Ruta Nadisauskiene

Prevalence of maternal group B streptococcal colonisation in European countries

Background. Group B streptococcus (GBS) is a leading cause of neonatal sepsis in many industrialised countries. However, the burden of perinatal GBS disease varies between these countries. We undertook a systematic review to determine the prevalence of maternal group B streptococcal colonisation, one of the most important risk factor for early onset neonatal infection, and to examine the serotype distribution of the GBS strains isolated and their susceptibility to antibiotics in European countries. Methods. We followed the standard methodology for systematic reviews. We prepared a protocol and a form for data extraction that identifies key characteristics on study and reporting quality. The search was conducted for the years 1996–2006 including electronic, hand searching and screening of reference lists. Results. Twenty‐one studies presented data on 24,093 women from 13 countries. Among all studies, GBS vaginal colonisation rates ranged from 6.5 to 36%, with one‐third of studies reporting rates of 20% or greater. The regional carriage rates were as follows: Eastern Europe 19.7–29.3%, Western Europe 11–21%, Scandinavia 24.3–36%, and Southern Europe 6.5–32%. GBS serotypes III, II and Ia were the most frequently identified serotypes. None of the GBS isolates were resistant to penicillin or ampicillin, whereas 3.8–21.2% showed resistance to erythromycin and 2.7–20% showed resistance to clindamycin. Conclusion. Although there is variation in the proportion of women colonised with GBS, the range of colonisation, the serotype distribution and antimicrobial susceptibility reported from European countries appears to be similar to that identified in overseas countries.

Psychosocial risk factors for depression during pregnancy

Objective. To assess the prevalence of antenatal depressive disorder in different trimesters and to evaluate the relation of psychosocial risk factors to antenatal depressive disorder. Design. Cohort follow‐up. Setting. University Hospital, Kaunas, Lithuania. Sample. Two hundred and thirty pregnant women consecutively admitted. Methods. At 12–16 weeks, 22–26 weeks, and 32–36 weeks of pregnancy, participants were screened for depression using the World Health Organizations Composite International Diagnostic Interview Short Form (CIDI‐SF). Women who gave at least one positive answer to the CIDI‐SF depression‐screening question were evaluated for depressive disorder using the non‐patient version of the Structured Clinical Interview for DSM‐III‐R (SCID‐NP). Psychosocial stressors and two Big Five Personality dimensions, neuroticism and extraversion, were also evaluated. Main outcome measures. Prevalence of depressive disorder. Results. The prevalence of the antenatal depressive disorder at 12–16 weeks’ gestation was 6.1%, at 22–26 weeks 3.5%, and at 32–36 weeks 4.4%. In the first trimester, a greater prevalence of current depressive disorder was independently associated with unplanned and unwanted pregnancy, high neuroticism, low education, and a previous history of depression; in the second trimester with unplanned and unwanted pregnancy and high neuroticism; in the third trimester with unplanned and unwanted pregnancy, high neuroticism, and the occurrence of psychosocial stressors during the last year. Conclusions. The highest prevalence of depressive disorders was found in the first trimester, the lowest in mid‐pregnancy. Several determinants (unwanted and unplanned pregnancy, high neuroticism) were independent predictors of antenatal depressive disorders throughout whole pregnancy, while other determinants (low education, previous history of depression, the occurrence of psychosocial stressors at the end of pregnancy) were trimester specific.

Vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women

Objective: To evaluate the effectiveness and possible adverse effects of vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women. Methods: A total of 105 women scheduled for hysteroscopy were randomly assigned to 2 groups. The study group (n = 51) received 400 μg of vaginal misoprostol at least 12 h before the procedure and the control group (n = 54) received no cervical priming agent. The primary outcome measure was the number of women who required cervical dilation. Secondary outcomes were cervical width (the largest size of Hegar dilator inserted without resistance) as well as complications and adverse effects. Results: In the misoprostol group 27 women (52.9%) required cervical dilation vs. 53 (98.1%) in the control group (P < 0.0001). The largest size of Hegar dilator inserted without resistance was 7.6 ± 1.4 mm in the misoprostol group vs. 5.0 ± 1.1 mm in the control group (P < 0.0001). A similar effect of misoprostol on cervical dilation was also found in the subgroup of treated postmenopausal women. Only 2 women (3.9%) experienced mild lower abdominal pain after misoprostol application. Conclusion: Vaginal misoprostol applied before hysteroscopy reduced cervical resistance and the need for cervical dilation in perimenopausal and postmenopausal women, with only mild adverse effects.

