Maternal sepsis is a significant problem in obstetrics, with almost one in four maternal deaths related to severe sepsis. We carried out a retrospective review of clinically significant bacteraemia in obstetric patients attending Rotunda Hospital over 14 years. From 2001 to 2014, there were 252 clinically significant positive blood culture episodes in obstetric patients. There were 112,361 live births >500 g during the study period giving an overall rate of 2.24 clinically significant positive maternal blood culture episodes per 1000 live births >500 g. The median rate over the 14 years was 2.12 episodes per 1000 live births >500 g, with an interquartile range of 1.74–2.43 per 1000 live births >500 g. There was no discernable increasing or decreasing trend over the 14 years. E. coli was the most commonly isolated organism (n = 92/252, 37%), followed by group B Streptococcus (n = 64/252, 25%), Staphylococcus aureus (n = 28/252, 11%), and anaerobes (n = 11/252, 4%). These top four organisms represented three-quarters of all positive blood culture episodes (n = 195/252, 77.3%). Of note, there were only five cases of listeriosis, representing a rate of 4.4 cases per 100,000 live births >500 g. The rate of invasive group A streptococcal infection was also very low at 5.3 cases per 100,000 live births >500 g.
Original research article of hysterectomies performed annually (3-5), contributing to a large proportion of healthcare spend worldwide. The effects of endometriosis are wide ranging and include pain, infertility, inability to attend work and/or school, and depression, all of which have a negative impact on patients' quality of life (QOL). Despite its relatively high prevalence and large impact upon patients, the condition is underdiagnosed, with the average patient experiencing symptoms for 4-5 years before a diagnosis of endometriosis is made (6). The main factors to be considered when deciding as to whether hormonal medical treatment or surgical treatment of endometriosis is more appropriate are the success of medical treatment and the desire for pregnancy or need for contraception (7). Medical treatment of endometriosis is by means of analgesic therapy and hormonal therapy. Analgesic agents such as paracetamol, ibuprofen and mefenamic acid are commonly used first line for the treatment of dysmenorrhoea. This is despite the fact that little conclusive evidence exists regarding their efficacy, largely due to a paucity of good quality research data (8).
Platelet function has not been well characterised in pregnancy. We used a modification of light transmission aggregometry to prospectively assess SPA in normal and complicated pregnancies. The study was powered (80%) to detect a 6% change in platelet aggregation across the time-points and an 8% change for PET or IUGR. In 50 patients with normal pregnancy, platelet function was assessed in the three trimesters and post-natally. In 35 patients with pre-eclampsia (PET) and 18 patients with intra-uterine growth restriction (IUGR) platelet function was assessed in the third trimester. Comparisons between platelet function assays in the four time points of normal pregnancy were made using a mixed effects model with study participant as a random-effect, allowing for possible correlations between the repeated assessments. ANOVA was used to compare these assessments with the PET and IUGR groups. The results are presented as Bonferroni adjusted p-values. SPA increased significantly between the 1st and 2nd trimester (7% increase, p-value=0.0001); the 3rd trimester (9% increase, p-value=0.0020) and the post-natal assessment (15% increase, p-value=0.0002) in normal pregnancy. In contrast there was no increase in the platelet aggregation profile of patients with either PET or IUGR. We demonstrate for the first time a significant incremental increase in SPA with advancing gestational age in normal pregnancy. In contrast this increase in platelet aggregation does not occur in the third trimester in platelets from patients with either PET or IUGR. These results suggest that sequential analysis of SPA may be a novel marker for at risk pregnancies.
Forty patients diagnosed with either pre-eclamspia or gestational hypertension were recruited. Inclusion criteria were singleton pregnancies between 24+0 and 39+6 with either pre-eclampsia or gestational hypertension as defined by ACOG criteria. Exclusion criteria included diabetes, clotting disorders, aspirin usage or BMI >30. Patients were in the third trimester of pregnancy and the values obtained were compared to patients (N=30) who were in the third trimester of uncomplicated ‘normal’ pregnancy. A 30ml whole blood sample was drawn according to a strict protocol to maintain platelet integrity. A platelet function assay was performed on each sample within 30 minutes of blood draw. A modification of standard light transmission aggregometry was used to assess platelet function, with light absorbance measured following addition of 5 different agonists at maximal and sub-maximal concentrations. Since platelets have multiple receptors it is necessary to study more than one receptor with the various agonists. The percentage aggregation response for each concentration of each agonist was calculated. Platelet reactivity differed significantly between the two groups of patients for each agonist. Platelet aggregation to arachidonic acid (p<0.0042), epinephrine (p<0.00001) and collagen (p<0.00001) was less reactive in pre-eclamptic and gestational hypertension than in uncomplicated third trimester patients. This pattern of platelet aggregation was not repeated for the agonists TRAP and ADP. We have demonstrated a significant reduction in platelet reactivity in patients with both pre-eclampsia and gestational hypertension compared to patients with uncomplicated pregnancies in the third trimester. These data may be of value when designing interventions for prevention or treatment of pre-eclampsia.
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