Letha Thomas

Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates

OBJECTIVES (1) To study the prevalence of HEV infection in a cohort of pregnant women in the United Arab Emirates (UAE). (2) The rate of mother-to-infant transmission. METHOD Sera of 469 pregnant women residing in the UAE was tested for anti-HEV with ELISA and for HEV-RNA by polymerase chain reaction (PCR). Neonatal cord-blood and infant blood was similarly tested for anti-HEV and HEV-RNA. Out of these 469 women, 33% were UAE nationals (Group A) and Egyptians (Group B), respectively, and 34% were from the Indian sub-continent (Group C). RESULTS Out of 469 mothers 93 (20%) were anti-HEV positive and 28 (30%) of these 93 were HEV-RNA positive and symptomatic with on-going infection. The prevalence of anti-HEV was significantly increased amongst Groups B and C (Group A:B, P<0.001; Group A:C, P<0.001). Twelve of these 28 symptomatic women developed acute hepatic disease and two died undelivered, thus, were excluded from further study. Six of the remaining 10 women had non-fulminant acute viral hepatitis and four developed fulminant hepatic failure, of which one died in the early post-partum period. The remaining 16 women had mild symptomatic disease with complete recovery as did the remaining nine women with acute illness. Of the 10 babies born to mothers with acute disease, two were pre-term, three had anicteric hepatitis and two babies were born with hypothermia and hypoglycaemia and died within 48h. Noteworthy is the fact that, the 26 infants born to the 26 HEV-RNA positive mothers developed acute/on-going clinical infection and were HEV-RNA positive. Apart from the two early neonatal deaths, the remaining 24 infants had full recovery. No infant of the other mothers were symptomatic or had HEV-RNA. Thus, the mother-to-infant transmission was 100%. The remaining 65 sero-positive women remained asymptomatic with no evidence of clinical infection, continued to be HEV-RNA negative and delivered at term. Their infants had no evidence of infection and were sero-negative by 9 months of age, suggesting transplacental transmission of IgG antibodies. CONCLUSIONS There is a high prevalence of anti-HEV among pregnant women residing in the UAE. Twelve of infected women developed fulminant/acute hepatitis resulting in three fatalities. Evidence suggests significant vertical transmission of HEV among HEV-RNA positive mothers with appreciable perinatal morbidity and mortality. Excluding mothers with acute hepatic disease, Breast-feeding appears to be safe in HEV sero-positive mothers.

The prevalence and determinants of health care-seeking behavior for urinary incontinence in United Arab Emirates women.

Abstract: The aim of this study was to determine the prevalence and sociodemographics of urinary incontinence (UI) in women in the United Arab Emirates (UAE). Women at risk, such as multiparous and climacteric women, were selected from the community (n= 200) and health-care centers (n= 200) and interviewed about inappropriate urine loss in the past 12 months, using a structured and pretested questionnaire. Of these, 81 (20.3%) admitted UI; only 25 of these (30.9%) had sought medical advice. The reasons were embarrassment (38.2%), choice of self-treatment because of low expectations from medical care (38.2%), and preferring to discuss the matter with friends, assuming that UI is normal (23.3%). Sufferers were troubled by their inability to pray (90%) and to have sexual intercourse (33.3%). Perceived causes of UI were paralysis (45%), childbirth (35.4%) and old age or menopause (33.7%). UI is common yet underreported by UAE women because of cultural attitudes and inadequate public knowledge.

Relationship between the length of the perineum and position of the anus and vaginal delivery in primigravidae.

Abstract: The aim of the study was to determine perineal length and anal position in primigravidae and to evaluate their effect on vaginal delivery. The distances between the fourchette and each of the center of the anal orifice and the inferior margin of the coccyx were measured in 212 primigravidae with singleton term pregnancies during the first stage of labor. Anal position index was calculated by dividing the first measurement by the second. The mean ± SD length of perineum was 4.6 ± 0.9 cm. The mean ± SD anal position index was 0.49 ± 0.12. Women with a short perineum (<4 cm) or a small anal position index (<0.42) had significantly higher rates of episiotomy, perineal tears and instrumented delivery. This association was also significant by multiple logistic regression analysis. It was concluded that a short perineum and anterior displacement of the anus were associated with traumatic vaginal delivery in primigravidae.

Abnormal Vascular Coiling of the Umbilical Cord in Gestational Diabetes Mellitus

The objective of this study was to identify abnormal vascular coiling of the umbilical cord in neonates of mothers with gestational diabetes mellitus. The umbilical cords of 57 neonates of gestational diabetic mothers were examined and the coiling index determined by dividing the total number of complete vascular coils by the length of the cord in centimeters. Obstetric history, delivery data and neonatal outcome were also evaluated. These variables were compared with those obtained for 389 normal pregnancies. The frequency distribution of umbilical coiling index in the control population and gestational diabetic mothers were normal (10th and 90th percentiles = 0.17 and 0.37; mean ± SD = 0.26 ± 0.09 and 0.24 ± 0.12 coils/cm, respectively). Non-coiling and hyper-coiling were significantly more frequent with diabetic than with normal pregnancy (p = 0.004; p = 0.008, respectively). Both abnormalities of umbilical vascular coiling were also significantly associated with adverse perinatal outcome (p = 0.04) and emergency cesarean delivery (p < 0.0001) in the diabetic and control (p = 0.03; p < 0.0001, respectively) groups. Neonates of gestational diabetic mothers are therefore more likely to have hyper-coiled or non-coiled umbilical blood vessels. Perinatal morbidity and emergency cesarean delivery are increased in this subgroup.

