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Cervical length (CL) measurement is now accepted as a screening strategy for identifying women at risk for preterm birth (PTB). However, patient acceptability may limit its implementation. Our objective was to identify characteristics associated with women who decline this screening.This is a secondary analysis of a prospective cohort study of women offered UCL screening from January 2012 to June 2012. Women with a singleton gestation 18 0/7-23 6/7 weeks at the time of anatomy scan were included. Trained sonographers were instructed to perform UCL screening on all eligible patients using an "opt-out" approach. Chi square statistics and Wilcoxon rank sum tests were used to compare categorical and continuous data, where appropriate. Logistic regression was used to calculate odds ratio for factors associated with declining UCL screening Results: 1348 women were offered CL screening; 131 (9.7%) declined. Overall, multiparous women were more than twice as likely to decline UCL screening compared to primiparous women [OR 2.4 (1.6-3.8)]. Patient acceptance of screening was significantly dependent on the sonographer (p .05).Multiparous women are less likely to accept this strategy of PTB prevention. A standardized counseling approach may improve patient acceptance and mitigate variability in acceptance rates observed amongst sonographers.

Problem Genital tract secretions inhibit Escherichia coli (E. coli) through antimicrobial peptides (AMP) secreted by the host and vaginal microbiota. However, there are limited data against group B Streptococcus (GBS). Method of Study Group B Streptococcus were incubated with cervico-vaginal lavage (CVL) samples from healthy non-pregnant women (n = 12) or synthetic AMP and monitored for bacterial growth using a turbidimetric approach. E. coli inhibitory activity was determined by a colony-forming unit assay. Results None of the CVL samples inhibited GBS. The human neutrophil peptide-1 and human defensin 5 inhibited GBS growth by ≥80% at concentrations ≥20 μg/mL and ≥50 μg/mL, respectively, while human beta-defensin 2 and LL-37 did not inhibit at highest concentration tested (100 μg/mL). In contrast, all AMP inhibited E. coli. Conclusions Antimicrobial peptides may protect against E. coli colonization but have more limited activity against GBS. Future studies will focus on augmenting host defense with specific AMP to prevent genitourinary infection with these pathogenic organisms.

Objective The objective was to determine if women with symptoms of preterm labor who ultimately have a spontaneous preterm birth (sPTB) have a distinct cervicovaginal (CV) metabolome compared with women who deliver at term. Study Design A nested case–control study of women presenting with symptoms of preterm labor was performed. CV fluid was collected from women between 22 and 336/7 weeks' gestation. The CV metabolome was compared between women with sPTB (n = 20) and women who delivered at term (n = 30). Global biochemical profiles were determined using ultraperformance liquid chromatography/tandem mass spectrometry. Welch's two-sample t-test was used to identify metabolites that differed significantly. Level of significance was defined as p ≤ 0.05. Results Eighty-eight percent of women were African-American and none had a prior history of sPTB. A total of 301 metabolites were identified in CV fluid. Thirty metabolites were significantly different in women with preterm birth compared with term birth. Two metabolites (mannitol and methyl phosphate) were significantly upregulated, and the remaining 28 metabolites were significantly downregulated and consisted of medium chain-fatty acids and collagen degradation markers. Conclusion The CV metabolome is significantly altered among women who present with preterm labor symptoms and ultimately have a sPTB.

Objective To study the impact of a prenatal electronic medical record (EMR) on the adequacy of documentation. Study Design The authors reviewed paper prenatal records (historical control arm and contemporaneous control arm), and prenatal EMRs (study arm). A prenatal quality index (PQI) was developed to assess adequacy of documentation; the prenatal record was assigned a score (range, −1 to 2 for each element, maximum score = 30). A PQI raw score and PQI ratio—that controlled for which elements of care were indicated for a patient—were calculated and compared between the study arm versus historical control arm and then the study arm versus contemporaneous control arm. Results The median PQI raw score was significantly lower in the study arm compared with historical control arm; however, the PQI ratios were similar between these groups. The PQI raw score was similar in both the study arm and contemporaneous control arm; however the PQI ratio was significantly higher in the study arm when compared with the contemporaneous control arm. Conclusion Implementation of this prenatal EMR did not have a significant impact on completeness of documentation when compared with a standardized paper prenatal record. Adequacy of documentation seems to be related to the type of practice.

