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BACKGROUND The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of

Background Female youth with perinatally acquired human immunodeficiency virus (PHIV) may be at higher risk than uninfected youth for persistent anogenital human papillomavirus (HPV) infection, due to prolonged immunodeficiency. Methods A 3-year cohort study was conducted between 2013 and 2017 among Thai and Vietnamese PHIV and HIV-uninfected females 12–24 years, matched by age group and number of lifetime sexual partners. For HPV genotyping, cervical and anal samples were obtained at baseline and annually. Vaginal samples were collected at baseline and every 6 months. Factors associated with high-risk HPV (HR-HPV) persistence and incidence were assessed. Results We enrolled 93 PHIV and 99 HIV-uninfected females. Median age was 19 (interquartile range [IQR] 18–20) years. For the 7 HR-HPV types (16, 18, 31, 33, 45, 52, 58) in the nonavalent HPV vaccine, PHIV had significantly higher incidence (P = .03) and persistence (P = .01) than HIV-uninfected youth over a 3-year period. Having HIV (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.1–3.9) and ever using illegal substances (aHR 4.8, 95% CI 1.8–13.0) were associated with incident 7 HR-HPV infections. HIV-positive status (adjusted prevalence ratio [aPR] 2.2, 95% CI 1.5–3.2), recent alcohol use (aPR 1.75, 95% CI 1.2–2.5), and higher number of lifetime partners (aPR 2.0, 95% CI 1.4–3.1, for 3–5 partners; aPR 1.93, 95% CI 1.2–3.2, for ≥6 partners) were significantly associated with persistent 7 HR-HPV infections. Conclusions Female PHIV were at higher risk of having anogenital HR-HPV acquisition and persistence. Primary and secondary prevention programs for HPV infection and HPV-related diseases should be prioritized for PHIV children and youth.

Despite significant progress in reaching some milestones of the United Nations Sustainable Development Goals, neonatal and early infant morbidity and mortality remain high, and maternal health remains suboptimal in many countries. Novel and improved preventative strategies with the potential to benefit pregnant women and their infants are needed, with maternal and neonatal immunization representing effective approaches. Experts from immunology, vaccinology, infectious diseases, clinicians, industry, public health, and vaccine-related social sciences convened at the 5th International Neonatal and Maternal Immunization Symposium (INMIS) in Vancouver, Canada, from 15 to 17 September 2019. We critically evaluated the lessons learned from recent clinical studies, presented cutting-edge scientific progress in maternal and neonatal immunology and vaccine development, and discussed maternal and neonatal immunization in the broader context of infectious disease epidemiology and public health. Focusing on practical aspects of research and implementation, we also discussed the safety, awareness, and perception of maternal immunization as an existing strategy to address the need to improve maternal and neonatal health worldwide. The symposium provided a comprehensive scientific and practical primer as well as an update for all those with an interest in maternal and neonatal infection, immunity, and vaccination. The summary presented here provides an update of the current status of progress in maternal and neonatal immunization., SCOPUS: ar.j, info:eu-repo/semantics/published

A new generation of recombinant acellular pertussis vaccine containing genetically inactivated pertussis toxin (PTgen) was licensed as a monovalent pertussis vaccine (aPgen; Pertagen®) and in combination with tetanus and reduced-dose diphtheria (TdaPgen; Boostagen®) for active immunization in individuals aged 11 years and older in Thailand in 2016. We here report post-marketing safety data on the use of the vaccines in individuals in the community obtained through active pharmacovigilance surveillance including pregnant women participating in a prospective observational study. Between May 2017 and February 2020 for TdaPgen and between June 2018 and February 2020 for aPgen, participating health care providers vaccinated and collected safety data for 11,429 exposed adolescents and adults. This included 1778 pregnant women. The incidence rate of adverse events following immunization (AEFIs) was 11.5 per 1000 of vaccinated individuals (95% confidence interval (95% CI) 9.7–13.6). AEFIs mostly concerned local pain at the injection site and muscle pain, and symptoms were mild and mostly resolved within a few days with no complications. The incidence rate of AEFIs in women vaccinated during pregnancy was 1.1 per 1000 (95% CI 0.3–4.1). Of 833 pregnant women vaccinated with recombinant aPgen or TdaPgen, 91.4% (95% CI 89.3–93.3) had uncomplicated pregnancies and 98.7% (95% CI 97.7–99.4) of the 855 babies delivered by these women were born healthy, which exceeds rates generally reported in Thailand. There were no vaccine-related serious adverse events reported during the surveillance period. In conclusion, active pharmacovigilance confirms that the recombinant pertussis vaccines aPgen (Pertagen) and TdaPgen (Boostagen) are safe in adolescents and adults, including pregnant women vaccinated in the second or third trimester of pregnancy.

