HIV infection and maternal outcome of pregnancy in Mozambican women: a case-control study.
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Case-Control Studies↗
Biomedical subjects
S Bergström
Publications and source records attributed to S Bergström.
Management of amniocentesis in women with oligohydramnios due to membrane rupture: evaluation of a cervical adapter.
Thirty-five pregnant women with gestational age 22-37 completed weeks and with prelabour rupture of the membranes in the preterm period (PROM) volunteered to participate in the study. Sixteen women had a sterile cervical adapter, stopping the leakage of amniotic fluid, applied to the ectocervix for 24 h. The remaining 19 women were managed accordingly to prevailing expectant routine without the cervical adapter. All 35 women were assessed initially and after 24 h by ultrasound to obtain amniotic fluid index (AFI) registered. The results show that the average AFI value in the adapter group almost doubled while it changed insignificantly in the group without adapter. The difference in change between the two groups is significant (p < 0.001). There were no infectious complications in the newborn or in the mother. It is concluded that, in case amniocentesis is indicated to enable improved diagnostic accuracy in women with oligohydramnios due to PROM, application of the cervical adapter designed in this study will increase AFI and facilitate a less complicated amniocentesis.
Adult↗
Endocervical pathogens in women with preterm and term labour.
The purpose of this study was to compare the endocervical microflora of women in preterm and term labour and to determine whether the presence of a specific microflora is significantly associated with preterm labor. A prospective study was performed in Lithuania among 212 women in preterm labour (latent phase, n = 110; active phase, n = 102) and among 62 healthy women in term labour. Microbiological assessment included cultures for aerobic bacteria, yeasts, and Trichomonas vaginalis and direct immunofluorescence reaction for Chlamydia trachomatis, Escherichia coli (odds ratio 8.16; 95% confidence interval 1.27-340.23) and Staphylococcus aureus (odds ratio 7.79; 95% confidence interval 1.21-325.40) were significantly more often isolated from women in preterm than from women in term labour. The prevalence of C. trachomatis was the same in the preterm and in the term labour group. The pregnancy outcome during the latent or active phase of preterm labour with or without C. trachomatis infection did not differ. It is concluded that E. coli and S. aureus are significantly more prevalent in endocervical cultures from Lithuanian women in preterm than from those in term labour.
Adult↗
Low birth weight and genital infections. An incident case-referent study.
In an attempt to elucidate the potential association between genital infections and low birth weight (LBW) births, 51 women with LBW neonates were identified and compared to 51 women with normal birthweight (NBW) neonates. Both groups were matched according to age and parity. All women were subjected to interviews regarding socioeconomic background and obstetric history. The were examined clinical and tested regarding serum haemoglobin, malaria parasitaemia, syphilis and HIV serology. Cultures were taken from the vagina, endocervix, amniotic fluid and from various sites of newborn, including the conjunctivae and the stomach and from the interior of the placenta. Whilst socioeconomic background factors did not differ among cases and referents, previous neonatal death did. Significant differences were also found in mid-upper-arm circumference (OR 3.08) and body mass index (OR 6.00). The prevalence of alleged risk factors according to the antenatal card was similar among cases and referents. Birthweight < 2,000 g was significantly more often associated with chorioamnionitis than birthweight between 2,000 and 2,499 g (OR 5.46). Bacteriological findings did not show significant differences in cases and referents. Haemoglobin values and prevalence of malaria parasitaemia were similar as was the neonatal mortality. It is concluded that LBW births is difficult to predict by use of alleged risk factors in existing antenatal cards.
Adolescent↗
Aetiology of late fetal death in Maputo.
