A systematic review of the literature was conducted to determine the estimates of and definitions for human papillomavirus (HPV) persistence in women following treatment of cervical intra-epithelial neoplasia (CIN). A total of 45 studies presented data on post-treatment HPV persistence among 6,106 women. Most studies assessed HPV persistence after loop excision (42%), followed by conization (7%), cryotherapy (11%), laser treatment (4%), interferon-alpha, therapeutic vaccination, and photodynamic therapy (2% each) and mixed treatment (38%). Baseline HPV testing was conducted before or at treatment for most studies (96%). Follow-up HPV testing ranged from 1.5 to 80 months after baseline. Median HPV persistence tended to decrease with increasing follow-up time, declining from 27% at 3 months after treatment to 21% at 6 months, 15% at 12 months, and 10% at 24 months. Post-treatment HPV persistence estimates varied widely and were influenced by patient age, HPV-type, detection method, treatment method, and minimum HPV post-treatment testing interval. Loop excision and conization appeared to outperform cryotherapy procedures in terms of their ability to clear HPV infection. This systematic review provides evidence for the substantial heterogeneity in post-treatment HPV DNA testing practices and persistence estimates.

To estimate the association between timing of administration of adjunctive azithromycin for prophylaxis at unscheduled cesarean delivery and maternal infection and neonatal morbidity. METHODS:We conducted a secondary analysis of a randomized trial of adjunctive azithromycin prophylaxis in patients with singleton gestations who were undergoing unscheduled cesarean delivery. The primary exposure was the timing of initiation of the study drug (after skin incision or 0-30 minutes, more than 30-60 minutes, or more than 60 minutes before skin incision). The primary outcome was a composite of endometritis, wound infection, and other maternal infections occurring up to 6 weeks after cesarean delivery. Secondary outcomes included composite neonatal morbidity, neonatal intensive care unit admission for longer than 72 hours, and neonatal sepsis. The association of azithromycin with outcomes was compared within each antibiotic timing group and presented as risk ratios (RRs) with 95% CIs. A Breslow-Day homogeneity test was applied to assess differences in association by antibiotic timing. RESULTS:Of 2,013 participants, antibiotics were initiated after skin incision (median 3 minutes, range 0-229 minutes) in 269 (13.4%), 0-30 minutes before skin incision in 1,378 (68.5%), more than 30-60 minutes before skin incision in 270 (13.4%), and more than 60 minutes before skin incision (median 85 minutes, range 61-218 minutes) in 96 (4.8%). The RRs (95% CIs) of the infectious composite outcome for azithromycin compared with placebo were significantly lower for groups that initiated azithromycin after skin incision or within 1 hour before skin incision (after skin incision: RR 0.31, 95% CI 0.13-0.76; 0-30 minutes before: RR 0.62, 95% CI 0.44-0.89; more than 30-60 minutes before: 0.31, 95% CI 0.13-0.66). Risks were not significantly different in patients who received azithromycin more than 60 minutes before skin incision (RR 0.59, 95% CI 0.10-3.36). Results were similar when endometritis and wound infections were analyzed separately. Neonatal outcomes were not significantly different for azithromycin compared with placebo across all timing groups.

No abstract

deficient pregnant women, defined as ferritin < 30 ng/mL, who received oral iron or IV iron therapies during pregnancy. Patients were eligible if they were ! 24 weeks singleton gestations and delivered at Oregon Health & Science University Hospital. Exclusion criteria were multifetal gestations, major fetal anomalies, and hemoglobinopathies. The primary outcome was cord blood ferritin levels and secondary outcome was maternal ferritin levels. We used Chi-square or Fisher exact test to compare patient demographics and clinical characteristics. Independent two sample t-tests were used to compare continuous variables. RESULTS: A total of 32 women were enrolled in the oral iron group and 32 in the IV iron group. There was no statistical significance between subject demographics and clinical characteristics between treatment groups. Maternal ferritin levels were significantly higher in the IV iron groups (165.1 AE 148.8) versus the oral iron (25.0 AE 16.5) group (p< 0.001). However, the average cord ferritin level was not significantly different and estimated to be 209.3 AE 136.4 for the oral iron group and 203.3 AE 122.9 for the IV iron group (p¼0.86). CONCLUSION: Our study demonstrated that although IV iron may be more effective than oral iron in increasing maternal ferritin levels, this does not translate into a difference in cord blood ferritin levels between treatment groups. This study contributes to our evolving understanding of the impact of maternal IV iron supplementation on the fetus.

No abstract

No abstract

INTRODUCTION: Pregnancy of unknown location (PUL) (positive pregnancy test with no evidence of intrauterine or extrauterine pregnancy on Transvaginal sonogram) requires serial hCG levels and imaging till final location of pregnancy is ascertained. Inflammation plays part in pathogenesis of abnormal pregnancies. Neutrophil/lymphocyte ratio (NL) is a marker of inflammation and prognosis. We conducted the first study to investigate the role of NL as predictor of outcomes of PUL. METHODS: Retrospectively, 145 patients presenting to ER at tertiary care hospital from Jan 2011-Jan 2016 were included, with exclusion criteria of hemodynamic instability, intraperitoneal hemorrhage, underlying cancer or hematological disorder, infection, smoker. Study was IRB exempted. Demographics, parity, presenting symptoms, b-hCG levels and NL ratio at presentation were noted. Patients followed up in time and final outcomes classified as: Definite intrauterine pregnancy, Nonviable pregnancy, definite ectopic pregnancy, probable ectopic, spontaneously resolving PUL, treated persistent PUL. SPSS software was used for statistical analysis. RESULTS: NL for normal versus abnormal pregnancy (all other categories) was 1.868±0.12 vs 3.08±1.81 (P=.001). NL for intrauterine versus extrauterine pregnancies were compared = 2.077±1.11 vs 2.74±0.83 (P=.0058). For hCG levels less than 3500, NL for normal versus abnormal pregnancies were 1.93±0.25 vs 2.92±0.34 (P<.001). NLR > 1.83 had AUC =0.793, sensitivity 86.9%, specificity 62.3% (ROC). Binary regression analysis revealed NLR was statistically significant (beta= 2.83, P=.002). CONCLUSION: NL could triage patients with PUL. Larger studies are needed to confirm the utility of this test which could save multiple labs and imaging, and avoid catastrophes like administration of methotrexate to normal Intrauterine pregnancy.

No abstract