Aim To compare the efficacies and side effects of intravenous and oral dexamethasone (IV-D and PO-D) for paclitaxel-associated hypersensitivity reaction (P-HSR) prophylaxis in patients with primary ovarian, fallopian tube and peritoneal carcinomas (POC/PFTC/PPC) receiving a first cycle of paclitaxel plus carboplatin (TC). Methods In this double-blind randomized controlled trial, patients with POC/PFTC/PPC receiving a first cycle of TC were randomly allocated in a 1:1 ratio to either the IV-D or PO-D groups. Those were followed at 28 days. Primary outcomes were incidence of overall and severe P-HSRs. Secondary outcomes included incidence of dexamethasone-related side effects, other chemotherapy-related adverse events (AEs), and quality-of-life (QoL). Results A total of 288 patients were enrolled from February to July 2015, of whom 281 were eligible for analysis, including 140 allocated to IV-D and 141 to PO-D. There was no significant difference in P-HSR rate between the IV-D and PO-D groups (17.9% vs. 19.1%, P = 0.780). Severe P-HSR occurred in one women in the IV-D group (0.7% vs. 0%, P = 0.498). There were no significant differences in other chemotherapy-related AEs and QoL scores. However, women in the PO-D had more side effects from short-term corticosteroid use than those in the IV-D group, especially acne (10.6% vs. 2.1%, P = 0.004). Conclusions IV-D and PO-D have similar efficacies for preventing P-HSR. However, short-term IV-D may be associated with fewer side effects than PO-D. IV-D is thus suggested for P-HSR prophylaxis in patients with POC/PFTC/PPC receiving a first cycle of TC.

The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI)20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue.

BackgroundInfection with high-risk human papillomavirus (HR-HPV) may be higher in perinatally human immunodeficiency virus (HIV)–infected (PHIV) than HIV-uninfected (HU) adolescents because of long-standing immune deficiency.MethodsPHIV and HU females aged 12–24 years in Thailand and Vietnam were matched by age group and lifetime sexual partners. At enrollment, blood, cervical, vaginal, anal, and oral samples were obtained for HPV-related testing. The Wilcoxon and Fisher exact tests were used for univariate and logistic regression for multivariate analyses.ResultsNinety-three PHIV and 99 HU adolescents (median age 19 [18–20] years) were enrolled (June 2013–July 2015). Among PHIV, 94% were currently receiving antiretroviral therapy, median CD4 count was 593 (392–808) cells/mm3, and 62% had a viral load ConclusionsPerinatal HIV infection was associated with a higher risk of HR-HPV and abnormal cervical cytology. Our results underscore the need for HPV vaccination for PHIV adolescents and for prevention and screening programs for HPV and other STIs.

We determined the effect of short-chain galacto-oligosaccharides (scGOS), long-chain fructo-oligosaccharides (lcFOS) and Bifidobacterium breve M-16V on the gut microbiota of cesarean-born infants. Infants were randomized to receive a standard formula (control), the same with scGOS/lcFOS and B. breve M-16V (synbiotic), or with scGOS/lcFOS (prebiotic) from birth until week 16, 30 subjects born vaginally were included as a reference group. Synbiotic supplementation resulted in a higher bifidobacteria proportion from day 3/5 (P 0.0001) until week 8 (P = 0.041), a reduction of Enterobacteriaceae from day 3/5 (P = 0.002) till week 12 (P = 0.016) compared to controls. This was accompanied with a lower fecal pH and higher acetate. In the synbiotic group, B. breve M-16V was detected 6 weeks postintervention in 38.7% of the infants. This synbiotic concept supported the early modulation of Bifidobacterium in C-section born infants that was associated with the emulation of the gut physiological environment observed in vaginally delivered infants.

