Association of anti-Chlamydia antibodies with ectopic pregnancy in Benin city, Nigeria: a case-control study

Relationship between Vaginal Bacterial Infections and Pregnancy Outcomes: A Systematic Review and Meta-Analysis

Background

Bacterial infections are among the most serious infections worldwide. They can cause miscarriage, premature birth, stillbirth, and ectopic pregnancy in pregnant women. The aim of this study was to investigate the relationship between bacterial infections and pregnancy outcomes through a systematic review and meta-analysis.

Materials and Methods

PubMed, Scopus, Web of Science, and Embase databases were searched from January 2000 to December 2018 using appropriate keywords to identify related articles. The final related studies were selected and evaluated using the Newcastle-Ottawa Scale (NOS).

Results

Results of this meta-analysis based on combining case-control studies showed that the presence of bacterial infections could lead increase in the odds of all pregnancy outcomes like premature infant birth (odd ratio [OR]: 1.50; 95% Confidence Interval [CI], 1.39-1.61), preterm delivery (OR: 1.54; 95% CI, 1.39-1.70), abortion (OR: 1.16; 95% CI, 1.04-1.29), stillbirth (OR, 1.29; 95% CI, 1.12-1.49), and ectopic pregnancy (OR: 1.12; 95% CI, 1.05--1.19). The results showed that the Risk Ratio (RR) of preterm delivery in pregnant women with vaginal infections was 1.57 (95% CI, 1.46-1.67), whereas the RR of abortion was 2.02 (95% CI, 1.72-2.38).

Conclusions

Based on the results of this meta-analysis, the presence of bacterial infections in pregnant women can lead increase in the risk of pregnancy outcomes especially, preterm delivery, abortion, stillbirth, and ectopic pregnancy. Therefore, it is necessary for obstetricians and gynecologists to pay attention to the diagnosis of these infections in women before pregnancy and during pregnancy in order to prevent the consequences of these infections.

Chlamydia trachomatis Seropositivity and Associated Risk Factors Among Women Attending A Northern Nigerian Tertiary Hospital

Background

Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted infection globally. Acquisition of Ct infection is affected by biological and behavioural factors.

Aim

Determine the prevalence of Ct infection and identify risk factors associated with Ct infection in sexually active fertile women in Northern Nigeria.

Materials and Methods

One hundred and fifty sexually active women presenting to the Obstetrics and Gynaecology department of Ahmadu Bello University Teaching Hospital, Zaria were studied. Socio-demographic characteristics and history of risk factors for acquisition of genital Ct were obtained from the participants using a questionnaire. Their sera were tested for the presence of Ct immunoglobulin G using Enzyme-Linked Immunosorbent Assay.

Results

The mean ages ± standard deviation of seropositive and seronegative women were 29.1 ± 7.3 years and 28.9 (SD 6.7) years respectively (P = 0.438). The prevalence of Ct infection was 6.7% (10/150). Occupation was associated with Ct seropositivity (P = 0.02). Number of sexual partners, age at coitarche; duration of sexual exposure and previous history suggestive of sexually transmitted infection were not associated with Ct seropositivity (P > 0.05).

Conclusion

A low prevalence of Ct was found among fertile women. Lack of regular source of personal income was associated with Ct infection but the sexual behavioural factors studied were not.

[Factors associated with the failure of medical treatment for ectopic pregnancy: case study conducted at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital]

Introduction

the purpose of this study was to identify factors associated with the failure of medical treatment for ectopic pregnancy (EP) in women at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital.

Methods

we conducted a case-control study using a retrospective data collection over a 10-year period from January 1st 2008 to December 31st 2017. Our study included all patients treated for EP; the study group was composed of patients in whom medical treatment had been unsuccessful while the control group was composed of patients in whom medical treatment had been successful. The variables studied were: socio-demographic, clinical, paraclinical and therapeutic features. Consecutive and complete sampling were used. Multivariate analysis was performed.