Oral, vaginal and sublingual misoprostol for induction of labor

Objective: To evaluate the effectiveness and safety of different administration routes of misoprostol for induction of labor.Method: PubMed, Cochrane Library and EMBASE searches were carried out using the keywords oral, vaginal, sublingual, buccal, misoprostol, labor induction, identifying randomized case–controlled trials comparing different routes for giving misoprostol to induce labor, published in English between 1994 and 2004. Results: Seventeen studies (3549 participants) were included. Compared to vaginal administration, oral misoprostol was associated with higher failure rates for achieving vaginal delivery within 24 h (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23–2.10), higher rates of uterine hyperstimulation without fetal heart rate (FHR) changes (OR 2.21, 95% CI 1.12 – 4.34) and lower cesarean section rates (OR 0.74, 95% CI 0.56–0.97). A lower dose of oral misoprostol (50 μg) compared to the 25–50 μg administered vaginally was associated with a higher rate of vaginal delivery not being achieved within 24 h (OR 3.60, 95% CI 2.10 – 6.18), more need for oxytocin augmentation (OR 2.19, 95% CI 1.65–2.92), less uterine hyperstimulation both without FHR changes (OR 0.58, 95% CI 0.42–0.80) and with FHR changes (OR 0.34, 95% CI 0.17–0.67) and fewer cesarean sections (OR 0.69, 95% CI 0.51–0.91). Compared to vaginal administration, buccal misoprostol resulted in a higher rate of failure to achieve vaginal delivery after 24 h, more frequent uterine hyperstimulation and lower rates of cesarean section, but these differences were not significant. When 50 μg of misoprostol used sublingually was compared to oral administration, the sublingual misoprostol was associated with less failure to achieve vaginal delivery after 24 h, less oxytocin augmentation and reduced cesarean section, but none of the differences were statistically significant. Conclusions: Vaginal misoprostol appears more effective than the equivalent dosage administered orally. However, the vaginal route appears to be associated with a higher risk of uterine hyperstimulation. Sublingual misoprostol seems an effective route of administration, but a lack of data necessitates more clinical trials to establish the effectiveness and safety of the buccal/sublingual route.

A case‐referent study on fetal bacteremia and late fetal death of unknown etiology in Lithuania

Background. The objectives were to test the hypothesis that certain strains of microorganisms are present in fetal blood in a significant proportion of parturient women suffering unexplained third trimester fetal death, and to examine the correlation between fetal bacteremia and histologic chorioamnionitis and vasculitis.

Prevalence and risk factors of HPV infection among high-risk rural and urban Lithuanian women.

Aims: To investigate the prevalence, persistence and risk factors of high oncogenic risk human papillomavirus (HPV) among urban and rural women of reproductive age coming to consult a gynaecologist. Methods: A prospective cohort study in urban (Kaunas) and rural (Marijampole) regions of Lithuania. The data were collected in 8 healthcare institutions from women seeking consultation of gynaecologists using a questionnaire for finding out demographic, social, behavioural and biomedical factors. HPV DNA was determined by molecular hybridization method (hybrid capture version II) determining HPV of high oncogenic risk. Result: 1,120 women participated in the study. The prevalence of high-risk HPV among the studied women was 25.1%. It was higher among the urban women than among the rural women. The prevalence of high-risk HPV was increased if the subjects had 2 or more sexual partners during the last 12 months (OR 2.81; 95% CI 1.83–4.32), were 19 years of age or younger (OR 2.68; 95% CI 1.47–4.91), were smoking (OR 1.81; 95% CI 1.16–2.81), and had secondary or lower education level (OR 1.43; 95% CI 1.01–2.04). This infection was obviously associated with high- and low-grade squamous intraepithelial changes of the cervix (OR 1.66, 95% CI = 1.08–2.53). Conclusion: The incidence rate for cervical cancer in Lithuania is one of the highest in comparison with other European countries. HPV infection was also particularly common in the studied population. About one-fourth of the women were infected with high-risk HPV infection. Young and less educated women were found to be the group that was most exposed to HPV, and therefore public health interventions and education seem to be essential in programs aimed at reducing the incidence of cervical cancer.

Socio‐economic, demographic and obstetric risk factors for late fetal death of unknown etiology in Lithuania:

Background. The purpose of this study was to evaluate the association between third trimester unexplained prelabor fetal deaths and various socio‐economic, demographic and obstetric factors in Lithuania.

GROUP B STREPTOCOCCUS AND ESCHERICHIA COLI COLONIZATION IN PREGNANT WOMEN AND NEONATES IN LITHUANIA

To evaluate the prevalence of maternal and neonatal colonization with group B streptococcus (GBS) and Escherichia coli, and examine GBS serotypes and susceptibility to antibiotics.

Comparison of clinical and laparoscopic diagnoses of pelvic inflammatory disease.

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Fetal middle cerebral artery Doppler velocimetry in cases of rhesus alloimmunization.

Objective. To assess fetal middle cerebral artery (MCA) peak systolic velocity (PSV) in cases of rhesus alloimmunization and to establish whether MCA-PSV is valid for the prediction of fetal anemia. Methods. The study population included 157 pregnant women diagnosed with rhesus alloimmunization. MCA-PSV measurements were obtained within 3 days of blood sampling for estimation of hemoglobin concentration either at delivery or cordocentesis by the same operator and by means of the same ultrasound machine using techniques described previously. To evaluate the measurements of the MCA-PSV as the multiples of median (MoM) for gestation we used original nomograms for various gestational ages derived from a group of 273 normal fetuses between 22 and 40 weeks of gestation, not at risk for anemia. Receiver–operator characteristic (ROC) curves were employed to evaluate the relation of the sensitivity (the true positive rate) and the false positive rate (100% specificity) of different threshold values of the MCA-PSV. Results. The sensitivity of the MCA-PSV was 94.4% in the case of the subgroup of fetuses with severe anemia. The sensitivity of the MCA-PSV test decreased in less anemic fetuses and was 77.3% in the subgroup with moderate anemia and 32% in the subgroup with mild anemia. According to ROC curves, we selected the optimal MCA-PSV threshold values of 1.15, 1.44, and 1.53 MoM for the prediction of mild, moderate, and severe anemia, respectively. Conclusions. MCA-PSV is a significant Doppler index valid for the prediction of moderate and severe fetal anemia.