Maternal and Perinatal Outcomes in women with Hepatitis B Carrier State | Author : Meei Jiun Seet | Abstract | Full Text | Abstract :Introduction
Hepatitis B is the most common form of viral hepatitis. Much has been done for the prevention of Hepatitis B transmission from mother to child. However, there is still very limited evidence looking at maternal obstetrics and perinatal outcomes, such as gestational diabetes, antepartum haemorrhage and preterm labour, hypertensive disorders in pregnancy and small for gestational age, with Hepatitis B infected women. These adverse pregnancy outcomes, if significant, may affect future antenatal care and have a negative impact on public health. This study aims to determine the association between these adverse pregnancy and neonatal outcomes with maternal Hepatitis B carrier state.
Methods
This is a retrospective cohort study comparing adverse pregnancy and neonatal outcomes in primigravid women who delivered singleton babies after 24 completed weeks of gestation and are carrier for Hepatitis B virus with those who are non-carrier for Hepatitis B virus, between 1992 and 2013 in Aberdeen Maternity Hospital. The adverse pregnancy and neonatal outcomes studied include hypertensive disorders in pregnancy, antepartum haemorrhage, preterm birth <37 weeks, induction of labour, caesarean delivery, low birth weight and admission to neonatal unit. Data was extracted from the Aberdeen Maternity and Neonatal Databank (AMND), which was established in 1950 to record all pregnancy-related events occurring in Aberdeen city and district in the northeast of Scotland. Statistical analysis was done with SPSS version 21 using independent samples t-test for normally distributed continuous variables and chi-squared test for categorical variables. Multivariate logistic regression analysis using a multilevel random effects regression model was also conducted to adjust for confounding factors.
Results
The data set contained a sample size of 35116 primigravid women with singleton pregnancies, with 59 being carrier for Hepatitis B virus (represented by positive HBsAg status). HBsAg-positive women had significantly lower mean Body Mass Index and were more likely to be from the manual social class (registrar general’s occupation-based social class). On unadjusted analysis, there were no significant differences in the prevalence of all maternal and perinatal outcomes in both groups. However, after adjusting for confounding factors, HBsAg-positive women were more likely to have smaller babies (aOR 4.28; 95% CI 1.57-11.66).
Conclusion
Our study suggested higher frequencies of low birth weight babies in women with hepatitis B infection. We found no statistically significant differences in other adverse pregnancy and perinatal outcomes. As current evidence still shows inconsistent results, further research evaluating the possible effects of Hepatitis B viraemia on pregnancy outcomes is justified. |
| Direct and Indirect Effects of Janani Suraksha Yojana on Antenatal Care and Institutional Delivery | Author : Mohammad Mahbubur Rahman | Abstract | Full Text | Abstract :Janani Suraksha Yojana (JSY) provides conditional cash incentives to eligible pregnant women in India so that they can take at least three antenatal care services including tetanus injection and iron-folic acid, to deliver their babies in health institutions, and to take at least one postnatal service for them and their neonatal babies. We examine its effects on antenatal care and the institutional delivery. We also decompose effects into direct and indirect categories, deriving parameters from the theoretical model, then estimating them using several regression methods including the propensity score matching. We use the fourth round of the District Level Household Survey (DLHS), which has an advantage over the previous waves of DLHS. |
| Catheter-Associated Urinary Tract Infections: Diagnosis, Treatment, and Prevention | Author : Karen Clarke | Abstract | Full Text | Abstract :The most common type of healthcare-associated infection (HAI) is a urinary tract infection (UTI), and 80 percent of these are associated with the use of indwelling urinary catheters (IUCs). These are termed catheter-associated urinary tract infections (CAUTIs). It has been estimated that about 25 percent of all hospitalized patients have an IUC placed during their hospital stay. In addition to the morbidity and mortality that may be associated with a CAUTI, there are also financial consequences. This is particularly true since as of October 1, 2008, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for several types of infections acquired during a hospital stay, including CAUTIs. In United States (U.S.) the estimated annual cost of treating these CAUTIs is $350 million. It has been proposed that a large percentage of CAUTIs should be preventable. This article will discuss the diagnosis, treatment, and prevention of CAUTIs |
| Management of endometrial polyps | Author : Vasilios Tanos | Abstract | Full Text | Abstract :The epidemiology of endometrial polyps is reported to be between 7.8 and 50% of women. The range remains quite broad and inconsistent due to confounding study factors such as the method of research, population studied, histological type and anatomical location of polyps. The development of polyps is influenced by a multitude of genetic and epigenetic factors. Chromosomes 6,7 and 12 are incriminated in this process. A fraction of these polyps may undergo malignant transformation, most commonly in postmenopausal patients. 3D ultrasound (US) and hysterosalpingo-contrast-sonography (HyCoSy) provide an accurate diagnosis and location of endometrial polyps (EPs). Expectant management is recommended when the polyp is up to 10mm in length, in asymptomatic young patients. When indicated, hysteroscopic removal of polyps can be performed as an outpatient without requiring a general anaesthetic. The use of a small tip diameter hysteroscope and 5Fr instruments offers safe, efficient and low-cost treatment. The hysteroscopic morcellator and shaver are the best surgical option for bigger polyps since it is a quick and time-effective method with the technique easily learned by surgeons. |
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