Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

Background Ectopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy. Methods This cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period. Results There was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%). Conclusions Our results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

Predictive Risk Factors for Mild and Severe Germinal Matrix Hemorrhage and Associated Neurodevelopmental Prognosis: A Retrospective Study

Aims: To compare commonly mentioned risk factors between mild germinal matrix hemorrhage-Intraventricular hemorrhage (GMH-IVH) (grade I & II) and severe GMH-IVH (grade III & IV) and to study the long-term neurodevelopmental outcomes in relation to severe GMH-IVH. Study Design: Retrospective cohort study. Place and Duration of Study: Neonatal intensive care unit, King Fahad University Hospital, between 2000 and 2020. Methodology: We included 54 premature infants at ≤36 weeks of gestation and with birth weight <2500g admitted to our neonatal intensive care unit. Premature neonates were divided into two subgroups: mild GMH-IVH (grade I and II) and severe (grade III and IV). We investigated the risk factors and neurodevelopmental outcomes in association with GMH-IVH. Results: Amnionitis (OR: 1.190, 95% CI 0.515-2.749), lower genital tract infection (OR: 1.190, 95% CI 0.515-2.749), antenatal infection (OR: 1.406, 95% CI 0.866-2.283), gestational diabetes mellitus (OR: 1.815, 95% CI 1.410-2.337), usage of inotropes (OR: 1.731, 95% CI 1.348-2.222), APGAR score <7 (OR: 0.806, 95% CI 0.493-1.316), birth trauma (OR: 1.767, 95% CI 1.396-2.236), catecholamines (OR: 1.470, 95% CI 0.903-2.393), intubation (OR: 1.300, 95% CI 0.686-2.464), asphyxia (OR: 1.135, 95% CI 0.718-1.794), Abnormal coagulation (OR: 1.197, 95% CI 0.756-1.896), congenital heart disease (OR: 1.727, 95% CI 1.124-2.653), low hematocrit (OR: 1.140, 95% CI 0.688-1.889), resuscitation (OR: 1,193, 95% CI 0.748- 1.904) and ventriculoperitoneal (VP) shunt as a prognosis of hydrocephalus (P-value: 0.005) all showed a higher incidence with severe GMH-IVH Conclusion: Amnionitis, lower genital tract infection, antenatal infections, GDM, usage of inotropes, APGAR score <7, birth trauma, catecholamines, intubation, asphyxia, resuscitation, abnormal coagulation parameters, congenital heart disease, low hematocrit and hydrocephalus with VP shunt were higher in severe GMH-IVH.

Vaginal Microbiota, Genital Inflammation and Extracellular Matrix Remodelling Collagenase: MMP-9 in Pregnant Women With HIV, a Potential Preterm Birth Mechanism Warranting Further Exploration