Objectives First, to evaluate the longitudinal changes of HIV RNA in genital secretions in HIV-positive women with plasma HIV RNA 50 copies/mL in 27% of the participants, and in 40% after menopause. The GVL was

Contains fulltext : 97408.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To investigate whether Thai HIV-1-infected pregnant women require a dose increase of lopinavir/ritonavir (LPV/r) and to assess the safety and efficacy of the generic tablets during pregnancy. DESIGN: Prospective, single-center pharmacokinetic study. METHODS: HIV-infected pregnant, antiretroviral therapy-naive or experienced women started HAART containing generic LPV/r 400/100 mg tablets twice daily. The 12-h pharmacokinetic curves were recorded at gestational age 20 weeks (GA20, optional), 33 weeks (GA33) and 12 weeks postpartum (12PP, optional). RESULTS: Twenty women were included. Median [interquartile range (IQR)] age was 28 (25-33) years and mean (SD) weight at GA33 was 59.9 (4.2) kg. Mean (SD) values for LPV area under the curve(0-12 h), C(max), C(min), and T(half) were 72.9 (19.2) mg/l h, 9.3 (2.2) mg/l, 3.2 (1.3) mg/l and 4.8 (2.4) h, respectively, on GA33 and 98.0 (24.1) mg/l h, 11.7 (2.2) mg/l, 4.7 (2.2) mg/l and 5.9 (2.7) h, respectively on 12PP. Twelve women recorded both GA33 and 12PP curves; mean LPV AUC(0-12) was significantly lower at GA33 [-24.1 (95% confidence interval -44.4 to -3.7) mg/l h]. At GA33, 19 of 20 women had sufficient LPV trough concentrations (>1.0 mg/l) and at 12PP, all had sufficient LPV trough concentrations. None of the women stopped LPV/r before planned discontinuation due to side-effects. At delivery, 19 of 20 women had a viral load below 50 copies/ml. One woman had a viral load of 60 copies/ml, but was undetectable at 12PP. CONCLUSION: Standard dose generic LPV/r (400/100 mg twice daily) in Thai HIV-1-infected pregnant women leads to adequate plasma concentrations during the third trimester. The generic LPV/r tablet is well tolerated and effective for use during pregnancy.

Objectives: To evaluate the prevalence and risk factors of anal squamous intraepithelial lesions (ASIL), the putative anal cancer precursor, in Asian HIV positive and HIV negative men who have sex with men (MSM). Methods: Men who underwent anal Pap smear reported clinical, sociodemographic and behavioural information collected through questionnaire and interview between January 2007 and April 2008. χ2 and logistic regression were used to evaluate ASIL prevalence and risk factors among HIV positive and HIV negative MSM. Results: Of the 174 MSM (mean age 32.1 years), 118 (67.8%) were HIV positive. Overall, 27% had abnormal anal cytology: 13.2% had atypical squamous cells of undetermined significance (ASC-US), 11.5% had low-grade squamous intraepithelial lesion (LSIL) and 2.3% had high-grade squamous intraepithelial lesion (HSIL). Prevalence of ASIL was higher among HIV positive than HIV negative MSM (33.9% vs 12.5%; p = 0.003). Among HIV positive MSM, 16.1% had ASC-US, 14.4% had LSIL and 3.4% had HSIL and 7.1%, 5.4% and 0% in HIV negative MSM, respectively. Anal condyloma was detected in 22% of HIV positive and 16.1% (9/56) of HIV negative MSM (p = 0.5). In HIV positive MSM, anal condyloma (OR 3.42, 95% CI 1.29 to 9.04; p = 0.01) was a significant risk factor for ASIL. Highly active antiretroviral therapy use and CD4+ T cell count were not associated with ASIL. Conclusions: One-third of HIV positive and 12.5% of HIV negative MSM had ASIL. Thus, as greater numbers of HIV positive MSM live longer due to increasing access to HAART worldwide, effective strategies to screen and manage anal precancerous lesions are needed.

Background Twin pregnancies are associated with a high risk of neonatal mortality and morbidity due to an increased rate of preterm birth. Betamimetics can decrease contraction frequency or delay preterm birth in singleton pregnancies by 24 to 48 hours. The efficacy of oral betamimetics in women with a twin pregnancy is unproven. Objectives To assess the effectiveness of prophylactic oral betamimetics for the prevention of preterm labour and birth for women with twin pregnancies. Search methods We searched the Cochrane Pregnancy and Childbirth Group Trials Register (21 September 2015), MEDLINE (January 1966 to 31 July 2015), EMBASE (January 1985 to 31 July 2015) and reference lists of retrieved studies. Selection criteria Randomised controlled trials in twin pregnancies comparing oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. Quasi-randomised controlled trials, cluster-randomised trials and cross-over trials were not eligible for inclusion. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two authors assessed the quality of the evidence using the GRADE approach. Main results Overall, the quality of evidence is low for the primary outcomes. All of the included trials had small numbers of participants and few events. Preterm birth, the most important primary outcome, had wide confidence intervals crossing the line of no effect. Six trials (374 twin pregnancies) were included, but only five trials (344 twin pregnancies) contributed data. All trials compared oral betamimetics with placebo. Betamimetics reduced the incidence of preterm labour (two trials, 194 twin pregnancies, risk ratio (RR) 0.37; 95% confidence interval (CI) 0.17 to 0.78; low quality evidence). However, betamimetics did not reduce prelabour rupture of membranes (one trial, 144 twin pregnancies, RR 1.42; 95% CI 0.42 to 4.82; low quality evidence), preterm birth less than 37 weeks' gestation (four trials, 276 twin pregnancies, RR 0.85; 95% CI 0.65 to 1.10; low quality evidence), or less than 34 weeks' gestation (one trial, 144 twin pregnancies, RR 0.47; 95% CI 0.15 to 1.50; low quality evidence). Mean neonatal birthweight in the betamimetic group was significantly higher than in the placebo group (three trials, 478 neonates, mean difference 111.22 g; 95% CI 22.21 to 200.24). Nevertheless, there was no evidence of an effect of betamimetics in reduction of low birthweight (two trials, 366 neonates, average RR 1.19; 95% CI 0.77 to 1.85, random-effects), or small-for-gestational age neonates (two trials, 178 neonates, average RR 0.90; 95% CI 0.41 to 1.99, random-effects). Two trials showed that betamimetics significantly reduced the incidence of respiratory distress syndrome (388 neonates, RR 0.30; 95% CI 0.12 to 0.77), but the difference was not significant when the analysis was adjusted to account for the non-independence of twins (194 twins, RR 0.35; 95% CI 0.11 to 1.16). Three trials showed no evidence of an effect of betamimetics in reducing neonatal mortality, either with the unadjusted analysis, assuming twins are completely independent of each other (452 neonates, average RR 0.90; 95% CI 0.15 to 5.37, random-effects), or in the adjusted analysis, assuming non-independence of twins (226 twins, average RR 0.74; 95% CI 0.23 to 2.38, random-effects). A maternal death was reported in one trial without a significant difference between the groups (144 women, RR 2.84; 95% CI 0.12 to 68.57). Authors' conclusions There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women with a twin pregnancy.

Purpose: To determine the prevalence of chromosomal abnormalities in fetuses with prenatally diagnosed pleural effusions and to identify factors associated with an increased risk of aneuploidy. Methods: A retrospective analysis of the Genzyme Genetics database was performed for samples submitted from October 1994 to April 2003 with an indication of fetal pleural effusion. Results: There were 246 samples in which pleural effusion was identified as an indication for prenatal chromosome analysis. Ninety-four were from fetuses with isolated pleural effusions and 152 had other abnormalities in addition to pleural effusion. The prevalence of chromosome abnormalities was 35.4% (95% confidence interval, 29.2–41.4%). Among the eight first trimester samples, the aneuploidy rate was 63%. Pleural effusion cases associated with additional sonographic findings had a significantly higher aneuploidy rate than the isolated pleural effusion cases (50% vs. 12%, P < 0.001). Conclusions: Chromosome analysis is warranted after the prenatal detection of a fetal pleural effusion. The risk of aneuploidy is greater with first trimester detection and is significantly increased in the presence of other associated anomalies.

Objective To compare the effectiveness of ceftriaxone versus cefazolin for the prevention of febrile morbidity and postoperative infections among patients after abdominal hysterectomy. Methods In a double-blind, randomized, controlled trial in Bangkok, Thailand, 320 patients undergoing abdominal hysterectomy between July 2008 and July 2009 were randomly assigned to receive 1 g of either ceftriaxone or cefazolin intravenously in a single dose before surgery. The participants were evaluated for postoperative fever and infection for up to 4 weeks. χ2 or Fisher exact tests were used for statistical analysis. Results There was no significant difference between the ceftriaxone and cefazolin groups in incidence of febrile morbidity (9.4% versus 11.2%), wound infection (3.8% versus 1.9%), vaginal cuff infection (3.8% versus 1.9%), or urinary tract infection (1.9% versus 1.9%). Conclusion There was no difference between the use of single-dose preoperative ceftriaxone and cefazolin in preventing infectious morbidity among patients undergoing hysterectomy.

There are limited data for age at menopause (AM) and menopause-related symptoms in human immunodeficiency virus (HIV)-infected Asian women. We investigated AM and menopause-related symptoms in HIV-infected Thai women.HIV-infected Thai women 40 years or older who did not receive any hormone therapy in the 8-week period preceding the study were enrolled. Participants completed the Menopause-Specific Quality of Life survey for their symptoms in the past 30 days. Menopause was defined as having the last menstrual period more than 1 year ago. Multivariate Cox proportional hazard regression analysis was used to identify factors associated with menopause.Two hundred sixty-eight HIV-infected women were enrolled; their median age was 44.6 (41.8-48.7) years, and the ratio of their Centers for Disease Control and Prevention clinical classifications (A:B:C) was 53%:34%:13%; 95% were using highly active antiretroviral therapy. The median (interquartile range [IQR]) CD4 count was 575 (437-758) cells/μL, and 93% had HIV-RNA of less than 1.7log10 copies/mL. Among the 55 women who had reached menopause, the mean (SD) AM was 47.3 (5.1) years. The mean (SD) AM in our study was earlier than the previous report of 49.5 (3.6) years in non-HIV-infected Thai women (difference, -2.2 y; 95% CI, -3.2 to -1.2, P0.01). Postmenopausal women had more symptoms, including night sweats (P = 0.03), change in sexual desire (P = 0.01), and avoiding intimacy (P = 0.01), compared with nonpostmenopausal women. No differences in psychosocial or physical domains between groups were found. Factors associated with menopause were Centers for Disease Control and Prevention clinical classification B or C (hazard ratio, 1.7; 95% CI, 1.0-3.03, P = 0.04), and no sexual act in the past month (hazard ratio, 4.9; 95% CI, 1.5-16.0, P = 0.01). No associations of later age of menarche, parity, marital status, educational level, income, body mass index, CD4 count, and HIV-RNA with menopause were found.AM in HIV-infected Thai women was 47.3 years, which is significantly earlier than the findings of a previous AM report on non-HIV-infected women. Postmenopausal HIV-infected women had more vasomotor and sexual symptoms. More studies are needed to investigate the cause and appropriate interventions for accelerated menopause in HIV-infected women.

Aim: To identify the risk factors for cesarean hysterectomy in a tertiary center in Bangkok, Thailand. Methods: A case–control study was conducted by reviewing the medical records of pregnant women delivered at BMA Medical College and Vajira Hospital between 1 January 2001 and 28 February 2007. The case refers to pregnant women who underwent hysterectomy immediately or within 24 h following cesarean delivery. Controls included pregnant women who received cesarean section during the same study period by a ratio of 1:5 (case : control). Results: During the study period, cesarean hysterectomy complicated 30 deliveries out of 31 106 deliveries (0.96:1000). Independent risk factors for cesarean hysterectomy from a multivariate logistic regression analysis were placental adherence (odds ratio [OR] = 440, 95% confidence interval [CI] 28–7000), placenta previa (OR = 57, 95% CI 6.0–540) and uterine atony (OR = 37, 95% CI 7.5–190). Sixty-three percent (5/8) of placental adherence were associated with placenta previa. Of these five patients, four had a uterine scar from a prior cesarean section. The following outcomes were significantly higher in the cesarean hysterectomy group as compared to the controls: operative time, blood loss, hypovolemia, coagulopathy, transfusions, febrile morbidity, secondary surgery, and duration of hospitalization. Conclusion: Placental adherence, placenta previa and uterine atony were identified as significant risk factors for cesarean hysterectomy. Cesarean section due to placenta previa should be electively scheduled with well-prepared blood components. The obstetrician should provide counsel and obtain detailed informed consent with regard to the possibility of cesarean hysterectomy.

We sought to estimate the effect of indomethacin on duration of pregnancy in women with dilated cervix between 14 (0)/ (7) to 25 (6)/ (7) weeks. Demographics, risk factors, and outcomes were compared in women 14 (0)/ (7) to 25 (6)/ (7) weeks with a dilated cervix > or = 1 cm who received indomethacin versus no indomethacin therapy, stratified for cerclage. Primary outcome was interval from presentation until delivery. Of 222 singleton gestations, 68 (31%) received indomethacin. In unadjusted and adjusted analyses, no significant differences were observed in interval from presentation to delivery and preterm birth < 28, < 32, or < 35 weeks comparing the indomethacin and no indomethacin groups, even after stratification for cerclage. In multivariate logistic regression analysis limited to women receiving cerclage, preterm birth < 32 weeks (odds ratio 0.56, 95% confidence interval 0.26, 1.25) and < 35 weeks (odds ratio 0.52, 95% confidence interval 0.23, 1.14) suggested a possible but not significant benefit for indomethacin use. Indomethacin therapy in women with dilated cervix at 14 (0)/ (7) to 25 (6)/ (7) weeks, regardless of cerclage or not, had no effect on pregnancy outcomes.

