Fernanda Press

Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations

BACKGROUNDnWomen who work commercially in sex work (female sex workers [FSW]) are considered a high-risk group for sexually transmissible infections (STI), yet the level of reported pathogens varies in studies around the world. This study reviewed STI rates reported in 42 studies of FSW around the world published between 1995 and 2006 and analysed the trends and types of populations surveyed, emphasising difficult to access FSW populations.nnnMETHODSnStudies were retrieved by PUBMED and other search engines and were included if two or more pathogens were studied and valid laboratory methods were reported.nnnRESULTSnThe five most commonly assessed pathogens were Neisseria gonorrhea (prevalence 0.5-41.3), Chlamydia trachomatis (0.61-46.2), Treponema pallidum (syphilis; 1.5-60.5), HIV (0-76.6), and Trichomonas vaginalis (trichomoniasis; 0.11-51.0). Neisseria gonorrhea and C. trachomatis were the most commonly tested pathogens and high prevalence levels were found in diverse areas of the world. HIV was highly prevalent mostly in African countries. Although human papillomavirus infection was surveyed in few studies, prevalence rates were very high and its aetiological role in cervical cancer warrant its inclusion in future FSW monitoring. Hard-to-access FSW groups tended to have higher rates of STI.nnnCONCLUSIONSnThe five most commonly detected pathogens correspond to those that are highly prevalent in the general population, however there is an urgent need to develop rapid testing diagnostics for all five pathogens to increase prevention and treatment, especially in outreach programs to the most vulnerable groups among FSW.

Predictors of recommendation and acceptance of intrapartum epidural analgesia.

We conducted this prospective study to characterize the obstetric and sociodemographic variables that predict physicians’ recommendations and patients’ acceptance of intrapartum epidural analgesia. The study population consisted of 447 consecutive, low-risk parturients in early active labor. Epidural analgesia was recommended to 393 patients (87.9%), however only 164 (41.7%) consented to receive it. A multiple logistic regression analysis demonstrated that the severity of pain, as assessed by the medical staff (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.13, 1.93), low parity (OR = 0.57, 95% CI 0.44, 0.74), and low maternal age (OR = 0.89, 95% CI 0.79, 0.99) were significant factors affecting recommendations of epidural analgesia. In a multivariate analysis, severity of subjective pain (OR = 1.39, 95% CI 1.16, 1.68), low parity (OR = 0.80, 95% CI 0.73, 0.99), high education (OR = 90.09, 95% CI 27.02,257.06), and the patients’ being secular compared with religious (OR = 2.14, 95% CI 1.08,4.21) were found to be independent predictors of acceptance of epidural analgesia. There are differences between patients offered and those not offered epidural analgesia and between parturients who accept and those who do not accept this analgesia. Implications: We studied the factors that influence the recommendation of epidural analgesia by obstetricians, as well as its acceptance by the laboring patients at a university hospital in Israel. Epidural analgesia was recommended more often to low parity, younger women exhibiting more pain. Parturients who perceived greater pain were more secular, had low parity, and had a higher level of education were more likely to accept it.

Neonatal outcome in preterm deliveries between 23 and 27 weeks’ gestation with and without preterm premature rupture of membranes