BackgroundPregnant women living with HIV infection (PWLWH) have elevated rates of preterm birth (PTB) in which HIV and cART are implicated. PWLWH also have a high prevalence of adverse vaginal microbiota, which associate with genital tract inflammation. The mechanism underlying PTB in PWLWH is unknown. We present the first data in PWLWH on genital-tract matrix-metalloproteinase-9(MMP-9), an important collagenase implicated in labour onset, and tissue inhibitor of metalloproteinases-1(TIMP-1) and explore correlations with local inflammation and vaginal bacteria.Material and MethodsCervical vaginal fluid (CVF) collected by a soft cup and high vaginal swabs (HVS) were obtained from PWLWH and HIV uninfected pregnant women (HUPW) at three antenatal time points. Maternal characteristics, combination antiretroviral therapy (cART) exposure, and pregnancy outcome were recorded. Concentrations of MMP-9, TIMP-1 and ten cytokines were measured by immunoassays. Vaginal microbiota composition was determined through 16S rRNA amplicon sequencing. MMP-9, TIMP-1 and cytokine concentrations were compared by HIV status, cART, and prematurity and in PWLWH correlations with polymorphonuclear leucocytes, cytokines and bacterial genera were explored.ResultsCVF was available for 50 PWLWH (108 samples) and 12 HUPW (20 samples) between gestation weeks 14-38. Thirty-six PWLWH conceived on cART and 14 initiated post-conception. There were five and one PTB outcomes in PWLWH and HUPW respectively. PWLWH had higher mean CVF concentrations of MMP-9 (p&lt;0.001) and TIMP-1 (p=0.035) in the second trimester compared with HUPW with a similar trend in the third trimester. PWLWH also had higher CVF values of cytokines: IL-1β, IL-8, IL-12 and TNF-α in both trimesters compared to HUPW (p ≤ 0.003). In PWLWH, MMP-9 positively correlated with TIMP-1 (r=0.31, p=0.002) and CVF polymorphonuclear leucocytes (r=0.57, p=0.02). Correlations were observed between MMP-9 and three cytokines: IL-1β (r=0.61), IL-8 (r=0.57) and TNF-α (r=0.64), p&lt;0.001, similarly for TIMP-1. Abundance of anaerobic pathobionts correlated with MMP-9: Gardnerella (r=0.44, p&lt;0.001), Atopobium (r=0.33, p=0.005), and Prevotella genera (r=0.39, p&lt;0.001). Conversely proportion of Lactobacillus genera negatively correlated with MMP-9 (rho=-0.46, p&lt;0.001). MMP-9/TIMP-1 ratio increased with gestational age at sampling in PWLWH, but this was no longer significant after adjusting for confounders and no difference by prematurity was observed in this sub-study.ConclusionsHere we show strong correlations of MMP-9 to genital tract inflammation and sub-optimal bacterial genera in PWLWH indicating the ascending genital tract infection pathway may be a contributory mechanism to the high risk of PTB.

Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis

Background Puerperal sepsis is a genital tract infection that can occur from amniotic fluid rupture to six weeks after birth. Maternal complication associated with puerperal sepsis includes prolonged hospital stay, septicemia, disseminated intravascular coagulation, pelvic inflammatory disease, infertility, and death. Even though, puerperal sepsis is the fourth leading cause of maternal morbidity and mortality in Ethiopia the overall prevalence of puerperal sepsis and its associated factors are not studied at the national stage. As a result, this systematic review and meta-analysis bring out the pooled prevalence of puerperal sepsis and its associated factors in Ethiopia. Methods A variety of data sources such as Pub Med, Web of Science, Science Direct, Embase, Google Scholar, HINARI, and Ethiopian universities online repositories were searched to identify the primary studies which were used for this systematic review and meta-analysis. The article search was conducted from February10/2021-March 10/2021. The quality of the selected primary studies was assessed using the Newcastle - Ottawa quality assessment Scale (NOS). Data extraction was done with Microsoft Excel and then exported to STATA 11 version statistical software for analysis. The Cochran (Q-test) and I2 test statistics were used to assess the heterogeneity of the studies. Publication bias was evaluated by the eggers regression test. Subgroup analysis was performed with region and sample size category. Result In this review, a total of 2222 respondents were involved from seven studies. The pooled prevalence of puerperal sepsis was 14.811% (95%CI; 8.46: 21.16; I2 = 94.2, P ≤ 0.001). Cesarean section delivery (CSD) (OR = 3.26, 95%CI: 1.90, 5.61), membrane rupture≥24 h (OR = 4.04, 95%CI: 2.54, 6.42), being multiparous mother (OR = 3.99, 95%CI: 1.82, 8.78), vaginal examination≥5 times (OR = 3.15, 95%CI: 1.17, 8.52), and anemia (OR = 5.68, 95%CI: 4.38, 7.36) were factors significantly associated with puerperal sepsis. Conclusion The prevalence of puerperal sepsis was high in Ethiopia. CSD, membrane rupture≥24 h, being multiparous mother, vaginal examination≥5, and anemia were factors associated with puerperal sepsis. Appropriate standard infection prevention techniques during CSD shall be practiced to reduce the maternal burden of puerperal sepsis. The unnecessary vaginal examination should be discouraged during the intrapartum period. Besides this, routine Iron sulfate supplementation and counsel on iron reach foods during ante partum and postpartum shall be considered for all mothers.

