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.

Risk factors for the development of tubo-ovarian abscesses in women with ovarian endometriosis: a retrospective matched case–control study

Background The purpose of this study was to assess the risk factors associated with the development of tubo-ovarian abscesses in women with ovarian endometriosis cysts. Methods This retrospective single-center study included 176 women: 44 with tubo-ovarian abscesses associated with ovarian endometriosis and 132 age-matched (1:3) patients with ovarian endometriosis but without tubo-ovarian abscesses. Diagnoses were made via surgical exploration and pathological examination. The potential risk factors of tubo-ovarian abscesses associated with ovarian endometriosis were evaluated using univariate analysis. The results (p ≤ 0.05) of these parameters were analyzed using a multivariate model. Results Five factors were included in the multivariate conditional logistic regression model, including in vitro fertilization, presence of an intrauterine device, lower genital tract infection, spontaneous rupture of ovarian endometriosis cysts, and diabetes mellitus. The presence of a lower genital tract infection (odds ratio 5.462, 95% CI 1.772–16.839) and spontaneous rupture of ovarian endometriosis cysts (odds ratio 2.572, 95% CI 1.071–6.174) were found to be statistically significant risk factors for tubo-ovarian abscesses associated with ovarian endometriosis. Conclusions Among the factors investigated, genital tract infections and spontaneous rupture of ovarian endometriosis cysts were found to be involved in the occurrence of tubo-ovarian abscesses associated with ovarian endometriosis. Our findings indicate that tubo-ovarian abscesses associated with ovarian endometriosis may not be linked to in vitro fertilization as previously thought.

Risk Factors for the Development of Tubo-ovarian Abscesses in Women with Ovarian Endometriosis: A Retrospective Matched Case-control Study

Background: The purpose of this study was to assess the risk factors associated with the development of tubo-ovarian abscesses in women with ovarian endometriosis cysts. Methods: This retrospective single-center study included 176 women: 44 with tubo-ovarian abscesses associated with ovarian endometriosis and 132 age-matched (1:3) patients with ovarian endometriosis but without tubo-ovarian abscesses. Diagnoses were made via surgical exploration and pathological examination. The potential risk factors of tubo-ovarian abscesses associated with ovarian endometriosis were evaluated using univariate analysis. The results (p ≤ 0.05) of these parameters were analyzed using a multivariate model.Results: Five factors were included in the multivariate conditional logistic regression model, including in vitro fertilization, presence of an intrauterine device, lower genital tract infection, spontaneous rupture of ovarian endometriosis cysts, and diabetes mellitus. The presence of a lower genital tract infection (odds ratio 5.462, 95% confidence interval, 1.772–16.839) and spontaneous rupture of ovarian endometriosis cysts (odds ratio 2.572, 95% confidence interval, 1.071–6.174) were found to be statistically significant risk factors for tubo-ovarian abscesses associated with ovarian endometriosis.Conclusions: Of the factors investigated, the occurrence of tubo-ovarian abscesses associated with ovarian endometriosis was found to be associated with genital tract infections and spontaneous rupture of ovarian endometriosis cysts. Our findings indicate that tubo-ovarian abscesses associated with ovarian endometriosis may not be linked to in vitro fertilization as previously thought.

The Profile of Bacterial Vaginosis in Academic Hospital Surabaya: A Retrospective Study

Background: Bacterial vaginosis (BV) is a lower genital tract infection, which occur as a result of vaginal microbiome dysbiosis. This vaginal infection can lead to symptoms such as vaginal discharge, malodor and irritation. It is the most common condition occurred in reproductive age but may give 50–75% of asymptomatic signs. Purpose: To overview new BV patients at the Sexually Transmitted Infection Division of Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital Surabaya in 2015–2017. Methods: A retrospective study was performed by evaluating medical records of new BV patients, including identity, history taking, examination, diagnosis, treatment, follow up and counselling. Result: The number of new BV cases was 35 (1,38%). The most infected age group was 25–44 years old (51%), and 65.7% of them were married. The most common chief complaint was vaginal discharge without subjective complaints (74.3%), the most common type of complaint was recurrence (48.6%), the most partner roles which affected by BV patients were husbands (51.4%), history of vaginal douching (34.2%), and the most vaginal discharges were severe (75.8%). The whiff test showed positive results and pH > 4.5 in 48.6% of patients. All microscopical preparations showed clue cells. The most prescribed drug was metronidazole. Conclusion: The overview new BV cases showed a small incidence with commonly occurred among women in childbearing age and were asymptomatic. A routine high vaginal swab helps the proper diagnosis and management to prevent the recurrence and complication of BV.

A novel gonorrhea vaccine composed of MetQ lipoprotein formulated with CpG shortens experimental murine infection