Background Benefits of exposure to global health training during medical education are well documented and residents’ demand for this training is increasing. Despite this, it is offered by few US obstetrics and gynaecology (OBGYN) residency training programmes. Objectives To evaluate interest, perceived importance, predictors of global health interest and barriers to offering global health training among prospective OBGYN residents, current OBGYN residents and US OGBYN residency directors. Methods We designed two questionnaires using Likert scale questions to assess perceived importance of global health training. The first was distributed to current and prospective OBGYN residents interviewing at a US residency programme during 2012–2013. The second questionnaire distributed to US OBGYN programme directors assessed for existing global health programmes and global health training barriers. A composite Global Health Interest/Importance score was tabulated from the Likert scores. Multivariable linear regression was performed to assess for predictors of Global Health Interest/Importance. Results A total of 159 trainees (77%; 129 prospective OBGYN residents and 30 residents) and 69 (28%) programme directors completed the questionnaires. Median Global Health Interest/Importance score was 7 (IQR 4–9). Prior volunteer experience was predictive of a 5-point increase in Global Health Interest/Importance score (95% CI −0.19 to 9.85; p=0.02). The most commonly cited barriers were cost and time. Conclusion Interest and perceived importance of global health training in US OBGYN residency programmes is evident among trainees and programme directors; however, significant financial and time barriers prevent many programmes from offering opportunities to their trainees. Prior volunteer experience predicts global health interest.

ObjectivePlasma HIV RNA levels have been associated with the risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositive women. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia.Design/methodsIn an HIV-seropositive women's cohort with semiannual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident high-grade squamous intraepithelial lesions (HSIL) subclassified as severe (severe HSIL), as provided for under the Bethesda 2001 classification system. Specifically, 66 incidents of severe HSIL were matched to 130 controls by age, CD4 count, highly active antiretroviral therapy use, and other factors. We also studied HPV prevalence, incident detection, and persistence in a random sample of 250 subjects.ResultsRisk of severe HSIL was associated with genital tract HIV RNA levels (odds ratio comparing HIV RNA ≥ the median among women with detectable levels versus undetectable, 2.96; 95% confidence interval: 0.99 to 8.84; Ptrend = 0.03). However, this association became nonsignificant (Ptrend = 0.51) after adjustment for plasma HIV RNA levels. There was also no association between genital tract HIV RNA levels and the prevalence of any HPV or oncogenic HPV. However, the incident detection of any HPV (Ptrend = 0.02) and persistence of oncogenic HPV (Ptrend = 0.04) were associated with genital tract HIV RNA levels, after controlling plasma HIV RNA levels.ConclusionsThese prospective data suggest that genital tract HIV RNA levels are not a significant independent risk factor for cervical precancer in HIV-seropositive women, but they leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumorigenesis.

Objective Metabolomics has the potential to reveal novel pathways involved in the pathogenesis of preterm birth (PTB). The objective of this study was to investigate whether the cervicovaginal (CV) metabolome was different in asymptomatic women destined to have a PTB compared with term birth. Study Design A nested case-control study was performed using CV fluid collected from a larger prospective cohort. The CV fluid was collected between 20-24 weeks (V1) and 24-28 weeks (V2). The metabolome was compared between women with a spontaneous PTB (n = 10) to women who delivered at term (n = 10). Samples were extracted and prepared for analysis using a standard extraction solvent method. Global biochemical profiles were determined using gas chromatography/mass spectrometry and ultra-performance liquid chromatography/tandem mass spectrometry. An ANOVA was used to detect differences in biochemical compounds between the groups. A false discovery rate was estimated to account for multiple comparisons. Results A total of 313 biochemicals were identified in CV fluid. Eighty-two biochemicals were different in the CV fluid at V1 in those destined to have a PTB compared with term birth, whereas 48 were different at V2. Amino acid, carbohydrate, and peptide metabolites were distinct between women with and without PTB. Conclusion These data suggest that the CV space is metabolically active during pregnancy. Changes in the CV metabolome may be observed weeks, if not months, prior to any clinical symptoms. Understanding the CV metabolome may hold promise for unraveling the pathogenesis of PTB and may provide novel biomarkers to identify women most at risk.

Objective Female genital tract secretions inhibit E. coli ex vivo and the activity may prevent colonization and provide a biomarker of a healthy microbiome. We hypothesized that high E. coli inhibitory activity would be associated with a Lactobacillus crispatus and/or jensenii dominant microbiome and differ from that of women with low inhibitory activity. Study Design Vaginal swab cell pellets from 20 samples previously obtained in a cross-sectional study of near-term pregnant and non-pregnant healthy women were selected based on having high (>90% inhibition) or low (

Objective Genital tract secretions exhibit bactericidal activity against Escherichia coli . We hypothesized that this defense may be modulated during pregnancy. Study Design Secretions were collected by vaginal swab from 70 pregnant women (35-37 weeks' gestation) and 35 nonpregnant controls. We mixed E coli with swab eluants or control buffer and colonies enumerated to measure bactericidal activity. Cytokines, chemokines, and antimicrobial peptides were quantified by multiplex or enzyme-linked immunosorbent assay. Results Pregnant women had significantly greater bactericidal activity, higher concentrations of proinflammatory cytokines, and lower levels of beta defensins compared to controls. Seven (10%) pregnant and 8 (23%) nonpregnant women were vaginally colonized with E coli ; colonization was inversely associated with bactericidal activity. Conclusion The soluble mucosal immune environment is altered in pregnancy. We speculate that the observed changes may protect against colonization and ascending infection and could provide a biomarker to identify pregnant women at risk for infectious complications including preterm birth.