Objective This study assessed prevalence of connective tissue disease (CTDs), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) in women with previous adverse pregnancy outcome compared with uncomplicated livebirths. Design Retrospective case–control study. Setting UK Primary Care. Population or sample Records of women, 18 years and older, within the Clinical Practice Research Datalink (CPRD) (1 January 2000–31 December 2013). Methods Clinical Practice Research Datalink was searched for pregnancy terms to identify adverse pregnancy outcome. Each identified case was matched to five livebirths. Main outcome measures Diagnosis of SLE, CTD, APS or autoimmune antibodies. Poisson regression was performed to calculate relative risk ratios (RR), comparing adverse pregnancy outcome with livebirth cohorts. Results Clinical Practice Research Datalink identified 20 123 adverse pregnancy outcomes matched to 97 323 livebirths, with a total of 875 590 person‐years follow up. Median follow up from study entry was 7.29 years (SD 4.39). Compared with women with an uncomplicated livebirth, women with adverse pregnancy outcome had an increased risk of developing CTD or autoimmune antibodies (RR 3.20, 95% CI 2.90–3.51). Risk was greatest following a stillbirth (RR 5.82, 95% CI 4.97–6.81). For CTD and SLE, the risk was greatest within the first 5 years of adverse pregnancy outcome. Risk for aPL and APS diagnosis was highest ≥5 years from adverse pregnancy outcome. Conclusions Adverse pregnancy outcome is associated with increased risk of developing maternal CTD, including SLE. Either immunological factors predispose women to adverse pregnancy outcome and subsequent CTD diagnosis or, alternatively, adverse pregnancy outcome initiates autoimmune events which culminate in CTD in later life. Tweetable abstract Stillbirth is associated with increased maternal risk of developing systemic lupus erythematosus (SLE).
Aims This audit and re-audit was undertaken to ascertain whether women presenting to Triage, with symptoms suggestive of possible UTI, are being appropriately assessed/treated. Methods The Admission Proforma of all women attending Triage with lower abdominal pain with no clear cause, but where UTI was considered, was reviewed against agreed standards. Data was collected prospectively for a period of 2 and 3 weeks respectively. In each audit notes from 50 women were reviewed. Results In the initial audit 86% (43/50) had urine dipped but only 5% (2/43) of these showed nitrites (1 had confirmed UTI); 32% (16/50) were treated with antibiotics, 75% (12/16) of these had MSSU sent, but only 2 had confirmed UTI. In the re-audit 42% (21/50) of patients had an MSSU - 75% (6/8) of those prescribed antibiotics. Urine dipstick was performed in 94% (48/50) of all cases - 88% (7/8) of those treated. No nitrites were identified or UTI confirmed by culture. Conclusions Pregnancy increases the risk for UTIs and failure to treat has serious maternal/neonatal consequences, not least preterm delivery. Nevertheless a diagnosis of UTI is too frequently made; often without strong evidence, and women are being overtreated. Antibiotic resistance is an increasing problem; unnecessary prescriptions must be avoided. All women presenting with abdominal pain should have their urine dipped. Audit confirms that leucocytes and/or proteinuria are not indicative of infection; even nitrites may not be diagnostic. If positive for nitrites, MSSU must be sent and urgent microscopy could be considered, ahead of prescribing antibiotics.
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