ABSTRACTBacterial surface lipoproteins are emerging as attractive vaccine candidates due to their biological importance and the feasibility of their large-scale production for vaccine manufacturing. The global prevalence of gonorrhea, resistance to antibiotics, and serious consequences to reproductive and neonatal health necessitate development of effective vaccines. Reverse vaccinology identified the surface-displayed L-methionine binding lipoprotein MetQ (NGO2139) and its homolog GNA1946 (NMB1946) as gonococcal and meningococcal vaccine candidates, respectively. Here, we assessed the suitability of MetQ for inclusion in a gonorrhea vaccine by examining MetQ conservation, its function in Neisseria gonorrhoeae (Ng) pathogenesis, and its ability to induce protective immune responses using a female murine model of lower genital tract infection. In-depth bioinformatics, phylogenetics and mapping the most prevalent Ng polymorphic amino acids to the GNA1946 crystal structure revealed remarkable MetQ conservation: ~97% Ng isolates worldwide possess a single MetQ variant. Mice immunized with rMetQ-CpG (n=40), a vaccine containing a tag-free version of MetQ formulated with CpG, exhibited robust, antigen-specific antibody responses in serum and at the vaginal mucosae including secretory IgA. Consistent with the activity of CpG as a Th1-stimulating adjuvant, the serum IgG1/IgG2a ratio of 0.38 indicated a Th1 bias. Combined data from two independent challenge experiments demonstrated that rMetQ-CpG immunized mice cleared infection faster than control animals (vehicle, p<0.0001; CpG, p=0.002) and had lower Ng burden (vehicle, p=0.03; CpG, p<0.0001). We conclude rMetQ-CpG induces a protective immune response that accelerates bacterial clearance from the murine lower genital tract and represents an attractive component of a gonorrhea subunit vaccine.

Reproductive system infections in women: upper genital tract, fetal, neonatal and infant syndromes

ABSTRACT Lower genital tract infection and bloodborne spread of infection are the two principal modes for infection of the upper genital tract or for infection of the fetus, neonate or infant. Treponema pallidum and human immunodeficiency virus (HIV) are the two most common bloodborne pathogens that infect the fetus, neonate or infant. Most infections of the upper genital tract, however, spread along epithelial surfaces from the vagina or cervix to the upper genital tract or chorioamnion, fetus, neonate or infant. These infections are caused by either pathogens associated with a dysbiotic vaginal microbiome or those that are sexually transmitted. The clinical syndromes that these pathogens produce in the lower genital tract were discussed in part one of this review. We now discuss the syndromes and pathogens that affect the upper genital tract of both non-pregnant and pregnant women as well as fetus, neonate and infant.

The influence of associated infection on the development of miscarriage

The article presents the results of a study of the vaginal microbiota in women with miscarriage in early term of gestation. It has been established that pregnant women with lower genital tract infections are at high risk for perinatal and postpartum complications. In most of them (76.0 %) there was a lack of Preconception Prevention with the study of the vaginal biotope. In pregnant women at risk of miscarriage on the background of lower genital tract infection, microbial and viral associations are more common than monoinfection. Taking into account the negative effects of lower genital tract infection on the further course of pregnancy and childbirth and the condition of newborns, at the stage of Preconception Prevention should be studied vaginal microbiota. During pregnancy, it is necessary to conduct a thorough examination of women with timely identification of risk factors for miscarriage, which include associated infections, and their adequate correction.

Diagnosis of Lower Genital Tract Infection in Pregnancy: Routine Midtrimester High Vaginal Swab Followed by Gram Staining, Seems to be the Best Strategy

Background: Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim: To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in midtrimester by clinical symptom/signs and point of care tests (viz Amsel’s criteria) as against the gold standard microscopic tests using gram stain. Settings and Design: Prospective observational study in a tertiary care hospital over two years. The study population included 228 antenatal women between 18th-24th weeks. Materials and Methods: Symptoms of vaginal discharge were noted. Speculum examination was performed on all, to detect the type of discharge. High vaginal swabs were collected, subjected to the point of care tests (Amsel’s criteria) as well as gram staining. Microscopy (Eg: Nugent’s criteria) was taken as the gold standard, to which other methods were compared. Results: Thirty women (13.5%) were symptomatic. Among 198 that were asymptomatic, 91(45.92%) had LGTI. Speculum examination showed discharge in 221 (96.9%), but gram staining showed LGTI in only 104 (45.61%), among whom 45 (19.7%) had partial Bacterial vaginosis (BV), 14(6.1%) had full BV, and 40(17.5%) had candidiasis. The commonest discharge was homogenous thin white, suggestive of BV but 51% among them had normal vaginal flora (NVF); whereas 27% of those labelled physiological discharge were positive for BV. The appearance of discharge and gram stain thus did not correlate well. Amsel’s criteria had poor diagnostic accuracy compared to Nugent’s, although negative predictive value were high. Conclusion: There is a high prevalence of LGTI, especially BV among asymptomatic pregnant women at mid-trimester, best detected with a routine high vaginal swab and gram staining rather than relying on symptoms/speculum findings/point of care tests. Such testing may guide appropriate treatment for reducing the risk of PTB.

Bacterial Vaginosis in Pregnant Women at Maternal and Child Hospital, West Java, Indonesia, 2018: High Prevalence in Asymptomatic Females

Bacterial vaginosis (BV) is a lower genital tract infection of reproductive women which can occur in pregnant and non-pregnant women. BV in pregnant women can increase the risk of complications, including increased incidence of abortion, premature rupture of membranes, preterm birth, and babies with low birth weight. BV can also increase the risk of acquired sexually transmitted infection (STI) and their further transmission, including human immuno-deficiency virus (HIV). Each country has a different prevalence of BV. The previous report of BV prevalence in pregnant women was submitted in Jakarta, Indonesia in 1990. Until now, there is no update data of BV in pregnant women, especially in West Java, Indonesia. Thus, we conducted a descriptive observational study using a cross-sectional design and a consecutive sampling method in June 2018. This study included 60 pregnant women in the Maternal and Child Hospital, Bandung, Indonesia. Out of 60 participants, seven (11.67%) participants had BV according to Amsel criteria. Asymptomatic BV was diagnosed in all participants. This study shows the prevalence of BV in pregnant women in the Maternal and Child Hospital in Bandung during June 2018. The assessment of screening BV should be recommended as a routine workup. To avoid complications in pregnant women and infants it should not be waited for the symptoms to reveal.