BACKGROUND: To study the etiology of late fetal death in Maputo. PATIENTS: Stillbirths (n = 163) in Maputo were compared to 207 live births. RESULTS: A probable cause of fetal death could be determined in 112 cases (69%). Hypertension was the most common factor associated with stillbirth and occurred in 14% of the fetal deaths, followed by abruption of the placenta (13%), syphilis (8%), clinical intra-uterine infection (6%), malaria (4%), fetal malformation (4%), umbilical cord complications (4%) and anaemia (4%). Mothers of stillborns and referent mothers differed in the following parameters: fetal weight, gestational age, numbers of previous stillbirths, haemoglobin, packed cell volume (p < 0.001), age, number of pregnancies (p < 0.01), parity, number of live children and skinfold thickness (p < 0.05). In the stillborn cases where no probable cause of fetal death was established, newborn weight was significantly lower and estimated gestational age significantly shorter (p < 0.001), number of previous pregnancies and number of previous stillbirths were significantly larger (p < 0.05) than in the referent group, but otherwise no significant differences were found. In two randomly selected sub-groups, 28 mothers with stillbirth without probable diagnoses, and in 24 referent mothers, selected serum proteins and acute-phase reactants were determined. There were no statistically significant differences in the mean values of haptoglobin, pre-albumin, retinol-binding protein and alpha 1-antitrypsin in the two subgroups. The stillbirth subgroup had significantly higher mean values of C-reactive protein and serum orosomucoid than the referent group (p < 0.01). CONCLUSION: Signs of maternal illness were present in one third of the mothers with stillbirth, and half of them required medical care. In one third there was no final diagnosis, but these mothers showed significantly higher mean values of acute phase reactants, suggesting low-grade infection.
Acute-Phase Proteins↗
A case-control study on post-caesarean endometritis-myometritis in Mozambique.
Post-caesarean endometritis-myometritis (PCEM) was diagnosed in 49 Mozambican women. They were compared with 47 control women without signs of PCEM after caesarean section. The patients and controls were matched for age, parity and days post partum. Features of the socio-economic background and of past and current obstetric history were registered. Endocervical, intracavitary and blood cultures were carried out. Screening for syphilis seropositivity and HIV-1 and HIV-2 antibodies was performed. Socio-economic and obstetric background factors were similarly distributed in cases and referents, though previous caesarean section was less frequent among cases than among referents (OR 0.12). Moderate high-risk factors in existing antenatal card tended to be more frequent among cases than among referents (OR 3.29). Microbiological findings indicated more anaerobes in the vagina, in the endocervix and in the uterine cavity, though the differences only approached significance. It is concluded that women with PCEM in the setting studied expose few characteristic background features discriminating them from women with uneventful post-caesarean outcome. Further research efforts should be directed towards case-control studies with focus upon surgical factors and on a more comprehensive microbiology and serology approach.
Case-Control Studies↗
A comparative study of vaginal misoprostol and intravenous oxytocin for induction of labour.
Fifty-two women who had labour induced by intravenous oxytocin were compared with 404 women in whom labour was induced by vaginal misoprostol (50-150 micrograms). The induction-to-delivery intervals in the oxytocin and misoprostol groups, respectively, had the following durations. With Bishop's score < 6, 24.3 vs. 14.4 h (p = 0.002), with Bishop's score > or = 6, 10.5 vs. 7.6 h (p = 0.02), with ruptured membranes, 8.8 vs. 8.5 h (p = 0.83), and with intact membranes, 19.6 vs. 13.1 h (p = 0.005). The Caesarean delivery rate was 17.3% in the oxytocin group and 8.7% in the misoprostol group (p = 0.09). Maternal complications were few and drug side effects rare. It is concluded that vaginal misoprostol is a valuable and cost-effective alternative to intravenous oxytocin infusion for induction of labour.
Administration, Intravaginal↗
Vaginal misoprostol as an alternative to oxytocin for induction of labor in women with late fetal death.