We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count 3 compared with those with a higher nadir CD4 count, and 1.99 (1.11 -3.57) in those with an income of

Objectives The aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HIV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). Methods NVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/lamivudine (3TC)/NVP from >14 weeks of gestational age if their CD4 cell count was ≤200 cells/μL or from >28 weeks if their CD4 cell count was >200 cells/μL. Patients followed for at least 8 weeks after starting HAART or until delivery were included in the analyses. Results Of 409 patients, 244 were pregnant women, 87 were nonpregnant women and 78 were men. Hepatotoxicity occurred in 15.6% of all patients. Men had a significantly higher rate of asymptomatic hepatotoxicity (P=0.021). Pregnant women receiving HAART for PMTCT (92% had CD4 cell counts >250 cells/μL) had a significantly higher rate of symptomatic hepatotoxicity (P=0.0003) than pregnant women receiving HAART for therapy. Rash occurred in 16.1% of all patients. The patients' sex and baseline CD4 cell count were not associated with the risk of hepatotoxicity or rash. NVP was discontinued in 4.2% and 6.8% of patients because of hepatotoxicity and rash, respectively. Conclusions The incidence of NVP-related hepatotoxicity and rash in Thai adults is similar to incidences reported for other populations. While larger studies are needed, our data support continued use of NVP-containing regimens as first-line treatment in developing countries for HIV-infected patients, including pregnant women. Pregnant women with high CD4 cell counts may experience higher rates of symptomatic hepatotoxicity and thus require careful clinical and laboratory monitoring.

Objective The objective of the study was to compare pregnancy outcomes in selected women with a dilated cervix who underwent expectant management or physical examination–indicated cerclage. Study Design This was a historical cohort study conducted by the Global Network for Perinatal and Reproductive Health. Women between 14 0/7 and 25 6/7 weeks' gestation with a dilated cervix were identified at 10 centers by ultrasound or digital examination. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks. Multivariate regression was used to assess the likelihood of neonatal outcomes and control for confounders. Results Of 225 women, 152 received a physical examination–indicated cerclage, and 73 were managed expectantly without cerclage. Cervical dilation, gestational age at presentation, and antenatal steroid use differed between groups. In the adjusted analyses, cerclage was associated with longer interval from presentation until delivery, improved neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks, compared with expectant management. Similar results were obtained in the analyses limited to women dilated between 2 and 4 cm (n = 122). Conclusion In this study, the largest cohort reported to date, physical examination–indicated cerclage appears to prolong gestation and improve neonatal survival, compared with expectant management in selected women with cervical dilation between 14 0/7 and 25 6/7 weeks. A randomized, controlled trial should be conducted to determine whether these potential benefits outweigh the risks of cerclage placement in this population.

To find the sensitivity, specificity, and positive and negative predictive values of the high-risk group human papillomavirus (HPV) DNA testing as a triage tool to detect high-grade squamous intraepithelial lesions (HSILs, ie, cervical intraepithelial neoplasia [CIN] 2 or worse) in women with a cytologic smear showing atypical squamous cells of undetermined significance (ASC-US). All new cases with cytologic smears showing ASC-US that presented in King Chulalongkorn Memorial Hospital from January 2003 to November 2003, excluding known cases of HSILs and pregnancies, were enrolled. Cervical cell samplings were done by cervical cytobrush technique and tested for high-risk group HPV with the Hybrid Capture 2 (HC2) test. All participants were examined under a colposcope. Then cervicographs were taken before colposcopic-directed cervical biopsies were done. Of the 90 ASC-US cases enrolled, the pathologic results were normal in 30.0%, squamous metaplasia in 16.7%, CIN 1 in 37.8%, CIN 2 in 1.1%, CIN 3 in 11.1%, and microinvasive cervical carcinoma in 3.3%. The prevalence of HSILs and the prevalence of high-risk HPV detection were 15.6% and 38.9%, respectively. Using pathologic results from cervical biopsy as the gold standard, the HC2 has the sensitivity, specificity, and positive and negative predictive values of 85.7%, 69.7%, 34.3%, and 96.4%, respectively, to detect HSILs. High-risk group HPV detection can be used as an additional triage test to detect HSILs in women having ASC-US with high sensitivity and negative predictive value.

The objective of the study was to determine the prevalence of bacterial vaginosis and the distribution of associated morphotypes among asymptomatic pregnant women in different countries.In 8 institutions participating in the Global Network for Perinatal and Reproductive Health (www.gnprh.org) from July 1999 to September 2001, 1466 women were enrolled. Vaginal smears were Gram stained and scored with Nugent's method at a reference laboratory. The prevalence of bacterial vaginosis and bacterial morphotype distributions were compared.Overall, 12.3% of women had bacterial vaginosis according to Nugent's criteria. Zimbabwe had the highest prevalence (24.4%) when compared with all other sites, except Myanmar (P.05). Among bacterial vaginosis cases, 98.9% of vaginal smears had more than 30 Gardnerella/Bacteroides morphotypes present per oil immersion field. Individual centers showed significant differences in the number of Mobiluncus and lactobacillus morphotypes (P.01).The prevalence of bacterial vaginosis and distribution of bacterial morphotypes in vaginal smears among asymptomatic pregnant women vary significantly in populations from different countries.

PRETERM DELIVERY IN THE 2ND TRIMESTER: RESULTS FROM THE GLOBAL NETWORK FOR PERINATAL AND REPRODUCTIVE HEALTH (GNPRH) INTERNATIONAL COHORT STUDY AMEN NESS, LEONARDO PEREIRA, AMANDA COTTER, VINCENZO BERGHELLA, RICARDO GOMEZ, WITOON PRASERTCHAROENSUK, JUHA RASANEN, S CHAITHONGWONG-WATTHANA, S. MITTAL, SEAN DALY, JORGE E. TOLOSA, Stanford University Medical Center, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Palo Alto, California, OHSU, Portland, Oregon, University of Miami, Miami, Florida, Thomas Jefferson University, Philadelphia, Pennsylvania, Center for Perinatal Diagnosis and Research (CEDIP), Sotero del Rio Hospital, Puente Alto, Chile, Khon Kaen University, Khon Kaen, Thailand, University of Oulu, Oulu, Finland, Chulalongkorn University, Bangkok, Thailand, All India Institute of Medical Sciences, New Delhi, Delhi, India, Coombe Women’s Hospital, Dublin, Ireland, Oregon Health & Science University, Obstetrics and Gynecology, Portland, Oregon OBJECTIVE: To evaluate predictors of pregnancy and neonatal outcomes of expectantly managed women with 2nd trimester suspected preterm labor and/or dilated cervix STUDY DESIGN: Retrospective multicenter cohort study of women with singleton preganancies between 14-25 6/7 weeks gestation with suspected preterm labor or dilated cervix between 1998-2004. Women with PPROM, cerclage or who terminated pregnancy were excluded. Women were divided into those with visible membranes (VIS) and non-visible membranes (NoVIS) and cervical dilatation (CD) more or less than 4cm. Outcomes studied: median interval from presentation until delivery (ITD) and neonatal survival. 2 and Mann-Whitney, multivariate linear and logistic regression were used. RESULTS: Of 449 women identified, 107 remained after exclusions (97 PPROM, 225 cerclage, 17 termination, 3 no outcome data). Median CD was 2cm and median gestational age (GA) at presentation was 23.3 weeks. Unadjusted median ITD was significantly longer and neonatal survival higher for NoVIS vs VIS [4.4 (0-17.7) vs 0.4 weeks (0-11.7) p .000 and 61.4% vs. 33.3% p .007, respectively]. After controlling for GA, race, tocolytics, steroids and prior PTB, NoVIS p .015 and CD p .003 were independently associated with greater ITD. CD 4cm, regardless of membrane status (OR 12.1 95%CI 2.8-51.6), GA at presentation (OR 1.8, 95%CI 1.2-2.7), and black race (OR 3.8 95%CI 1.2-12.7) were all predictive of neonatal survival. CONCLUSION: In a strictly defined cohort of women, non-visible membranes and less cervical dilatation were predictive of a longer ITD. CD was the strongest predictor of neonatal survival regardless of membrane status. This analysis provides data upon which to counsel women with 2nd trimester threatened preterm delivery about their anticipated outcomes with expectant management.

