Browsing by Subject "pregnancy"

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    Hypoxaemia during tracheal intubation in patients with hypertensive disorders of pregnancy: analysis of data from an obstetric airway management registry
    (2021) Smit, Maretha Isabel; Hofmeyr, Ross; du Toit, Leon; Dyer, Robert A
    Background In South Africa, hypertensive disorders of pregnancy are the leading cause of maternal mortality. More than 50% of anaesthesia-related deaths are attributed to complications of airway management. We compared the prevalence and risk factors for hypoxaemia (SpO2<90%) during induction of general anaesthesia in parturients with and without hypertensive disorders of pregnancy. We hypothesised that hypertensive disorders of pregnancy are associated with desaturation during tracheal intubation. Methods Data from 402 cases in a multicentre obstetric airway management registry were analysed. The prevalence of peri-induction hypoxaemia (SpO2<90%) was compared in patients with and without hypertensive disorders of pregnancy. Quantile regression of SpO2 nadir was performed to identify confounding variables associated with, and mediators of hypoxaemia.Results In the cohort of 402 cases, hypoxaemia occurred in 19% with and 9% without hypertension (estimated risk difference, 10%; 95% CI 2% to 17%; P=0.005). Quantile regression demonstrated a lower SpO2 nadir associated with hypertensive disorders of pregnancy as body mass index increased. Room-air oxygen saturation, Mallampati grade, and number of intubation attempts were associated with the relationship. Conclusions Clinically significant oxygen desaturation during airway management occurred twice as often in patients with hypertensive disorders of pregnancy, compounded by increasing body mass index. Intermediary factors in the pathway from hypertension to hypoxaemia were also identified.
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    Perinatal Mental Health project
    (2014-09-29) Honikman, Simone; Baron, Emily; Field, Sally; Meintjies, Ingrid; van Heyningen, Thandi
    The Perinatal Mental Health Project (PMHP) addresses mental illness among pregnant and postnatal women and girls. The aim of PMHP is to ensure all women in South Africa have access to mental health care during and after pregnancy, as a routine part of their health care. Maternal mental illnesses, particularly common mental disorders such as depression and anxiety, are very common in low-income and informal settings. While maternal mental illness affects 10% to 15% of women in developed countries, prevalence is almost 40% in South Africa. Most of the women in South Africa who experience maternal mental illness are poor, from disadvantaged communities who face many challenges in accessing health services and treatment.
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    Protein clearances and renal protein selectivity in the proteinurias of pregnancy
    (1971) Simanowitz, Milton David; McClure Brown J C
    Ever since the association between altJ.Jminuria and eclampsia was noted by Lever in 1843, the kidney has figured in the forefront in the search for aetiological factors. Lever, who was a contemporary of Bright at Guy's Hospital, observed the close similarity in appearance between many of his eclamptic patients and patients with Bright's disease. Examination of the urine was the logical next step. Having fould albumin in nine out of ten eclamptic patients in whom the urine had been examined, he went on to exanine the urine of fifty "normal 11 controls, and (rather surprisingly, since one would have anticipated a proportion of unrecognised preeclamptic patients amongst these) found albumin to be absent in every case. Lever recognised the "transitory nature 11 of pregnancy proteinuria and concluded that the condition differed from the permanent proteinuria of Bright's disease.In the same month of the same year (1843), Simpson made a similar observation in Edinburgh regarding proteinuria and eclampsia. Whilst also recognising that albuminuria disappeared in those patients who survived, he never theless attributed the syndrome of albuminuria and convulsions to underlying Bright's disease. This was a view that persisted for some time despite its obvious inconsistencies. Carl Braun of Vienna endorsed this concept and the chapter dealing with albuminuria and eclampsia in his "Lerbuch" was translated and run as a series of articles in the Edinburgh Medical Journal (1856 57). In this work, Braun states firmly that eclampsia is a direct result of the uraemia resulting from poorly functioning kidneys. The kidney featured prominently in many subsequent theories on aetiology but the idea of primary renal disease being the origin of the process leading to eclampsia was shortlived.
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    Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions
    (BioMed Central Ltd, 2015) Sharma, Gaurav; Mathai, Matthews; Dickson, Kim; Weeks, Andrew; Hofmeyr, G; Lavender, Tina; Day, Louise; Mathews, Jiji; Fawcus, Sue; Simen-Kapeu, Aline; de Bernis, Luc
    BACKGROUND: Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. RESULTS: Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. CONCLUSIONS: Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.
