2 research outputs found
Risk factors for adverse outcomes in women with high-risk pregnancy and their neonates, Haiti
Objectives. To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)
eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales,
an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse
pregnancy outcomes.
Methods. We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence
des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were
age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services.
Results. A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204
(0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%)
low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated
pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending
antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55–6.55) and low birthweight (OR 1.40; 95% CI 1.05–1.86) for women with complicated
pregnancies.
Conclusion. To prevent and treat pregnancy complications as early as possible, antenatal care attendance
is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant
women in Haiti is recommended
Rectal screening displays high negative predictive value for bloodstream infections with (ESBL-producing) gram negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.
Objectives
We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti.
Methods
We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis.
Results
We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4–28.0%] and 20.6% (95% CI 16.0–26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%.
Conclusions
The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile