Study of Underlying Factors among Women Presenting with Septic/Unsafe Termination of Pregnancy

Background: In our nation, induced abortions are common. Unexpected and unintentional births are serious public health issues in both developed and underdeveloped nations. According to the WHO, abortion complications account for 2–12% of maternal fatalities in Pakistan. The circumstances surrounding these abortions have major ramifications for both females and communities. However, insufficient information about factors leading to septic induced abortions at the country level was the reason to determine the contributing factors among women with abortion. Objective: The objective of our current research is to regulate occurrence of underlying factors contributing in patients presenting with septic induced abortion in a tertiary care setup. Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynecology, Jinnah hospital, Lahore for six months after approval of synopsis. Sample size of 130 cases was included through non-Probability consecutive sampling technique after the approval from hospital ethical committee. Informed consent was taken from each patient before including them in the study. Results: The mean age of the women was noted 26.24±4.93 years of which the minimum age was 18 year and maximum of 40 years. Out of these 130 women 26(20%) had no child, at least one abortion was most common as it was noted in 197(82%) of women. The underlying factors contributing to septic induced abortion it was noted that unwanted pregnancy in 41(31.5%) of cases, failed contraception in 37(28.5%) of cases, divorce in 6(4.6%) of cases, displeased family relation in 27(20.8%) of women and out of wedlock was noted in 19(14.6%) of cases. When data were stratified for effect modifiers statistically significant difference was found between parity and contributing factors for abortions (P-value = 0.000) and insignificant difference was observed with respect to age, educational status and economic status i.e., P-value > 0.05. Conclusion: The most common reason for abortion was unwanted pregnancy among the pregnant women. Keyword: Pregnancy, Abortion, Septic, maternal fatalities in Pakistan, WHO

Risk Factors of Childhood Cancer in Armenia: A Case-Control Study

Background: Childhood cancer (CC) is a leading cause of death among children aged 0-19 years worldwide. Each year, 400,000 new cases of CC are diagnosed globally. Given the between-country differences in CC incidence rates, types and trends, this study aimed to identify possible risk factors for CC in Armenia. Methods: We used a case-control study design by enrolling participants from the only specialized pediatric hematology and oncology center in Armenia. Cases included patients ≤14 years old diagnosed and treated with a malignant disease between 2017-2020 in the centre. Controls included patients diagnosed and treated in the center during the same period for a non-malignant disease. We conducted telephone interviews with mothers of cases and controls. Independent risk factors of cancer were identified using multivariable logistic regression analysis. Results: Overall, 234 participants (117 cases, 117 controls) were included in the study. Based on the fitted model, maternal usage of folic acid during pregnancy was protective against CC, almost twice decreasing its odds (OR=0.54; 95% CI: 0.31-0.94). On the contrary, experiencing horrifying/terrifying event(s) during pregnancy (OR=2.19; 95% CI: 1.18-4.07) and having induced abortions before getting pregnant with the given child (OR=2.94; 95% CI: 1.45-5.96) were associated with higher odds for a child to develop cancer. Conclusion: This study identified three important modifiable risk factors for CC in Armenia, all related to the period of pregnancy. The findings indicate the importance of education on stress reduction during pregnancy, the use of folic acid prior to and during pregnancy, and avoidance of induced abortions.

Pregnancy outcome in women with APECED (APS-1) – A multicenter study on 43 females with 83 pregnancies

Context Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED or APS-1) has a severe, unpredictable course. Autoimmunity and disease components may affect fertility and predispose to maternal and fetal complications, but pregnancy outcomes remain unknown. Objective To assess fetal and maternal outcomes and course of clinical APECED manifestations during pregnancy in women with APECED. Design and setting A multicenter registry-based study including five national patient cohorts. Patients 321 females with APECED. Main outcome measure Number of pregnancies, miscarriages, and deliveries. Results Forty-three patients had altogether 83 pregnancies at median age of 27 years (range, 17–39). Sixty (72%) pregnancies led to a delivery, including two stillbirths (2.4%) and five (7.1%) preterm livebirths. Miscarriages, induced abortions, and ectopic pregnancies were observed in 14 (17%), eight (10%), and one (1.2%) of pregnancies, respectively. Ovum donation resulted in five (6.0%) pregnancies. High maternal age, premature ovarian insufficiency, primary adrenal insufficiency, or hypoparathyroidism did not associate with miscarriages. Women with livebirth had on average four APECED manifestations (range 0–10); 78% had hypoparathyroidism and 36% had primary adrenal insufficiency. APECED manifestations remained mostly stable during pregnancy, but in one case development of primary adrenal insufficiency led to adrenal crisis and stillbirth. Birth weights were normal in >80% and apart from one neonatal death of a preterm baby, no serious perinatal complications occurred. Conclusions Outcome of pregnancy in women with APECED was generally favorable. However, APECED warrants careful maternal multidisciplinary follow-up from pre-conceptual care until puerperium.

