Who is at high risk? A comparison of the seroprevalence of human immunodeficiency virus in pregnant women and a high risk group

To compare the seroprevalence of HIV in Jamaican pregnant women with that in substance abusers, two groups of antenatal patients were studied, one (A) attending a public hospital clinic and the other (B) attending private clinics. The HIV seroprevalence in the antenatal patients was compared with that in the substance abusers, group C, in 1996 and five years later in 2001. HIV antibody was determined by enzyme immunoassay. The HIV seroprevalence in group A more than doubled (1.6-3.8) in five-years, 1996-2001. There were no seropositives in group B. In group C, the seroprevalence rose from 2.08 in 1996 to 5.76 in 2001. There was indication that group A might no longer be considered [quot ]low risk[quot ], as there was no significant difference from group C in HIV seroprevalence in 1996 and 2001. The trend seen in this study is worthy of further investigation

Successful pregnancy after hysteroscopic metroplasty

Congenital anomalies of the uterus have been estimated to affect 0.06-10 of women. Uterine septae account for approximately 80 to 90 of these anomalies and is also associated with the poorest reproductive outcome. Pregnancy loss in patients with a septate uterus has been reported to be as high as 90 after other causes for miscarriages have been excluded. We present here the first experience in Jamaica, of a successful pregnancy outcome after hysteroscopic metroplasty in a woman with a septate uterus and three previous miscarriages

Cervical pregnancy. Case report and literature review

Cervical pregnancy is an uncommon life threatening form of ectopic pregnancy that is associated with the unexpected occurrence of uncontrollable haemorrhage from the cervix. To avoid hysterectomy and to maintain fertility, several conservative methods of termination have been used. We present herein, one such case which relates to a young woman who had successful conservative management of a cervical pregnancy using vasopressin infiltration of the cervix, a McDonald cerclage and cervical curettage followed by balloon tamponade. Subsequently, she became pregnant again with a normal intra-uterine pregnancy and had a successful vaginal delivery

In vitro fertilization. The Jamaican experience

In June 2000, twenty-eight infertile couples were treated by in vitro fertilization and embryo transfer at our initial assisted reproduction programme carried out in conjunction with Midland Fertility Services, Aldridge, Birmingham, England. A pre-requisite for treatment was that on day 3 of the menstrual cycle the levels of follicle stimulating hormone (FSH) and oestradiol (E2) should be < 10 i mu/l and < 100 pg/ml respectively in the female partner. The ages of the women ranged from 26 to 42 years with a mean age of 35.5 years. Down regulation was carried out by using buserelin acetate 0.5 microgram subcutaneously from day 21 of the cycle for 21 days. This process was completed when the ovaries and pituitary gland were quiescent and the endometrial thickness < 4 mm in diameter. On completion of down regulation the gonadotrophin hormone, pergonal (dosage of 150-450 units) was used for ovarian hyperstimulation. A total of 294 oocytes (mean of 10.5, range 2-45) were retrieved of which 138 were fertilized (mean of 4.9, range of 0-28). Twenty-four patients each received a mean of two embryos. Five patients (20.8) had positive pregnancy tests. Three patients (0.1) developed ovarian hyperstimulation syndrome (OHSS), one had the severe, and two, the mild form of the syndrome. All three cases were treated successfully. The success at the initial IVF controlled ovarian hyperstimulation augers well for the future of infertile couples seeking treatment at the Fertility Management Unit, The University of the West Indies, Jamaica.

Prevalence of viral and bacterial sexually transmitted pathogens in Jamaican pregnant women

In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19of the women had at least one pathogen: C. trachomatis was found in 16, HTLV-1 in 2, HIV-1, HBV and N. gonorrhoeae each in 0.5C. trachomatis infection was more prevalent in women less than 20 years of age (31) than in those 20 years and older (16; OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica.

Haemoglobin levels in West Indian antenatals

Studies conducted in the English-speaking Caribbean have shown that anaemia is a public health problem in pregnancy. However, these studies have been questioned because the World Health Organization (WHO) haemoglobin criteria, which are based on studies of North American and European women, may not apply to Caribbean women. Antenatal clinic records were studied at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. Over half of the antenatal women were between the ages of 21 and 27 years. Modal parity was 1 (41%) followed by a parity of 2 (31%). Median value for gestation was 13 weeks. The mean haemoglobin level was 12.4 ñ 1.5 gm/dl (median = 12.6). Twenty-one antenatal women (3.9%) had haemoglobin levels below 11 gm/dl and only 4 (0.6%) had haemoglobin levels below 10 gm/dl. The mean haemoglobin at the UHWI was 1.9 gm/dl higher than that of 159 patients from Antigua. However, the Antiguans were an average of 6 weeks further advanced in pregnancy. In Montserrat, the mean of 138 antenatal haemoglobin levels was 2.4 gm/dl lower than the UHWI mean/ these patients were also about 6 weeks further advanced in pregnancy. This study suggests that, given the right environment, the antenatal women in Montserrat and Antigua, who are of roughly the same ethnic origin as those from Jamaica, could achieve the same haemoglobin levels as those of pregnant women attending the antenatal clinic at the UHWI, Kingston, Jamaica