Determinants of the length of episiotomy or spontaneous posterior perineal lacerations during vaginal birth

The objective of this study was to measure the length of episiotomy or spontaneous posterior perineal laceration and their relationship to perineal measurements and obstetric variables. The length of the perineum and genital hiatus and vertical length of episiotomy or posterior perineal tears were measured in 114 consecutive parturients with spontaneous singleton term deliveries. Seventy-four (65%) women underwent episiotomy while 40 (35%) sustained spontaneous posterior tears. Perineal or genital hiatus length was significantly correlated to episiotomy (r=0.34, p=0.003) or laceration (r=0.37, p=0.02) length, respectively. This association was significant (p=0.001) in a generalized linear model with duration of second stage of labor (p=0.005), degree of tear (p=0), and parity (p=0). Perineal length was significantly related to maternal age (p=0.036) and weight (p=0.037) and hiatal length (p=0). Short perineum and genital hiatus, long second stage of labor, and low parity are associated with longer posterior perineal injury.

Women's perceptions and experiences of childbirth in United Arab Emirates.

Abstract Aims: To determine womens perceptions and experiences of childbirth in United Arab Emirates [UAE]. Methods: A consecutive sample of 715 women who delivered during a 3 month period were interviewed on the third postnatal day about their experience and satisfaction with maternity care using a structured questionnaire. Results: 95 (13.2 %) women had negative feelings including fear, anger, sorrow and regret, guilt, jealousy, sense of failure and disappointment while the rest felt that childbirth was enjoyable and that they had been well-informed, especially by nurses, about their perinatal care. Subjects delivered by cesarean (N = 104, 14.5 %) were significantly less satisfied with the information provided by their caregivers and their involvement in decision-making before the operation than the vaginal group (p = 0.001). Irrespective of mode of delivery, most participants strongly agreed that cesarean is worse than vaginal delivery whatever the reason and should be performed only for medical reasons. Adverse maternal experiences were significantly more frequent with cesarean delivery (p = 0.00001), older age (p = 0.04), primiparity (p = 0.03), higher education (p = 0.03), lack of antenatal care (p = 0.03) and prolonged labor (p = 0.04). Conclusions: Childbirth experience and the prevalence and correlates of postnatal psychosocial morbidity in UAE are not different from those observed elsewhere.

Knowledge and practice of contraception in United Arab Emirates women

Objective To determine the knowledge and practice of contraception among United Arab Emirates (UAE) women. Method Four hundred and fifty UAE women at risk of pregnancy were randomly selected from the community and primary health care centres and interviewed about knowledge and practice of contraception using a structured questionnaire. Results Four hundred women (89%) gave consent to participate in the study. One hundred and sixty-six participants (41.5%) were using contraception. All used natural methods backed with other methods. There were significant associations between using contraception and each of age, high level of education and low family income (p < 0.0001 for the three variables). Religious beliefs and low expectation of success of birth control were the reasons given for non-use. Eighty-five percent of subjects did not accept sterilisation without medical indications, nor using contraception before the first pregnancy. Of the women, 42.5% believed that contraceptive methods should not be used after the age of 40, and 78% were unaware that they could be used for treatment of gynaecological diseases. Disturbed bleeding patterns occurred in 48.7% of users, and these were most bothered by the inability to pray (100%) and to have sexual intercourse (97.5%). Conclusion Contraception is not commonly used by UAE women because of sociocultural traditions, religious beliefs and poor knowledge.

OP08.04: Early sonographic changes of fetal body composition in gestational diabetes mellitus

was performed in 289 women. Two different formulae were used: Shepard (SHEP EFW) and Hadlock (HAD EFW). In 262 of these women, the fetal weight was estimated clinically by both the doctor (DR EFW) and the woman herself (WM EFW). The four estimated fetal weights were compared to actual birthweight. Results: The mean absolute percentage error was 7.6 ± 5.6% for DR EFW, 9.7 ± 8.7% for WM EFW, 9.3 ± 7.3% for SHEP EFW and 10.7 ± 7.8% for HAD EFW. All four EFW’s were significantly different from birthweight (t = −4.7, t = −5.5, t = −2.9, t = −10.6 respectively, all P 4000 g were 16% and 99%, 29% and 96%, 46% and 91%, 40% and 90% respectively. Conclusions: Although in general clinical estimates of birthweight perform favorably compared to ultrasound, ultrasound immediately prior to labor is more accurate at predicting the smallor large-forgestational-age fetus.