RESUMEN
UNLABELLED: Chlamydia trachomatis infection is the most common sexually transmitted disease. It concerns both epidemiologists and clinicians as it is often asymptomatic and can cause permanent sequelae. Chlamydia trachomatis infection in women causes nongonococcal cervicitis, endometritis, urethritis, inflammation of the Bartholin's gland, acute and chronic pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome and can lead to Fallopian tube obstruction, infertility and ectopic pregnancy. During pregnancy it can cause chorioamnionitis, premature rupture of membranes, premature delivery, intrauterine growth restriction, low birth weight. post partum endometritis and also infection in the newborn. AIM: To assess the prevalence and to describe risk factors (behavioural and clinical) of genital infection caused by Chlamydia trachomatis in the population of pregnant women attending the Obstetrics Clinic at the Institute of Mother and Child and to study the impact of this infections of pregnancy outcome. METHODS: We have tested 80 pregnant women attending the clinic of obstetrics and gynaecology of the Mother and Child Institute in Warsaw: The presence of C. trachomatis in cervical swabs was assessed using the Polymerase Chain reaction (PCR). RESULTS: We found two cases of C. trachomatis infection, which represents 2.5% of the tested population. CONCLUSIONS: controversial data on the prevalence of C. trachomatis in pregnant women and its influence on pregnancy duration justify further investigations despite the observed law prevalence in this study. This will allow to determine the role and usefulness of routine screening for C. trachomatis in pregnant women in Poland.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Chlamydia trachomatis/genética , Femenino , Humanos , Polonia/epidemiología , Reacción en Cadena de la Polimerasa , Embarazo , Prevalencia , Factores de Riesgo , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Enfermedades Bacterianas de Transmisión Sexual/microbiologíaRESUMEN
BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers is unknown. Sexually active adolescents are at a greater risk for sexually transmitted infections, including Chlamydia trachomatis (ChT). Most inflections are asymptomatic and therefore untreated. Early detection and treatment of cervical chlamydial infections can prevent pelvic inflammatory disease and has a strong protective effect against infertility. AIM: To determine the prevalence and risk factors of Chlamydia trachomatis infections among sexually active female adolescents attending the outpatient gynaecological clinic of the Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: 249 sexually active girls, 16-19 years old, attending the outpatient clinic of the Institute of Mother and Child in Warsaw were enrolled in this study from December 2002 to May 2004, The participants filled out a questionnaire containing informations on age, purpose of the visit, level of education, age of the first intercourse, number of lifetime sexual partners, number of current partners (in the last 3 months), number of sexual partners in the past (patients' partner), contraceptive methods, use of condoms at the first and the last intercourse, past history of STD and obstetric history at first visit. Pelvic examination was done for the following reasons: checking vaginal discharge, presence of abnormalities of the cervix such as ectopy, erythroplakia and uterine tenderness and taking a Pap smear and a cervical swab for Chlamydia trachomatis detection. Cervical swabs for Chlamydia trachomatis were tested by Polymerase Chain Reaction (PCR). RESULTS: The prevalence of ChT genital infection in the studied group was 3.2%. Adolescent females infected by ChT less frequently reported the use of condom and more often did not use any contraception in comparison with the girls without ChT genital infections (42.8% and 42.8% vs. 49% and 12.8%), The existence of other STDs was more frequently noted in adolescents with Chlamydial infection in comparison to healthy girls (14.2% vs. 8.3%). There were no statistically significant differences in results of the Pap smears and the incidence of cervical ectopy between the two groups.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/transmisión , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Chlamydia trachomatis/aislamiento & purificación , Femenino , Humanos , Polonia/epidemiología , Prevalencia , Factores de Riesgo , Conducta Sexual , Encuestas y CuestionariosRESUMEN
Currently, in Poland the number of women infected by human immunodeficiency virus (HIV) is still increasing. The majority of them are in the reproductive age. It is well known that mother-to-child transmission of HIV can occur during pregnancy, delivery and postnatally through breastfeeding. The risk of transmission is related to maternal health, obstetric factors and infant prematurity. The management of pregnant women infected with HIV in Poland involves: recognizing HIV infection early by promoting HIV testing of all pregnant women; minimizing the risk of vertical transmission of HIV by using maternal antiretroviral therapy during pregnancy and labour, followed by six weeks of neonatal zidovudine therapy and performing elective caesarean section. Adequate care requires also specialized laboratory monitoring and appropriate psychological and social support. Some modifications of standards in routine care of pregnant HIV seropositive women are necessary. For HIV infected women more attention to pre-conception counselling should also be paid.
Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/prevención & control , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/transmisión , Humanos , Polonia , Embarazo , Calidad de la Atención de Salud/normas , Zidovudina/uso terapéuticoRESUMEN
OBJECTIVE: The aim of this study was to assess the effect of antiretroviral therapy (ART) on pregnancy outcome. MATERIAL AND METHODS: The study included 102 HIV-1-infected pregnant women. We investigated maternal and gestational age at delivery, time of ART initiation, mode of delivery, birth weight, maternal CD4 count and HIV-1 viral load at delivery and also drug use during pregnancy. Infant HIV-1 status was used to determine the rate of vertical transmission of HIV-1. RESULTS: Antiretroviral therapy was given to 81 (79.4%) patients, on zidovudine monotherapy there were 35 (34.4%) women, on Highly Active Antiretroviral Therapy (HAART) with a protease inhibitor (PI) there were 18 (17.6%) patients and 28 (27.4%) patients on HAART with no PI regimen. Overall rate of pre-term delivery (before 37 weeks of gestation) was estimated as 11.8% (12 out of 102). Premature delivery occurred in 16.7% of women on HAART with PI and in 17.9% of women on HAART without PI as compared to any case in patients not receiving ART. Combined therapy was started before pregnancy or during the first trimester in 62.5% of women who delivered prematurely versus 15,6% who gave birth at term. Low birth weight (<2500 grams) occurred in 13 of 81 (16%) newborns of treated mothers and in 2 of 21 (9.5%) children when mothers did not get any therapy. The highest risk of infant low birth weight was associated with receiving HAART containing PI (22.2% vs. 13.3% in the group of non-treated women). Vaginal deliveries occurred among 67.9% women on HAART without PI and in 76.5% of non-treated women. Elective caesarean section was performed in 28.1% of women under monotherapy and in 17.6% of non-treated women. Emergency caesarean section was highly prevalent in women on HAART without PI (14.2%) compared to non-treated women (5.9%). Rate of mother to child HIV-1 transmission among treated women was 8.8% as compared to 25% when no ARV therapy during pregnancy was used. No infected infants were born to mothers on HAART. Non-treated women had lower CD4 cell count and higher HIV-1 viral load at delivery. CONCLUSIONS: Pre-term deliveries were highly prevalent among women on HAART during pregnancy, especially when therapy was started before or in the first trimester of pregnancy. Women receiving HAART with PI were at a higher risk of delivering a baby with low birth weight. Antiretroviral therapy during pregnancy, together with elective caesarean section, was associated with a reduced risk of mother to child transmission of HIV-1.