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The study aimed to assess the feasibility and acceptability of third-trimester antenatal HIV testing within our service after two cases of HIV seroconversion in pregnancy were noted in 2008. North American Guidelines recommend universal third-trimester HIV testing in areas with an HIV prevalence of more than 1 per 1000. The HIV prevalence rate in our area is 3.01 per 1000. MethodsPregnant women prior to 28 weeks of gestation were recruited at booking between 1 September 2008 and 31 August 2009 and offered an additional third-trimester HIV test. Consent was obtained and testing was performed by hospital and community midwives. Information was entered into a modified existing electronic maternity database. A qualitative e-mail survey of midwives investigated barriers to participation in the study. ResultsA total of 4134 women delivered; three (< 0.1%) declined first-trimester testing. Twenty-two women (0.5%) tested HIV positive, of whom six were newly diagnosed. Overall, 2934 of 4134 women (71%) were offered and accepted a third-trimester HIV test and had results available. Data were unavailable for 195 women (4.7%). A total of 663 of 4131 women (16%) were not offered a third-trimester test. Of 3273 women documented as having been offered a test, 3177 (97.1%) accepted. There were no positive third-trimester tests. Forty of 50 (80%) midwives surveyed responded with questionnaire feedback and cited lack of national policy and extra workload as barriers to performing third-trimester testing. ConclusionsThird-trimester testing was feasible and consent rates were high in those offered repeat testing. Third-trimester testing has the potential to prevent paediatric HIV infection and universal testing should be considered in high-prevalence areas.Keywords: HIV testing, pregnancy, third trimester Accepted 1 October 2013 IntroductionFull adherence to national prevention of mother-to-child transmission of HIV guidelines has reduced the transmission rate from around 25% without intervention to less than 1% annually [1]. An audit exploring factors behind perinatal HIV transmission in 87 children between 2002 and 2005 concluded that around 70% were born to undiagnosed women and at least 20% of mothers had tested negative in pregnancy [2]. Thus, identifying seroconversion in pregnancy could help reduce mother-to-child HIV transmission further.US guidelines [3] recommend universal repeat thirdtrimester HIV screening for women receiving care in facilities where at least one HIV infection is diagnosed per 1000 pregnant women screened. In the last decade, approximately 1 in 250 women who booked with North West London Hospitals (NWLH) NHS Trust were HIV positive. In 2006, the perinatal HIV group at NWLH NHS trust observed two cases of HIV seroconversion in pregnancy. There is additionally one HIV-infected child in our service whose mother tested HIV negative in the first trimester of pregnancy and who reportedly mixed breast and bottle fed for 2 months after delivery.Following discussion among the Trust's multidisciplinary perinatal ...

Objective This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth. Study Design Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates. Results Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P. Conclusion In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.

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INTRODUCTION: Weekly intramuscular 17a-hydroxyprogesterone caproate (17P) is endorsed by the American College of Obstetricians and Gynecologists for recurrent preterm birth (PTB) prevention. Cerclage is indicated in patients with prior PTB and a midtrimester cervical length (CL) less than 25 mm. While 17P and CL screening are used concurrently in this population, 17P’s effect on CL is unclear. As such, we aimed to investigate the effect of 17P on midtrimester CL in patients with prior PTB. METHODS: Retrospective cohort of all singletons delivered at a single center that underwent CL screening from 2011 to 2016 for prior PTB. Exposure was defined as at least one dose of 17P administered prior to the last measured CL. Primary outcome was shortest observed CL. Secondary outcomes included rate of CL shortening to less than 25 mm and cerclage. ANCOVA was used to assess the relationship between 17P and shortest observed CL, controlling for significant covariates. RESULTS: Of 409 women who had CL screening, 211 received and 198 did not receive 17P prior to the last CL. Exposed and unexposed groups differed by initial CL (38.3 vs 36.0 mm, respectively; P < .005) and gestational age of earliest prior PTB (27.1 vs 29.2 weeks, respectively; P < .001). Rates of CL shortening to less than 25 mm (P = .93) and cerclage (P = .471) were similar. After controlling for confounders, shortest observed CL was significantly shorter in those who received 17P prior to the last CL (30.2 vs 32.7 mm; P < .001). CONCLUSION: 17P does not prevent midtrimester CL shortening in patients with prior PTB.