Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study

Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection and may influence pregnancy outcome. This study was conducted to assess the effect of chlamydial infection during pregnancy on premature delivery and birthweight. Pregnant women attending a participating midwifery practice or antenatal clinic between February 2003 and January 2005 were eligible for the study. From 4,055 women self-administered questionnaires and urine samples, tested by PCR, were analysed for C. trachomatis infection. Pregnancy outcomes were obtained from midwives and hospital registries. Gestational ages and birthweights were analysed for 3,913 newborns. The C. trachomatis prevalence was 3.9%, but varied by age and socio-economic background. Chlamydial infection was, after adjustment for potential confounders, associated with preterm delivery before 32 weeks (OR 4.35 [95% CI 1.3, 15.2]) and 35 weeks gestation (OR 2.66 [95% CI 1.1, 6.5]), but not with low birthweight. Of all deliveries before 32 weeks and 35 weeks gestation 14.9% [95% CI 4.5, 39.5] and 7.4% [95% CI 2.5, 20.1] was attributable to C. trachomatis infection. Chlamydia trachomatis infection contributes significantly to early premature delivery and should be considered a public health problem, especially in young women and others at increased risk of C. trachomatis infection

Observations on reproductive health programs in the baltic States.

Public attention in Sweden has been drawn to three neighboring states that recently joined the European Union: Estonia, Latvia, and Lithuania. At this historic moment, it seems instructive to look at how the rapidly reformed health sectors of these ex-Soviet republics are responding to the vision of reproductive health articulated in Cairo 10 years ago. Reproductive health and rights have improved in these states in spite of recent reforms often acting to oppose improvement. Reforms such as the introduction of family medicine need continued adjustment, especially regarding antenatal care. One special challenge is the retention of essential mid-level providers, such as midwives, as the mode of HIV transmission becomes increasingly sexual

The global maternal sepsis study and awareness campaign (GLOSS): study protocol

Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis.This is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days.GLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action

Lithuania’s experience in reducing caesarean sections among nulliparas

Abstract Background To evaluate the role of the TGCS to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate by using this tool. Methods The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The CS rate overall and in each Robson group was calculated and the results were discussed. The analysis was repeated in 2014 and the data from the selected hospitals were compared using MS EXCEL and SPSS 23.0. Results Nulliparas accounted for 43% (3746/8718) and 44.6% (3585/8046) of all the deliveries in 2012 and 2014 years, respectively. The CS rate among nulliparas decreased from 23.9% (866/3626) in 2012 to 19.0% (665/3502) in 2014 (p < 0.001).The greatest decrease in absolute contribution to the overall CS rate was recorded in groups 1 (p = 0.005) and 2B (p < 0.001). Perinatal mortality was 3.5 in 2012 and 3.1 in 2014 per 1000 deliveries (p = 0.764). Conclusion The TGCS can work as an audit intervention that could help to reduce the CS rate without a negative impact on perinatal mortality

Correlation of sonographic characteristics and pathomorphological findings in cases of early-stage cervical cancer: preliminary results.

Objectives: To correlate the sonographic two-dimensional (2D) gray-scale features with pathological findings in early-stage invasive cervical cancer. Methods: Eighteen patients with biopsy-confirmed invasive cervical carcinoma (stages IB1 IIA according to FIGO staging) who underwent surgery were enrolled in the study. Transvaginal 2D gray-scale sonography was performed in all of them at the Hospital of Kaunas University of Medicine prior to hysterectomy. The largest diameters of tumor mass, tumor shape, tumor area, as well as the deepest cervical stromal invasion and the largest thickness of tumorfree cervical stroma in sagittal and axial planes were correlated with their pathomorphological equivalents using Pearson correlation coefficients. Toshiba NICE and Canvas X Scientific Edition software packages were employed for the analysis and correlation of sonographic and pathomorphological images. The interobserver variability was evaluated by having two blinded sonologists interpret each examination and calculating kappa statistics. The intraobserver variability was assayed in nine patients at 24-h intervals. Results: At 2D gray-scale analysis 15 patients (83%) showed detectable tumor masses. The largest diameters of the tumor mass (maximum length, depth and width) measured at sonographic and pathomorphological examinations correlated well (R = 0.87, R = 0.89 and R = 0.76, respectively). The largest tumor area measured in both sagittal and axial planes also showed a strong correlation (R = 0.78 and R = 0.84, respectively). Poor correlation was seen in the deepest cervical stromal invasion (R = 0.14). A discrepancy of more than 10% of the tumor shape in the sagittal plane seen during sonography and pathomorphological examination occurred in seven cases (47%). Conclusions: Two-dimensional gray-scale sonography is accurate in the assessment of early-stage cervical cancer. This method should be considered in all patients with early-stage cervical cancer scheduled for radical treatment