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Author(s): Meighan Mary [sup.1] , Sadiqua Jafarey [sup.2] , Rasha Dabash [sup.1] , Imtiaz Kamal [sup.2] , Arjumand Rabbani [sup.2] , Dina Abbas [sup.1] , Jill Durocher [sup.1] , Yi-Ling [...], Objective To evaluate the safety and feasibility of a Family First Aid approach whereby women and their families are provided misoprostol in advance to manage postpartum hemorrhage (PPH) in home births. Methods A 12-month prospective, pre-post intervention study was conducted from February 2017 to February 2018. Women in their second and third trimesters were enrolled at home visits. Participants and their families received educational materials and were counseled on how to diagnose excessive bleeding and the importance of seeking care at a facility if PPH occurs. In the intervention phase, participants were also given misoprostol and counselled on how to administer the four 200 mcg tablets for first aid in case of PPH. Participants were followed-up postpartum to collect data on use of misoprostol for Family First Aid at home deliveries (primary outcome) and record maternal and perinatal outcomes. Results Of the 4008 participants enrolled, 97% were successfully followed-up postpartum. Half of the participants in each phase delivered at home. Among home deliveries, the odds of reporting PPH almost doubled among in the intervention phase (OR 1.98; CI 1.43, 2.76). Among those reporting PPH, women in the intervention phase were significantly more likely to have received PPH treatment (OR 10.49; CI 3.37, 32.71) and 90% administered the dose correctly. No maternal deaths, invasive procedures or surgery were reported in either phase after home deliveries. Conclusions The Family First Aid approach is a safe and feasible model of care that provides timely PPH treatment to women delivering at home in rural communities.

Author(s): Laura J. Faherty [sup.1] [sup.2] , Ashley M. Kranz [sup.3] , Joshua Russell-Fritch [sup.4] , Teague Ruder [sup.9] , Stephen W. Patrick [sup.5] [sup.6] [sup.7] [sup.8] [sup.9] , Bradley [...], Objectives (1) To compare the prevalence of antenatal admissions and mean length of stay among women with opioid-affected and non-opioid-affected deliveries; (2) examine predictors of admission; and (3) describe the most common discharge diagnoses in each group. Methods Using data from seven states in the State Inpatient Databases for varying years between 2009 and 2014, delivery hospitalizations among women 18 years of age and older were identified and classified as opioid-affected or non-opioid-affected. Antenatal admissions were linked to deliveries. The antenatal admission ratio and mean length of stay for each group were calculated; the percentage of deliveries in each group with no, any, one, two, or three or more antenatal admissions were compared with t-tests. Logistic regression models estimated odds of any antenatal admission, stratified by opioid-affected and non-opioid-affected deliveries. Frequencies were tabulated for the ten most common discharge diagnoses in each group. Results Of 2,684,970 deliveries, 14,765 were opioid-affected. Admissions among women with opioid-affected deliveries were more prevalent (26.4 per 100 deliveries) compared to 6.7 among women with non-opioid-affected deliveries and were associated with a 1.5-day longer mean length of stay. The presence of a behavioral health condition was associated with higher odds of antenatal admission in both groups, with a particularly strong association among women with opioid-affected deliveries. Six of the ten most common diagnoses for admissions prior to opioid-affected deliveries were behavioral health-related. Conclusions for Practice These results highlight the importance of addressing the large burden of behavioral health conditions among pregnant women, especially those with opioid dependence and abuse.