BACKGROUND: Induction of labor in women with late fetal death is often difficult in settings with scarce resources. The purpose of this study was to assess the value of vaginal misoprostol for induction of labor in women with such fetal death. METHODS: In Maputo 156 women with late fetal death were allotted in a non-randomised way to either vaginal misoprostol or intravenous infusion of oxytocin. Treatment outcomes were compared as to cost-effectiveness and safety. In the misoprostol group none received more than 800 micrograms. Oxytocin infusion followed an established routine. Statistical analyses were performed by EPI Info software. RESULTS: In cases with Bishop's score < 6 the induction-to-delivery interval averaged 14.8 hours in the misoprostol group and 31.0 hours in the oxytocin group (p = 0.001). The corresponding values for women with Bishop's score > or = 6 were 6.6 and 8.7 hours, respectively (p = 0.4). Women with intact membranes had an induction-to-delivery interval of 13.8 hours in the misoprostol group and 26.9 hours in the oxytocin group (p = 0.002). The corresponding values in women with ruptured membranes were 7.8 and 10.5 hours, respectively (p = 0.6). Successful induction was achieved in 81% of misoprostol-treated women at a dose of 100 micrograms or less. CONCLUSIONS: Vaginal misoprostol is a safe, low-cost drug particularly suitable in women of high average parity having late, fetal death.
Administration, Intravaginal↗
Low birthweight and post partum endometritis-myometritis.
BACKGROUND: The study aims at confirming or rejecting the hypothesis of an association between birthweight and post partum uterine infection. METHODS: A case-referent study was performed on 51 puerperal women with clinical signs of endometritis-myometritis. To each case an otherwise healthy puerperal woman was recruited and matched for age, parity and days after delivery. RESULTS: The proportion of women having had newborns with birthweight < 2500 g was 20/49 among cases and 2/50 among referents (odds ratio 16.6; 95% CI 3.5-152.3). Preterm births were registered in 15/50 cases and 2/49 referents (odds ratio 10.1; 95% CI 2.1-94.5). The average gestational age at delivery was approximately 2 weeks shorter among cases than among referents (37.5 versus 39.5 weeks). CONCLUSIONS: Low birth weight was ten times more prevalent among women with puerperal infection than among healthy puerperal women. The findings indicate that giving birth to a low birth weight baby is strongly associated with ensuing puerperal infection, possibly by a subclinical antenatal intrauterine infection, predisposing to both adverse fetal and maternal outcomes of pregnancy.
Endometritis↗
Socio-economic client characteristics and consequences of abortion in Nairobi.
In Nairobi, 281 women presenting with alleged miscarriage were subdivided in the following subgroups, 91 spontaneous abortions (group 1), 152 suspected induced abortions (group 2) and 38 admittedly induced abortions (group 3). In the statistical analysis women in group 1 were compared with women from groups 2 and 3 combined (here referred to as group 4). Group 4 differed significantly from group 1 in the following respects: they were younger (p = 0.03) although they had previously born more babies (p = 0.008), lived more often together with their parents (p = 0.024), were less often married (p = 0.000012), worked more often as housewives (p = 0.00079), and lived in bigger households (p = 0.000015). No significant differences were encountered regarding religious beliefs. Group 4 women were more informed about contraceptives than group 1 (p = 0.04), particularly regarding injectables (p = 0.000096) and oral contraceptives (p = 0.0013) but also intra uterine devices (p = 0.024). Almost 90% of group 4 women indicated post abortion contraceptive interest, while only 1/3 of group 1 women did so. Group 3 women needed extensive parenteral treatment with a total hospital treatment cost amounting to 300 times that of group 1. The total cost of intravenous infusions was almost 10 times as high in group 3 as in group 1. The total number of days in hospital was significantly higher in group 4 than in group 1 (p = 0.0098).(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Illegal↗
Use of fundal height as a proxy for length of gestation in rural Africa.
Lack of information on the date of the last menstrual period is a common problem in antenatal care in developing countries. The aim of this study was to see whether the fundal height can be used as a proxy for the length of gestation. A graph representing the expected remaining time to delivery was constructed from fundal height measurements in 7790 pregnant women delivered in a rural African hospital from 1970 to 1988. The graph was used to predict the probable week of delivery in 604 pregnant women giving birth to a singleton child in 1989. The mean deviation of the actual week of delivery from the predicted week was -0.6 (s.d. 3.4) weeks. In 270/604 cases (45%) delivery occurred within 2 weeks of the predicted week. Birthweight and perinatal mortality were strongly related to the deviation from the predicted week of delivery. The majority of perinatal deaths (34/50, 68%) occurred in children delivered early. The fundal height, as measured by paramedicals in routine antenatal care in rural Africa, may be used as a proxy for the length of gestation when the date of the last menstrual period is not known.