98 MATERNAL-FETAL MEDICINE REFERRAL ‘‘LEVEL 2’’ ULTRASOUND EXAMINATIONS: ASSESSING PATIENT PERCEPTIONS MARGARET BENNETT, RODNEY EDWARDS, University of Florida, Obstetrics and Gynecology, Gainesville, Florida OBJECTIVE: To evaluate perceptions of patients referred for ‘‘level 2’’ ultrasound examinations regarding reason for referral and understanding of who they will see. STUDY DESIGN: We conducted a survey of women referred for ‘‘level 2’’ ultrasound examinations from 10/05-4/06. Patients were excluded for multiple gestations, fetal death, or a prior ‘‘level 2’’ ultrasound in the current pregnancy. We asked the fill-in-the-blank question, ‘‘What is the main reason that you are here today for an ultrasound examination?’’ and grouped answers into categories. We also asked the multiple choice question, ‘‘You are scheduled to see a Maternal-Fetal Medicine (MFM) doctor for an ultrasound examination today. Compared to an obstetrician-gynecologist (Ob/Gyn), what type of training do you think this person has received?’’ RESULTS: The cohort consisted of 381 women. Of these women, 217(57.0%; 95% confidence interval (CI) 51.9, 61.8) understood the reason for the referral (fetal specific or maternal reason). Others gave nonspecific fetal reasons (e.g. see if baby is okay) (22.3%), stated that their doctor sent them (13.9%), were unsure (3.2%), or thought the purpose was to determine fetal gender (3.7%). More women understood the reason if they had an ultrasound examination in a prior pregnancy (P=0.04) but not if they had private insurance (P=0.66) or more education than a high school diploma (P=0.18). There were 198women (52.0%; 95%CI 47.0, 56.9) who correctly answered that anMFMhasmore training than an Ob/Gyn. The rest of the women didn’t know (32.3%) or thought the training was completely different (10.5%), the same (4.5%), or less (0.8%).More women correctly answered the training question if they had private insurance (P=0.0003) or at least some education beyond high school (P=0.003) but not if they had an ultrasound in a prior pregnancy (P=0.13). CONCLUSION: Barely more than half of patients undergoing referral ultrasound examinations know the true reason for the test. Additionally, nearly half of the women referred do not understand how an MFM specialist differs from an Ob/Gyn.

ASSESSING PATIENT PERCEPTIONS MARGARET BENNETT, RODNEY EDWARDS, University of Florida, Obstetrics and Gynecology, Gainesville, Florida OBJECTIVE: To evaluate perceptions of patients referred for ‘‘level 2’’ ultrasound examinations regarding reason for referral and understanding of who they will see. STUDY DESIGN: We conducted a survey of women referred for ‘‘level 2’’ ultrasound examinations from 10/05-4/06. Patients were excluded for multiple gestations, fetal death, or a prior ‘‘level 2’’ ultrasound in the current pregnancy. We asked the fill-in-the-blank question, ‘‘What is the main reason that you are here today for an ultrasound examination?’’ and grouped answers into categories. We also asked the multiple choice question, ‘‘You are scheduled to see a Maternal-Fetal Medicine (MFM) doctor for an ultrasound examination today. Compared to an obstetrician-gynecologist (Ob/Gyn), what type of training do you think this person has received?’’ RESULTS: The cohort consisted of 381 women. Of these women, 217(57.0%; 95% confidence interval (CI) 51.9, 61.8) understood the reason for the referral (fetal specific or maternal reason). Others gave nonspecific fetal reasons (e.g. see if baby is okay) (22.3%), stated that their doctor sent them (13.9%), were unsure (3.2%), or thought the purpose was to determine fetal gender (3.7%). More women understood the reason if they had an ultrasound examination in a prior pregnancy (P=0.04) but not if they had private insurance (P=0.66) or more education than a high school diploma (P=0.18). There were 198women (52.0%; 95%CI 47.0, 56.9) who correctly answered that anMFMhasmore training than an Ob/Gyn. The rest of the women didn’t know (32.3%) or thought the training was completely different (10.5%), the same (4.5%), or less (0.8%).More women correctly answered the training question if they had private insurance (P=0.0003) or at least some education beyond high school (P=0.003) but not if they had an ultrasound in a prior pregnancy (P=0.13). CONCLUSION: Barely more than half of patients undergoing referral ultrasound examinations know the true reason for the test. Additionally, nearly half of the women referred do not understand how an MFM specialist differs from an Ob/Gyn.