 3 controls with viable pregnancies at a similar gestation. A brief questionnaire on recent febrile<br>illness and prior dengue infection was answered. Blood was drawn from participants, processed and the frozen serum was<br>stored. Stored sera were thawed and then tested in batches with dengue specific IgM capture ELISA, dengue non-structural<br>protein 1 (NS1) antigen and dengue specific IgG ELISA tests. Controls remained in the analysis if their pregnancies continued<br>beyond 22 weeks gestation. Tests were run on 116 case and 341 control sera. One case (a misdiagnosed viable early<br>pregnancy) plus 45 controls (39 lost to follow up and six subsequent late miscarriages) were excluded from analysis.<br>Findings: Dengue specific IgM or dengue NS1 antigen (indicating recent dengue infection) was positive in 6/115 (5?2%)<br>cases and 5/296 (1?7%) controls RR 3?1 (95% CI 1?0–10) P = 0?047. Maternal age, gestational age, parity and ethnicity were<br>dissimilar between cases and controls. After adjustments for these factors, recent dengue infection remained significantly<br>more frequently detected in cases than controls (AOR 4?2 95% CI 1?2–14 P = 0?023).<br>Interpretation: Recent dengue infections were more frequently detected in women presenting with miscarriage than in<br>controls whose pregnancies were viable. After adjustments for confounders, the positive association remained.</p> <p> </p

Users&amp;rsquo; perspectives on Implanon in Malaysia, a multicultural Asian country

Asmah Mastor, Si Lay Khaing, Siti Zawiah Omar Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, MalaysiaBackground: The primary objective of this study was to evaluate Malaysian women&amp;rsquo;s &amp;not;perception, acceptance, and views on Implanon&amp;reg; as a contraceptive method. We also aimed to identify women who favor Implanon, their vaginal bleeding patterns, nonmenstrual adverse events, reasons for discontinuation, and effect of Implanon on breastfeeding.Study design: This study followed up 140 women after insertion of Implanon at the University of Malaya Medical Centre by examination of their medical records and telephone interviews. User profile, discontinuation rate, reasons for choice of Implanon, discontinuation, menstrual and nonmenstrual side effects, and satisfaction rate were assessed.Results: The average age of users was 34.7 years, and 94.2% were para 2 and above. The ethnic distribution of the women reflected that of the general Malaysian population. The majority had at least secondary education (94.2%), with 41.2% having a higher degree. All of the users reported that they chose Implanon because it does not need compliance, and 72.1% felt that Implanon was cost-effective in the long term. Most users (70%) reported irregular menses and this was the main reason given for discontinuation. The vast majority reported an overall decrease in menstrual blood loss. Almost half (46%) suffered prolonged bleeding/spotting, and infrequent bleeding was experienced by 71 users (50.7%). Half of the women did not experience any nonmenstrual adverse events. The commonest complaint was weight gain, with the next most common complaints being hair loss, acne, headache, nausea, mood swings, and reduced libido. Most of the nursing mothers denied a reduction in breast milk. There was a high mean satisfaction score with Implanon.Conclusion: Implanon is well accepted by Malaysian women despite a high incidence of irregular bleeding which was found to be a major concern among women who discontinued the implant.Keywords: implanon, contraception, implant, etonogestre

Differential expression of the receptors for thyroid hormone, thyroid stimulating hormone, vitamin D and retinoic acid and extracellular signal-regulated kinase in uterus of rats under influence of sex-steroids

Sex-steroids play important role in modulating uterine functions. We hypothesized that these hormones affect expression of proteins in the uterus related to thyroid hormone action. Therefore, changes in expression levels of receptors for thyroid hormone (TRα-1 and TRβ-1), thyroid stimulating hormone (TSHR), vitamin D (VDR) and retinoid acid (RAR) as well as extracellular signal-regulated kinase (ERK1/2) in uterus were investigated under sex-steroid influence. Methods: Two rat models were used: (i) ovariectomised, sex-steroid replaced and (ii) intact, at different phases of oestrous cycle. A day after completion of sex-steroid treatment or following identification of oestrous cycle phases, rats were sacrificed and expression and distribution of these proteins in uterus were identified by Western blotting and immunohistochemistry, respectively. Results: Expression of TRα-1, TRβ-1, TSHR, VDR, RAR and ERK1/2 in uterus was higher following estradiol (E2) treatment and at estrus phase of oestrous cycle when E2 levels were high. A relatively lower expression was observed following progesterone (P) treatment and at diestrus phases of oestrous cycle when P levels were high. Under E2 influence, TRα, TRβ, TSHR, VDR, RAR and ERK1/2 were distributed in luminal and glandular epithelia while under P influence, TSHR, VDR abn RAR were distributed in the stroma. Conclusions: Differential expression and distribution of TRα-1, TRβ-1, TSHR, VDR, RAR and ERK1/2 in different uterine compartments could explain differential action of thyroid hormone, TSH, vitamin D, and retinoic acid in uterus under different sex-steroid conditions

Characteristics of a total of 411 cases (confirmed miscarriages up to 22 weeks) and controls (pregnancies that remained viable beyond 22 weeks at follow up).

<p>Data displayed as number (%), mean ± standard deviation or median [interquartile range].</p>*<p>Analysis using Chi Square test (categorical data).</p>†<p>Included in logistic regression model.</p>‡<p>Analysis using Student t test (continuous data).</p>§<p>Analysis using Mann Whitney test (non-normal data distribution).</p>∥<p>Multivariable logistic regression analysis incorporating into the model recent dengue infection and adjusting for maternal age, gestational age, parity, and ethnicity, characteristics which are significantly associated with pregnancy miscarriage on bivariate analyses. Maternal age, gestational age and parity were entered as continuous variable and recent dengue and ethnicity as categorical variables.</p

Characteristics of women with and without recent dengue infection.

<p>Data displayed as mean ± standard deviation, median [interquartile range] or number (%).</p>*<p>Defined as women whose sera were dengue IgM positive and/or dengue NS1 particle positive.</p>†<p>Analysis using Student t test (continuous data).</p>‡<p>Analysis using Mann Whitney U test.</p>§<p>Analysis using Fisher exact test (2 or more cells with numbers <5).</p>∥<p>Analysis using Chi Square test.</p