Prevalence of Genitourinary Infections with Sodium Glucose Co-transporter-2 (sglt2) inhibitors in patients with type 2 diabetes

Objectives: The present study was conducted to observe the prevalence of urine and genital infections by the SGLT-2 inhibitors patients with type 2 diabetes Methods: This multi centre cross sectional study was conducted on type 2 diabetic patients using two different SGLT-2 inhibitors dapagliflozin and empagliflozin either as monotherapy or combination therapy over a period of 03 months from 02-02-2020 to 02-05-2020. The risk of urinary and genital tract infection was assessed on the basis of structured questionnaire performa and medical records. Results: Out of 615, 296(48%) patients were using dapagliflozin and 319(52%) were using empagliflozin. Male to female ratio in both group were i.e dapagliflozin: 65 %( 192) and 35 %( 104) empagliflozin 72 %( 230) and 28 %( 89%) respectively. The risk of urinary infection in dapagliflozin group was 4.3% while it was 6.5% in and empagliflozin. On the other hand the risk of genital tract infection was 3% in dapagliflozin and 4.3% empagliflozin respectively. The prevalence of genital infection was more in female 6(67%) by dapagliflozin and 10(71%) by empagliflozin versus male 3(33%) by dapagliflozin and 4(29%) by empagliflozin respectively. Similarly the prevalence of urinary infection was more in female 8(62%) by dapagliflozin and 14(67%) by empagliflozin versus male 5(38%) by dapagliflozin and 7(33%) by empagliflozin respectively. A significant co relation was found between prevalence of genitourinary infection with female sex and uncontrolled diabetes with p.value 0.001 and 0.003 respectively. Conclusion: SGLT-2 inhibitors are not associated with increased of risk of genitourinary infection in diabetic patients. Keywords: SGLT-2 Inhibitors, Dapagliflozin, Empagliflozin, Genitourinary infection

Pattern of menstrual cycle after kidney transplant in reproductive women

Background. In reproductive women, transplant disturbs the menstrual cycle pattern. The two major conditions usually encountered are amenorrhea and menorrhagia.The objective of the study was to assess the pattern of menstrual cycle after kidney transplant in reproductive women.Materials and methods. This cross-sectional study was carried out in a public sector hospital of Karachi, Pakistan. A total 69 patients of reproductive age were included who underwent living kidney donor transplant for more than a year ago. Women having genital tract infection, using hormonal treatment, organic cause of genital tract, clotting disorder and severe cardiac and/ or peripheral vascular disease were excluded. Frequency and percentages were calculated for demographic characteristics. Correlation and association analysis was calculated for type of menstruation with menstrual cycle pattern. A P-value less than 0.05 was considered statistically significant.Results. Majority of female included in the study aged between 35–39 years (36, 52.2%). The most frequent menstrual disturbance observed was heavy menstrual bleeding (22, 31.9%) and amenorrhea (21, 30.4%). Only 2.9% cases showed normal menstrual pattern. The cross tabulation indicated that 26.1% patients had amenorrhea, 24.6% had oligomenorrhea and 31.9% had menorrhagia. The Durbin–Watson value of 0.656 indicated a strong positive relationship between menstruation cycle pattern (dependent variable) and type of menstruation, marital status, donor’s age, children and living location of the patients (independent variables).Conclusion. From the result of the present study, it is concluded that the reproductive age women have shown a disturbed pattern of menstrual cycle after kidney transplant. The major observation was that such patients reported amenorrhea, menorrhagia, oligomenorrhea and hypomenorrhea.