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    Risk factors for substance use in pregnant women in South Africa
    (2012) Vythilingum, Bavanisha; Roos, Annerine; Faure, Sheila C; Geerts, Lut; Stein, Dan J
    Objectives. To study the prevalence of alcohol and substance use in a South African antenatal population and its correlates with socio-demographic factors, depression and perceived stress. Methods. A prospective self-report study on all women presenting for their first antenatal visit who consented to the study at a midwife obstetric unit (MOU) in the East Metropole district, Cape Town, using the Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Edinburgh Depression Scale (EDS) and Perceived Stress Scale (PSS). Statistical analyses using the chi-square test, separate one-way analyses of variance (ANOVA) and logistic regression analyses were performed as appropriate. Outcome measures were depression, alcohol use and substance use. Results. The questionnaire was completed by 323 women. During pregnancy 36.8% of women smoked, 20.2% used alcohol and 4% used substances. Using EDS cut-off scores of 12 and 15, respectively, 48.9% and 33.6% of the sample had scores consistent with major depression. An EDS cut-off score of 12 was significantly associated with both alcohol use (25.9% v. 15.2%, p=0.019) and risky drinking (76.9% v. 36.8%, p=0.04), while an EDS cut-off score of 15 was significantly associated with substance use (8.2% v. 1.4%, p=0.004) as well as alcohol dependence (23.1% v. 3.1%). Conclusions. We found high rates of both alcohol abuse and antenatal depression, and a significant association between depression, substance use and alcohol abuse; EDS scores greater than 12 could be used to identify women at risk of alcohol dependence and/or substance abuse.
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    Role of antiretroviral therapy exposure host genetics on cytomegalovirus infection status and association with gut microbiome profiles among pregnant black African women
    (2020) Mhandire, Doreen Zvipo; Dandara, Collet
    Cytomegalovirus (CMV) is an important antenatal infection that is prevalent in the developing world. The disabling and potentially fatal effects of CMV acquisition or reactivation during pregnancy on the developing foetus and or neonate are known but, factors predisposing pregnant women to CMV are not well studied. CMV has a wide host cell tropism that includes gut epithelial cells. CMV infection in the gut epithelial cells results in a leaky gut and potential gut microbial dysbiosis. In this study, we set out to determine the prevalence of CMV infection as well as factors associated with CMV reactivation in a cohort of pregnant Zimbabwean women. We also aimed to determine the role of CMV infection and CMV susceptibility host genetics on gut bacterial profiles. Seroprevalence of CMV was determined using the enzyme-linked immunosorbent assay. A high prevalence of previous exposure to CMV, as denoted by the presence of anti-CMV IgG antibodies in participants' sera, was observed. Anti-CMV IgM antibodies that denote active CMV infection were detected in the sera of 4.6% (n=35/524) study participants. Prevalence of CMV was also determined using real time PCR, CMV reactivation was higher (6.7%) when using PCR than when using immunological assays (4.6%). The presence of CMV DNA was significantly associated with HIV positivity (p=0.04). PCR is the gold standard for CMV diagnosis, thus, CMV DNA positivity was used to denote CMV infection status in this thesis. The second objective was to determine if the differential effect of CMV acquisition or reactivation among HIV infected participants was due to variability in plasma efavirenz containing antiretroviral therapy (ART) exposure. Efavirenz (EFV) plasma concentrations were determined using high performance liquid chromatography (HPLC). Single nucleotide polymorphisms (SNPs) in the CYP2B6 gene, which encodes the main EFV metabolizing enzyme were genotyped. Carriers of CYP2B6 poor metaboliser (PM) genotypes (c.516T/T and c.983T/C) had significantly higher mean plasma EFV concentration compared to carriers of CYP2B6 fast metabolizer genotypes (i.e., c.516G/G and c.983T/T). CYP2B6 PM genotype carriers were significantly less likely to be positive for CMV DNA when compared with fast metabolizer genotype carriers (pC (p=0.002), TLR7 rs179008A>C (pC (p=0.003). In contrast, presence of the IL6 rs10499563T>C polymorphism was inversely correlated with CMV infection (p=0.002). The reported genetic variants are reported to modulate proteins involved in immune responses against viral infections, thus, their association with susceptibility to CMV infection. Such findings may assist in the designing of a muchneeded candidate CMV vaccine. Lastly, we set out to determine the possible role of CMV infection in shaping gut microbiota profiles. We report on a significant difference (p=0.001) in the beta diversity of gut bacterial profiles between HIV- and age-matched CMV-infected (cases) and CMVuninfected (controls) participants. Using linear discriminant analysis (LDA) effect size (LefSe), significant differences in the relative abundance of specific bacterial taxa were observed between cases and controls (p2). Significantly lower