Results

we enrolled 92 patients, including 23 cases and 69 controls. The variables associated with the failure of medical treatment for EP after univariate analysis were: initial β-HCG (beta-human chorionic gonadotropin) level > 10000IU/L (OR=3.05; P=0.031), β-HCG level on day 4 > 10000IU/L (OR=7.15;P=0.000), β-HCG level on day 7 > 10000UI/L (OR=20; P=0.000), Fernandez score ≥ 13 (OR=3.09;P=0.020), the presence of fetal heart activity (OR=2.8; P=0.036), a history of voluntary abortion (OR=2.67;P=0.043) and primary level of education. (P=0.013). After multivariate analysis, predictors were: initial β-HCG level>10000 IU/L (OR=8.97; P=0.004), β-HCG level on day 4>10000 IU/L (OR=8.44;P= 0.007), Fernandez score ≥ 13 (OR=1.12;P=0.005), and the presence of fetal heart activity (OR=6.09;P=0,026).

Conclusion

at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital predictors of failure of medical treatment for EP were related to initial β-HCG level and fetal viability.

Ectopic pregnancy in the ampulla of the fallopian tube at 16 gestational weeks: lessons from a case report

Background

It is uncommon to find ampullary tubal pregnancy in the second trimester.

Methods

A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an empty uterus with an alive fetus in the right adnexa. She was provisionally diagnosed to have an abdominal pregnancy.

Results

The patient had an emergency laparotomy where 2.2 L of haemoperitoneum and a slow-leaking right ampullary tubal pregnancy were found. Right total salpingectomy was performed and she had an uncomplicated post-operative follow-up. Histology of the lesion confirmed tubal pregnancy.

Conclusion

The growth of a pregnancy in the ampulla beyond the first trimester is possibly due to increased thickness and or distensibility of the fallopian tube. A tubal pregnancy may present with a normal pulse despite significant haemorrhage.

Risk factors for ectopic pregnancy in a population of Cameroonian women: A case-control study

OBJECTIVE

To identify the risk factors for ectopic pregnancy (EP) in a population of Cameroonian women.

SAMPLE AND METHODS

We performed a matched case-control study; 88 women with diagnosed EP (cases), and 176 women with first trimester intrauterine pregnancy (IUP) (controls), who underwent questionnaires. Odds Ratio (OR) and 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors via multivariate logistic regression analysis.

RESULTS

Of the fifteen identified risk factors, 4 were independently associated with increased odds of EP: prior pelvic inflammatory disease (PID) (adjusted odds ratio [AOR] 13.18; 95% CI 6.19-27.42), followed by current use of levonorgestrel-only pills for emergency contraception (LNG-EC) (AOR 10.15; 95% CI 2.21-46.56), previous use of depot medroxyprogesterone acetate (DMPA) (AOR 3.01; 95% CI 1.04-8.69) and smoking at the time of conception (AOR 2.68; 95% CI 1.12-6.40).

CONCLUSION

The present study confirms the wide variety of EP's risk factors. Moreover, some new findings including current use of LNG-EC, previous use of DMPA, smoking at the time of conception are noteworthy. Thus, in our limited resources country where prevention remains the cornerstone for reducing EP chances of occurrence, clinicians should do enough counselling, especially to women with known risk factors. The necessity to facilitate access to more equipment to enable early diagnosis of EP is very crucial and should be seriously considered, in order to reduce the burden of EP in Cameroonian women.

Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015: A Systematic Review

BACKGROUND

Current literature comparing the prevalence rates of curable sexually transmitted infections (STIs) in pregnant women in various global regions is limited. As a result, antenatal screening practices for curable STIs in pregnant women, specifically Treponema pallidum (syphilis), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) vary around the world, differing by country and particular STI.

METHODS

We conducted a systematic review of publications on STI prevalence among pregnant women in 30 different low- and middle-income countries. We searched PubMed for studies reporting prevalence of syphilis, CT, NG, and TV in pregnant women. English language studies published between January 1, 2010, and March 1, 2015, were included. The adjusted mean STI prevalence by region was calculated via multivariable linear regression adjusting for health care setting, women's mean age, study sample size, and sensitivity of diagnostic test.