Birth Weight↗
[Malaria in Norway--a tropical disease off the track?].
Today, malaria is most often thought of as a tropical disease. Two and a half billion of the world's population live in malaria endemic areas, most of them in the tropics, and one million die of malaria annually. The explanation of the appearance and disappearance of malaria is multifactorial. However, increasing interest is being shown in the socioeconomic aspects of many diseases, and it is interesting to observe that diseases found in Europe as late as in the 18th and 19th century are also predominant in today's developing countries. Research in medical history can make a significant contribution to the efforts to find the reasons for the appearance and disappearance of a disease. It is well known that malaria was common on the European continent, but it is less well known that malaria also existed in Norway during the 19th century.
Disease Outbreaks↗
["You are in bed with the Vatican!" On family planning during 20 years of work in developing countries].
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Bangladesh↗
[Female circumcision--a genital mutilation].
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Africa↗
[AIDS in Africa can be conquered].
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Acquired Immunodeficiency Syndrome↗
Structure of the human beta-casein encoding gene.
The entire human beta-casein-encoding gene, Bca, was cloned and sequenced. The gene consists of eight exons ranging from 21 to 531 nucleotides (nt) in length and extending over 10,466 nt. Exon-2 contains the translational start, the entire signal sequence and the codons for the two first amino acids of the mature protein. This corresponds to the organization found in other species. The translational stop is localized to exon-7. Exon/intron boundaries are in accordance with the AG/GT rule and conform to suggested consensus sequences. Splice junctions are located between coding triplets. In all other species analyzed, Bca has been found to consist of nine exons; however, within intron-2 of the human gene, a sequence omitted from human mRNA, but corresponding to exon-3 of other known Bca genes, was revealed.
Amino Acid Sequence↗
PACS-RIS interconnection: results of a feasibility study.
In a study on behalf of the Swedish National Board of Development we have attempted to figure out what a complete information system for the small and medium sized radiology department should contain. Some of the results will be presented in this article. One of the main questions was whether a natural interface between what usually is referred to as PACS (picture archiving and communications system) and RIS (radiology information system) exists. Our answer to that question is, simply, no. We mean that an information system that handles all information on the radiology department has to be designed as one system and not be divided into a PACS and an RIS.
Computer Communication Networks↗
A bactericidal antibody to Borrelia burgdorferi is directed against a variable region of the OspB protein.
Borrelia burgdorferi, an agent of Lyme disease, is killed by some monoclonal antibodies in the absence of complement or phagocytes. In the present study, the bactericidal action of monoclonal antibodies against B. burgdorferi and B. hermsii, a cause of relapsing fever, was further characterized. H6831, an antibody recognizing the OspB proteins of some B. burgdorferi strains, and H4825, an antibody specific for one serotype of B. hermsii, were purified, and Fab fragments of the antibodies were prepared. In time-kill studies, more than 99.9% of strain B31 B. burgdorferi cells were killed after 30 min of exposure to H6831 Fab fragments. The MBC of the Fab fragments was 10 micrograms/ml. Electron microscopy revealed that the bactericidal Fab fragments produced numerous blebs and cell lysis of the borrelias for which they were specific. To identify the epitope for H6831, the OspB sequences of H6831-susceptible and -resistant strains and mutants were determined. The deduced OspB proteins of all H6831-resistant strains and mutants differed from the strain B31 OspB at residue 253. Murine antisera raised against a 21-mer synthetic peptide representing the region around residue 253 were specific for strain B31 by Western blot (immunoblot) and growth inhibition assays. Furthermore, the antipeptide serum inhibited the binding of H6831 to whole borrelias. These findings indicated that the linear component of the bactericidal antibody's epitope was located at or near residue 253.
Amino Acid Sequence↗