Cervicovaginal microbiota predicts Neisseria gonorrhoeae clinical presentation

Neisseria gonorrhoeae infection of the female lower genital tract can present with a spectrum of phenotypes ranging from asymptomatic carriage to symptomatic cervical inflammation, or cervicitis. The factors that contribute to the development of asymptomatic or symptomatic infections are largely uncharacterized. We conducted a pilot study to assess differences in the cervicovaginal microbial community of patients presenting with symptomatic vs. asymptomatic N. gonorrhoeae infections to a sexually transmitted infections (STI) clinic. DNA was isolated from cervicovaginal swab specimens from women who tested positive for N. gonorrhoeae infection using a clinical diagnostic nucleic acid amplification test. We performed deep sequencing of 16S ribosomal RNA gene amplicons, followed by microbiome analyses with QIIME, and species-specific real-time PCR to assess the composition of microbial communities cohabitating the lower genital tract with the infecting N. gonorrhoeae. Specimens collected from asymptomatic individuals with N. gonorrhoeae infection and no co-infection with Chlamydia trachomatis and/or Trichomonas vaginalis carried Lactobacillus-dominant microbial communities more frequently than symptomatic patients without co-infection. When compared to asymptomatic individuals, symptomatic women had microbial communities characterized by more diverse and heterogenous bacterial taxa, typically associated with bacterial vaginosis (BV) (Prevotella, Sneathia, Mycoplasma hominis and Bacterial Vaginosis-Associated Bacterium-1 (BVAB1)/”Candidatus Lachnocurva vaginae). Both symptomatic and asymptomatic N. gonorrhoeae patients with additional STI co-infection displayed a BV-like microbial community. We used a murine model of N. gonorrhoeae infection in mice pre-colonized with Lactobacillus crispatus to test whether pre-existing L. crispatus was protective from N. gonorrhoeae colonization or whether N. gonorrhoeae infection could drive the loss of L. crispatus during infection. Vaginal infection with either N. gonorrhoeae strain 1291 or an isogenic mutant known to exhibit lower inflammatory had no impact on Lactobacillus burden recovered from the mice. These data taken together suggest that Lactobacillus-dominant vaginal microbial community may protect individuals from developing symptoms during lower genital tract infection with N. gonorrhoeae.

Meningococcal Detoxified Outer Membrane Vesicle Vaccines Enhance Gonococcal Clearance in a Murine Infection Model

Background Despite decades of research efforts, development of a gonorrhea vaccine has remained elusive. Epidemiological studies suggest that detoxified outer membrane vesicle (dOMV) vaccines from Neisseria meningitidis (Nm) may protect against infection with Neisseria gonorrhoeae (Ng). We recently reported that Nm dOMVs lacking the major outer membrane proteins (OMPs) PorA, PorB, and RmpM induced greater antibody cross-reactivity against heterologous Nm strains than wild-type (WT) dOMVs and may represent an improved vaccine against gonorrhea. Methods We prepared dOMV vaccines from meningococcal strains that were sufficient or deleted for PorA, PorB, and RmpM. Vaccines were tested in a murine genital tract infection model and antisera were used to identify vaccine targets. Results Immunization with Nm dOMVs significantly and reproducibly enhanced gonococcal clearance for mice immunized with OMP-deficient dOMVs; significant clearance for WT dOMV-immunized mice was observed in one of two experiments. Clearance was associated with serum and vaginal anti-Nm dOMV IgG antibodies that cross-reacted with Ng. Serum IgG was used to identify putative Ng vaccine targets, including PilQ, MtrE, NlpD, and GuaB. Conclusions Meningococcal dOMVs elicited a protective effect against experimental gonococcal infection. Recognition and identification of Ng vaccine targets by Nm dOMV-induced antibodies supports the development of a cross-protective Neisseria vaccine.