Introduction There are more than 18 million HIV?infected women of childbearing age globally and an estimated 1.4 million pregnancies annually in HIV?infected women. Viral suppression through the use of lifelong [...], : Introduction: HIV viral load (VL) monitoring is a central tool to evaluate ART effectiveness and transmission risk. There is a global movement to expand VL monitoring following recent recommendations from the World Health Organization (WHO), but there has been little research into VL monitoring in pregnant women. We investigated one important question in this area: when and how frequently VL should be monitored in women initiating ART during pregnancy to predict VL at the time of delivery in a simulated South African population. Methods: We developed a mathematical model simulating VL from conception through delivery using VL data from the Maternal and Child Health ? Antiretroviral Therapy (MCH?ART) cohort. VL was modelled based on three major compartments: pre?ART VL, viral decay immediately after ART initiation and viral maintenance (including viral suppression and viraemic episodes). Using this simulation, we examined the performance of various VL monitoring schema in predicting elevated VL at delivery. Results and discussion: If WHO guidelines for non?pregnant adults were used, the majority of HIV?infected pregnant women (69%) would not receive a VL test during pregnancy. Most models that based VL monitoring in pregnancy on the time elapsed since ART initiation (regardless of gestation) performed poorly (sensitivity 60%). Across all permutations, inclusion of pre?ART VL values had a negligible impact on predictive performance (improving test sensitivity and specificity Conclusions: Development and evaluation of a novel simulation model suggests that strategies to measure VL relative to gestational age may be more useful than strategies relative to duration on ART, in women initiating ART during pregnancy, supporting better integration of maternal and HIV health services. Testing turnaround times require careful consideration, and point?of?care VL testing may be the best approach for measuring VL at delivery. Broadening the scope of this simulation model in the light of current scale up of VL monitoring in high burden countries is important.

References Kaminskiy G, Pronin A. Immune impairment and adaptive response in relation to antiretroviral therapy of HIV?infection. J Int AIDS Soc. 2010;13:61. Orlova?Morozova E, Pronin A, Kaminskiy G. CD4+ T?lymphocyte [...], Purpose of the study: To determine safety for the mother of termination after delivery of HAART, initiated with the aim to prevent mother to child transmission. Methods: 640 HIV?infected women were randomly selected and evaluated at baseline as not having standard HAART indications [1]. 32 of them got pregnant and short termed HAART (with one boosted protease inhibitor and two nucleoside reverse transcriptase inhibitors) was started at 14?26 week of gestation. It was stopped after delivery and women were additionally followed up for 3 years. Women were divided into 2 groups according to initial CD4[sup.+] T?lymphocyte count: the High Count Group (16 women) 700 to 1200 CD4[sup.+] cells/mm[sup.3] , and the Low Count Group (16 women) 500 to 700 CD4[sup.+] cells/mm[sup.3] . Data was subjected to statistical analisys by least square regression and Kaplan?Meier's method by means of SPSS software [2]. Summary of results: Women in the High Count Group had stable disease duration and lost at average only 9 CD4[sup.+] cells per year (0,9% of CD4[sup.+] cell count per year). The average elevation of viral load was 4306 copies per year. Only 6,3% (1 of 16) of women reinitiated HAART in 3 years. Women in the Low Count Group demonstrated immunological disease progression with outstanding loss of 80 CD4[sup.+] cells per year (12% of CD4[sup.+] cell count per year). Velocity of virological progression was 34940 HIV copies per year. 50% (8 from 16) of women reinitiated HAART in 3 years. 12,5% (2 of 16) of women had symptoms on viral rebound (acute pharyngitis, pneumonia). Differences in above mentioned indices were statistically significant. Both groups did not differ significantly in age, HIV infection duration, duration of short termed HAART during pregnancy, initial viral load. Even mild immune deficiency 500?700 CD4[sup.+] cells/ml results in evidently high velocity of immunological and virological HIV disease progression, leading to soon (within 3 years) HAART reinitiation. Termination of HAART in this case is considered to be not safe. Conclusions: 1. In case initial CD4[sup.+] cell count is less then 700 cells/ml termination of HAART after delivery is not safe and should not be recommended in practice. 2. If initial CD4[sup.+] cell count is more then 700 cells/ml HAART may be terminated after delivery but additional studies are needed to evaluate the best appropriate time of termination.

The competence of skilled birth attendants may not be up to international clinical standards, according to a study of 1,358 providers responsible for deliveries (i.e., doctors, medical students, and professional [...]