ObjectivesTo characterize neonatal morbidity and mortality rates in extreme preterm deliveries (between 23 and 27xa0weeks’ gestation) with and without PPROM, and to evaluate the association between PPROM and chorioamnionitis.MethodsA retrospective population-based study was conducted on preterm singleton pregnancies delivered between 23 and 27xa0weeks’ gestation from 1988 to 2007. Immediate neonatal morbidity and mortality rates in pregnancies complicated by PPROM were compared to pregnancies with intact membranes. A multivariate analysis was conducted in order to determine the independent association between PPROM and chorioamnionitis.ResultsOut of 1,437 preterm deliveries, 236 (16.4%) were complicated with PPROM. There were more neonates with low 1xa0min (61.0 vs. 42.5%; Pxa0=xa00.001) and low 5xa0min (30.1 vs. 23.8%; Pxa0=xa00.042) Apgar scores (of less than 7) in pregnancies complicated by PPROM than in the comparison group. There were more cases of chorioamnionitis in the PPROM group born at 23–24xa0weeks’ gestation (33.8 vs. 17.0%; Pxa0<xa00.001), and in the PPROM group born at 25–27xa0weeks (42.0 vs. 15.5%; Pxa0<xa00.001). In the group born at 23–24xa0weeks’ gestation, there were more postpartum deaths (PPD) in the PPROM group (70.0 vs. 54.8%; Pxa0=xa00.013); however, there was no significant difference in PPD in the groups born at 25–27xa0weeks. In the group born at 23–24xa0weeks, as well as at 25–27xa0weeks, there were fewer antepartum deaths (APD) in the PPROM group as compared to the control group (16.3 vs. 32.6%; Pxa0=xa00.002, and 5.3 vs. 36.3%; Pxa0<xa00.001; respectively). After adjusting for gestational age and gender, using a multivariate analysis, the association between PPROM and chorioamnionitis remained significant (ORxa0=xa03.32; 95% CI 2.43–4.51, Pxa0<xa00.001).ConclusionsPPROM is associated with adverse perinatal outcome in deliveries between 23 and 27xa0weeks’ gestation. Moreover, PPROM is an independent risk factor for chorioamnionitis.

DIC Score in Pregnant Women – A Population Based Modification of the International Society on Thrombosis and Hemostasis Score

Objectives The objectives of this study were: 1) To determine the component needed to generate a validated DIC score during pregnancy. 2) To validate such scoring system in the identification of patients with clinical diagnosis of DIC. Material and Methods This is a population based retrospective study, including all women who gave birth at the ‘Soroka University Medical Center’ during the study period, and have had blood coagulation tests including complete blood cell count, prothrombin time (PT)(seconds), partial thromboplastin time (aPTT), fibrinogen, and D-dimers. Nomograms for pregnancy were established, and DIC score was constructed based on ROC curve analyses. Results 1) maternal plasma fibrinogen concentrations increased during pregnancy; 2) maternal platelet count decreased gradually during gestation; 3) the PT and PTT values did not change with advancing gestation; 4) PT difference had an area under the curve (AUC) of 0.96 (p<0.001), and a PT difference ≥1.55 had an 87% sensitivity and 90% specificity for the diagnosis of DIC; 5) the platelet count had an AUC of 0.87 (p<0.001), an 86% sensitivity and 71% specificity for the diagnosis of DIC; 6) fibrinogen concentrations had an AUC of 0.95 (p<0.001) and a cutoff point ≤3.9 g/L had a sensitivity of 87% and a specificity of 92% for the development of DIC; and 7) The pregnancy adjusted DIC score had an AUC of 0.975 (p<0.001) and at a cutoff point of ≥26 had a sensitivity of 88%, a specificity of 96%, a LR(+) of 22 and a LR(−) of 0.125 for the diagnosis of DIC. Conclusion We could establish a sensitive and specific pregnancy adjusted DIC score. The positive likelihood ratio of this score suggests that a patient with a score of ≥26 has a high probability to have DIC.

CULDOCENTESIS IS AN OBSOLETE DIAGNOSTIC TOOL IN SUSPECTED ECTOPIC PREGNANCY

SummaryWe studied 332 patients with proven pregnancies. Prediction of hemoperitoneum by assessment of the Douglas pouch during bimanual examination had a false negative rate of 42.1%. The false negative rate for culdocentesis was 14.8%. It is therefore concluded that culdocentesis is not a useful tool in the diagnosis of suspected ectopic pregnancies.