abundance of Lactobacillus reuteri and Roseburia, genera associated with lower microbial translocation was observed in cases than controls. Lower relative abundance of Lactobacillus and Roseburia, is consistent with microbial translocation and heightened inflammation, respectively, hence higher likelihood of microbial translocation and inflammation occurring in cases than controls. Furthermore, Prevotella copri, a species that has been association with cytokine release and chronic inflammation was significantly more abundant in cases than controls. CMV is a known chronic inflammatory condition, and this study provides further confirmation through the higher relative abundance of P.copri in cases than controls. Biomarker identification has proven to be a successful means of translating molecular data into clinical practice, such as vaccine development in the case of CMV infection. Overall, this study reports the possible interaction of various host factors in facilitating CMV acquisition or reactivation during pregnancy. In the setting of HIV-CMV coinfection, our findings emphasise on the need for genotype guided drug dosage to achieve therapeutic EFV so as to maintain the balance between host and coinfecting microbes in HIV management. Comprehensive genotype guided drug dosage, if taken as a once-off test should be affordable especially in resource-limited settings. This is particularly important in pregnant women who are at a risk of vertically transmitting infection to the immunologically immature foetus and or neonate. Data from this study may assist in curbing the host associated challenges in designing an effective CMV vaccine. Moreover, the biomarkers reported may assist in diagnosis and management of potential CMV acquisition or reactivation during pregnancy. However, bigger prospective, functional studies would be needed to confirm the exact roles of the biomarkers identified in this study in the diagnosis, prognosis and therapeutics of CMV infection.
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    The anaemia of pregnancy: A report on the haematological study of 48 cases of pregnancy, with review of the literature
    (1941) Elliott, G A
    Studies of anaemia occurring during pregnancy have been of two main types. The first type, from which information of great value has been collected, is the mass survey of large series of cases. Studies of such a nature have the disadvantage that the less common varieties of pregnancy anaemia are pooled amongst the more common, a feature which is largely responsible for the perpetuation of traditional rather than factual ideas on the subject of these less common forms. The second type of study, of which the present is an example, consists of a more intensive and detailed investigation of individual cases with the main purpose of interpreting pathogenesis in terms of deviation from that which is physiological. Anaemia and pregnancy are common associations. It is important to distinguish between anaemia which is apparently due to pregnancy and anaemia which is associated coincidentally with pregnancy. In the present enquiry, the phrase "anaemia during pregnancy" generically denotes that a case is pregnant and anaemic at the same time. " Anaemia of pregnancy" and "pregnancy anaemia" are used synonymously to indicate that the anaemia is conditioned directly by pregnancy; it is perhaps too strong to refer to such anaemia as being due to pregnancy. ". Anaemia complicated by pregnancy" indicates that pregnancy occurs coincidentally with some disorder of the blood which ordinarily occurs quite apart from and is quite unrelated to pregnancy. The present investigation has sought to establish normal standards for the less commonly noted physical features of red cell fragility and red cell size during normal pregnancy, and to investigate these features in mild and severe grades of anaemia during pregnancy, followed through to the puerperium. At the same time, full haematological investigations were carried out and the results of various types of treatment followed. The type of response to treatment was used as an important aid to the diagnosis of the type of anaemia. That the investigation of the red cell fragility in pregnancy might afford information of value was suggested by Dr. J.M. Vaughan on the evidence of a single case under 2 her own observation some time previously in which the fragility was increased. The observations of Cassells (1938) also suggested that with an accurate technique for fragility estimation the red cells during pregnancy could be shown to behave differently from other forms of anaemia as regards their fragility. As no controlled work had been published on the subject, it was necessary to establish standards of red cell fragility for pregnancy uncomplicated by anaemia, and to compare these standards with the findings in pregnancy complicated by anaemia. On the assumption that red cell fragility is at least in part related to red cell thickness (Haden, 1934, Dacie and Vaughan, 1938), estimations of mean cell volume and mean cell diameter were an essential part of the investigation. Red cell counts, haemoglobin estimations, reticulocyte counts, white cell counts, and estimation of plasma bilirubin were part of the routine investigation.