RESULTS

We identified 75 studies that met inclusion criteria, providing 116 point prevalence estimates for curable STIs among 3,489,621 pregnant women. Adjusted mean prevalence for NG ranged from 1.2% (95% confidence interval [CI], 1.0-1.3) in Latin America to 4.6% (95% CI, 4.0-5.2) in Southern Africa; syphilis prevalence ranged from 1.1% (95% CI, 0.5-1.6) in Asia to 6.5% (95% CI, 4.7-6.3) in Southern Africa; CT ranged from 0.8% (95% CI, 0.4-1.1) in Asia to 11.2% (95% CI, 6.0-16.4) in Latin America; and TV ranged from 3.9% (95% CI, 2.2-5.6) in Latin America to 24.6% (95% CI, 17.9-31.4) in Southern Africa.

CONCLUSIONS

Although we observed a wide variation in STI burden in pregnancy after adjusting for age, test, and health care setting, further valid comparison may depend on adjustment for access to care and screening practices.

Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia

Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.

Reduced prevalence of chronic tubal inflammation in tubal pregnancies after levonorgestrel emergency contraception failure

PURPOSE

The aim of this study was to compare chronic fallopian tubal inflammatory disease and fibrosis between patients with general tubal pregnancy (TP) and TP with levonorgestrel (LNG) emergency contraception (EC) failure.

METHODS

We retrospectively studied patients with general TP (n = 79) and TP following LNG-EC failure (n = 81) within the same conception cycle. Information on the gynecological features of each subject was collected. Pelvic inflammatory disease and associated sequelae were assessed by the serum Chlamydia trachomatis (CT) IgG test, laparoscopic evaluation of tubal damage, and histopathological observation of tube tissues. Chi-square and Student's t-tests were employed to determine the difference between the two groups.

RESULTS

Compared with general TP, cases of TP following LNG-EC failure subjects were less likely to have a history of previous ectopic pregnancy (5.06% vs. 18.52%, p = 0.009) and adnexal surgery (6.33% vs. 22.22%, p = 0.010). Patients with TP following LNG-EC failure were less likely to have pelvic inflammatory disease and associated sequelae than those with general TP, as revealed by positive reaction to anti-CT IgG (18.18% vs. 35.94%, p = 0.031), assessment of tubal damage (grade I: 5.06% vs. 17.28%; grade II: 2.53% vs. 11.11%; grade III: 1.27% vs. 6.17%; p = 0.001), infiltration of chronic inflammatory cells (10.91% vs. 62.50%, p < 0.001), and positive Masson's staining (7.69% vs. 39.58%; p < 0.001).

CONCLUSIONS

Compared with cases of general TP, cases of TP following LNG-EC failure exhibited reduced rates of CT infection, fallopian tubal inflammation, and/or fibrosis.

Chlamydia trachomatis and Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health

The most prevalent, curable sexually important diseases are those caused by Chlamydia trachomatis (C. trachomatis) and genital mycoplasmas. An important characteristic of these infections is their ability to cause long-term sequels in upper genital tract, thus potentially affecting the reproductive health in both sexes. Pelvic inflammatory disease (PID), tubal factor infertility (TFI), and ectopic pregnancy (EP) are well documented complications of C. trachomatis infection in women. The role of genital mycoplasmas in development of PID, TFI, and EP requires further evaluation, but growing evidence supports a significant role for these in the pathogenesis of chorioamnionitis, premature membrane rupture, and preterm labor in pregnant woman. Both C. trachomatis and genital mycoplasmas can affect the quality of sperm and possibly influence the fertility of men. For the purpose of this paper, basic, epidemiologic, clinical, therapeutic, and public health issue of these infections were reviewed and discussed, focusing on their impact on human reproductive health.