A research note on the mortality consequence of denying all wanted induced abortions

In this research note, I estimate one component of the mortality impact of denying all wanted induced abortions in the U.S. This estimate quantifies the magnitude of an increase in pregnancy-related death which would occur solely due to the greater mortality risk of continuing pregnancy to term compared to having a legal induced abortion. Using published statistics on pregnancy-related mortality ratios, births, and abortions, I estimate U.S. pregnancy-related deaths by race/ethnicity before and in first and subsequent years of a total abortion ban. I estimate deaths after a total abortion ban by assuming all induced abortions are denied, assuming each abortion denied averts 0.8 births, and increasing exposure to pregnancy-related mortality accordingly. I find that in the first year of ban, estimated pregnancy-related deaths would increase from 675 to 724 (49 additional deaths, 7% increase), and in subsequent years to 815 (140 additional deaths, 21% increase). Non-Hispanic Black women would experience the greatest increase in deaths (33% increase in subsequent years). Estimated pregnancy-related deaths would increase for all race/ethnicities examined. Denying all wanted induced abortions in US would increase pregnancy-related mortality substantially, even if unsafe abortion does not increase.

748Misclassification of interpregnancy interval attributable to miscarriages/induced abortions: quantifying its impact on preterm births

Background A paucity of studies explored how intervening pregnancy events (miscarriages and induced abortions) contribute to interpregnancy interval (IPI) misclassification and whether this misclassification translates into bias in the estimated effect of IPI on adverse birth outcomes. Methods We included identified three national registries (Birth Register, the General Practitioner, and Patient Register) to obtain information on registered pregnancies (n = 167,012), with at least two consecutive pregnancies per mother, occurring between 2008 and 2016 in Norway. We computed two IPIs, one that accounted only two consecutive pregnancies ending after 20 weeks of gestation (standard IPI definition) and the other that accounted two consecutive pregnancies with various outcomes including miscarriages/induced abortions (corrected IPI definition). We independently assessed the association between the two IPIs and preterm births (PTB). Log binomial regression analysis was conducted. Relative risks (aOR) and 95% confidence interval (CI) were estimated. Results In the study, 4.7% of births were PTB. While 11.7% of pregnancies occurred <6 months in the corrected IPI definition, the proportion reduced to 4.4% in the standard IPI definition, with over 60% of IPIs were misclassified. After adjusting for confounders, there was a modest overestimation of risk of PTB for pregnancies following short IPI (<6 months) (RR = 1.76, 95% CI: 1.60-1.95) for the standard IPI definition as compared to the risk of PTB (RR = 1.52, 95% CI: 1.41-1.65) following short IPI in the corrected IPI definition. Conclusions There was a significant misclassification bias associated with miscarriages/induced abortions which should not be ignored when assessing the effect of IPI on PTB.

ASSESSMENT OF EFFICACY OF ELECTRONIC VACUUM ASPIRATION WITH INTRAVENOUS ANALGESIA

Objective: To assess efficacy of elecrtonic vacuum aspiration in evacuation of retained product of conception with intravenous analgesia. Study Design: A prospective observational study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan to Jun 2018. Methodology: All patients who were intended to undergo Electronic Vacuum Aspiration due to retained products of conception, early fetal demise, septic induced abortions and molar (all upto 12 weeks of gestation) were enrolled in this study after obtaining informed consent. Outcome measures of study were efficacy (defined as completeness of the evacuation procedure confirmed by ultrasound), occurrence of complications like uterine perforation, excessive bleeding >200ml and sepsis (diagnosed clinically or biochemically). Results: A total of 1080 patients underwent Electronic Vacuum Aspiration during the study period. Complete evacuation was achieved in 1026 (95%) cases. Four (<1%) patients experienced post procedure infection while none had uterine perforation. Average blood loss was <100ml while 18 (1.6%) patients had blood loss of >200ml. Conclusion: Electronic vacuum aspiration is a safe and efficacious method of uterine evacuation. It does not require special equipment. It is easy to learn and is readily available as well as cost effective. Hence it’s a very lucrative alternative to manual vacuum aspiration using I pass or medical termination of pregnancy in resource poor settings.

The pathology of natural and experimentally induced Campylobacter jejuni abortion in sheep

We describe here the gross and microscopic lesions in 18 experimentally induced and 120 natural Campylobacter abortions. In natural Campylobacter abortions, gross lesions were reported infrequently; placentitis was recorded in 6% and hepatic lesions in 4% of our field cases. Placentitis was the microscopic lesion identified most consistently in natural abortions (93%) and was often observed in association with abundant bacterial colonies in chorionic villi (54%) and less often with placental vasculitis (13%). In natural abortions, suppurative fetal pneumonia (48%), necrosuppurative hepatitis (16%), and purulent meningitis (7%) were also observed. The better-preserved specimens from experimentally induced abortions were utilized to define placental changes more precisely. Placentitis was identified in all 18 experimentally induced abortions and was observed most consistently in the chorionic villus stroma (100%), often accompanied by suppurative surface exudate (89%). An inflammatory infiltrate was less commonly identified in the cotyledonary hilus (39%) and intercotyledonary placenta (22%). Bacteria were visualized in H&E-stained sections in 89% of placentas from experimentally infected ewes, primarily as well-demarcated bacterial colonies within subtrophoblastic, sinusoidal capillaries (89%), in the cotyledonary villus stroma (89%), and within the cytoplasm of trophoblasts (22%). Transmission electron microscopy and immunohistochemistry confirmed that the vast majority of the well-demarcated bacterial colonies characteristic of Campylobacter abortion were within subtrophoblastic sinusoidal capillaries. The most characteristic microscopic lesions identified in cases of Campylobacter abortion in sheep were placentitis with placental bacterial colonies, placental vasculitis, and fetal pneumonia.