Sexually transmissible infections among illegal female sex workers in Israel

Due to the mobile and clandestine nature of those who enter a country illegally, female sex workers (FSWs) who are working without papers or work permits often have no access to sexual health care. This study reports on the sexually transmissible infection (STI) prevalence among a sample of 43 sex workers working illegally. Brothel workers from republics of the Former Soviet Union (FSU), working in two locales in Israel were tested for the presence of eight pathogens and the presence of pathology by Pap smear. Of these brothel workers, 48.8% had at least one positive STI result, 14% had two STIs and one woman had three STIs. There were no cases of HIV, gonorrhoea or malignancy detected; high rates of ureaplasma (26.8%) and chlamydia were found (16.7%). Four cases of hepatitis C (9%) and three cases of hepatitis B (7%) and mycoplasma (7%) were detected. There was no relationship between reported symptoms and the detection of STIs. The level of STIs is high among this population of FSWs and it is imperative to develop more accessible health services for these women.

A comparison between the effectiveness of epidural analgesia and parenteral pethidine during labor

Abstractu2002The study was aimed to define parturients’ opinion on either epidural analgesia or intravenous pethidine, and to determine the effect of both analgesics after delivery. We interviewed and examined 401 consecutive parturients who requested analgesia during the beginning of their active stage of labor. Of those, 131 women requested and underwent epidural analgesia, and 270 received parenteral pethidine. The pain experienced before admission of any analgesia, was significantly higher in the epidural group than in the parental group (mean visual analog scale (VAS) score 8.9 and 8.4, respectively; P=0.004). However, after analgesics, women from the epidural analgesia experienced significantly less pain during labor as compared to those receiving pethidine (mean VAS scores 5.05 vs. 9.14, respectively; p<0.001). The pain scores 24 h after labor were significantly lower in patients who underwent epidural analgesia (1.69 vs. 2.13, respectively; p<0.001). We conclude that epidural analgesia is more effective than parenteral analgesia in pain and discomfort relief. This method is helpful also the day after delivery. Thus, epidural analgesia should be strongly recommended to all patients who do not have any medical contraindications to this method of treatment.

Hypothyroidism and diabetes mellitus – a risky dual gestational endocrinopathy

Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome. Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296). Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53–4.75) and for preeclampsia (OR 1.82; 95%CI 1.16–2.84). Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies.

Spinal versus general anesthesia in cesarean sections: the effects on postoperative pain perception

ObjectiveTo compare postoperative pain perception and analgesia requirements in patients undergoing cesarean section (CS) using general versus spinal anesthesia.Study designA prospective, observational study of patients undergoing elective CS during 2009 under either general or spinal anesthesia. Postoperative pain intensity and analgesia requirements were evaluated for up to 48xa0h after surgery.ResultsA total of 153 women were enrolled; 77 received general and 76 received regional anesthesia. Postoperative meperidine requirements in the first 24xa0h were significantly higher in the general anesthesia group. Pain scores were mostly comparable between the groups. Nevertheless, lower pain scores were graded after 8xa0h in the general versus the spinal anesthesia and this reversed at 48xa0h.ConclusionSpinal anesthesia is comparable to general anesthesia in terms of post-operative pain control. In choosing the type of anesthesia in CS, other factors such as the urgency and potential maternal and fetal hazards should be taken into account.

Routine cervical dilatation during elective cesarean delivery - Is it really necessary?

Objective.u2003To examine the necessity of routine cervical dilatation during elective cesarean delivery (ECD). Material and methods.u2003A retrospective cohort study including all ECD during 2005 was performed, comparing post operative complications between patients with and without cervical dilatation. Results.u2003Out of 666 ECD, 348 underwent routine cervical dilatation. No significant differences were found between the cervical dilatation and the comparison group regarding postpartum febrile morbidity (5.1 and 3.1%, respectively; p = 0.071), hospitalisation duration (4.1 ± 1.4 and 4.1 ± 2.0 days; p = 0.95), wound infection (0.9% and 1.25%, p = 0.451) or anemia rate (9.50 ± 0.73 and 9.54 ± 0.65, p = 0.91). Nevertheless, among patients following a previous vaginal delivery, cervical dilatation was significantly associated with post-operative fever (OR = 5.8; 95%CI 1.2–38.0; p = 0.021). Conclusion.u2003Routine cervical dilatation during ECD does not reduce post operative morbidity. Moreover, among patients with a previous vaginal delivery cervical dilatation is a risk factor for febrile morbidity.