The role of Chlamydiales in adverse pregnancy outcome: a community-based nested case-control study.

OBJECTIVES: Over the last decades, the Chlamydiales order has expanded and a new group of Chlamydia-related bacteria has emerged, covering species such as Waddlia chondrophila associated with bovine abortion. However, it is unknown whether they compromise human reproduction such as Chlamydia trachomatis. We therefore aimed to investigate the association between vaginal colonization of selected species of the Chlamydiales order with spontaneous abortion, preterm birth, and animal exposure. METHODS: Pregnant women were enrolled at the nuchal translucency scan or when admitted for suspected miscarriage at Aarhus University Hospital, Denmark. Cases were defined as spontaneous abortion <22 weeks and preterm birth <37 weeks. Controls were defined as term birth ≥37 weeks. Vaginal samples from 1203 women were assessed using C. trachomatis, W. chondrophila, and pan-Chlamydiales-specific real-time PCRs targeting the 16S rRNA gene. RESULTS: A total of 1120 women of primarily Caucasian ancestry were enrolled, including 193 spontaneous abortions, 88 preterm births, and 839 term births. After sequencing for verification, the prevalence of Chlamydiales was 3 of 193 (1.6%; 95% CI, 0.5-4.8) in women experiencing spontaneous abortion, 2 of 88 (2.3%; 95% CI, 0.6-8.9) in women with preterm birth, and 20 of 839 (2.4%; 95% CI, 1.6-3.7) in women giving birth at term. Thus, Chlamydiales infection was neither significantly associated with spontaneous abortion (OR, 0.68; 95% CI, 0.15-2.01) nor preterm birth (OR, 1.02; 95% CI, 0.15-3.60) compared with women giving birth at term. Amplicons from the pan-Chlamydiales assay revealed close sequence homology and were primarily identified as uncultured Chlamydiales bacteria. DISCUSSION: Among Danish pregnant women, the prevalence of Chlamydiales was low and not associated with adverse pregnancy outcomes.

Effects of context-aware patient guidance on blood pressure self-measurement adherence levels.

Hypertensive disease and preeclampsia are serious medical disorders affecting pregnancy. Screening in early pregnancy may identify women at risk of developing hypertensive disease and enable prophylactic treatment. Accurate blood pressure measurement is an important part of this screening. The aim of this study was to investigate whether patients, with the aid of a context-aware sensor-based blood pressure self-measurement system, were able to correctly self-measure their blood pressure adhering to internationally established recommendations. Furthermore, to evaluate patient acceptance levels of performing self-measurements using context-aware adherence aids for guidance. A total of 100 pregnant women attending a routine ultrasound, at gestational week 12, at the outpatient clinic of the Department of Obstetrics and Gynecology, Aarhus University Hospital, were recruited in the waiting room before the scheduled scan. Blood pressure self-measurement was performed using a blood pressure self-measurement system called ValidAid consisting of a clinically approved blood pressure device, a sensor chair registering rest-time, back-supported, legs-crossed, and ambient noise levels respectively recording participant compliance, as well as a touch screen-based computer application with an interactive user interface for patient guidance and feedback, as well as a built-in decision support system. Acceptance of the automated self-measurement was evaluated by a questionnaire. In all, 99 percent followed the instructions with regard to both rest time and not talking. For both of these, ValidAid offered interactive and context-aware guidance. The recommendation of keeping legs uncrossed was only adhered to in 69 percent of measurements and back supported in 35 percent of measurements. For both of these, no interactive guidance was provided. The majority of the participants, 93 percent, felt comfortable using self-measurement equipment, while a minority of 8 percent would have preferred personnel-assisted measurements. The majority of participants were able to take reliable blood pressure self-measurements. Results indicate that recommendations that were not actively enforced were not followed to the same extent as those that were enforced. Thus, providing interactive context-aware guidance for all recommendations should be considered in the future. Furthermore, we found patient acceptance levels of performing self-measurements to be overall positive.

Automated blood pressure self-measurement station compared to office blood pressure measurement for first trimester screening of pre-eclampsia.

BACKGROUND: Preeclampsia is a serious medical disorder affecting pregnancy. Screening in early pregnancy can identify women at risk and enable effective prophylactic treatment. Accurate blood pressure (BP) measurement is an important element of the screening algorithm. Automated self-screening, while attending the first trimester ultra sound scan, using a BP self-measurement (BPSM) station, could be a low-cost alternative to office BP measurements (OBPM) on both arms performed by clinical staff, if the measurement quality can be ensured. OBJECTIVES: The aim of this study was to compare automated BPSM using a self-measurement station on one arm, with OBPM performed by clinical staff on both arms. Primary outcome was the difference in mean arterial pressure (MAP) between the two methods and secondary outcomes were safety and practicality issues. METHODS: Pregnant women attending ultrasound-examination at 12 weeks gestational age were recruited and randomized to start with having two OBPMs taken on both arms by staff, using two standard validated automatic upper arm BP devices, or self-measuring using an automated BPSM station following a crossover study design. The BPSM station consists of a validated blood pressure device, and an add-on sensor system capable of registering blood pressure values, rest-time, back-supported, legs-crossed, and ambient noise-levels respectively, and providing interactive guidance during the measurement process, for supporting the self-measurement process. RESULTS: A total of 80 complete BP measurement sets were obtained, for a total of 240 BPSM measurements and 320 OBPM measurements. We found no significant difference between the OBPM and BPSM methods (p=0.86) for mean arterial pressure (MAP). However, erroneous measurements were observed frequently during the experiment, mainly during the first of the 3 BPSM measurements (6%), secondary during the second BPSM measurement (3%). Only one data set (1%) was excluded due to OBPM errors. CONCLUSION: No significant difference in MAP between the two methods was found. Means for detecting and repeating erroneous BP measurements should be implemented. Measurement errors was found in 9 % of the measurement sets which is not acceptable for clinical use. Thus, several measures have been identified in order to properly identify and recover from such measurement errors in the future.