Objective We sought to determine demographic and behavioral factors associated with human papillomavirus (HPV) positivity in a community-based HPV self-collection cervical cancer screening pilot ...project. Study design HPV self-collected samples were obtained from 199 women aged 30-69 years in the impoverished urban Ugandan community of Kisenyi, during September through November 2011. Demographic and behavioral information was collected. Descriptive statistics and a logistic regression model were used to analyze factors associated with HPV positivity. Results There was overwhelming acceptance of HPV self-collection in this community. High-risk HPV prevalence was found to be 17.6%. Lower levels of formal education (adjusted odds ratio AOR, 0.40; 95% confidence interval CI, 0.08–2.03) were associated with higher prevalence of HPV as was use of oral contraception (AOR, 2.01; 95% CI, 0.83–4.90) and human immunodeficiency virus status (AOR, 0.43; 95% CI, 0.14–1.37). Conclusion Screening should be targeted and prioritized for women with lower levels of education, oral contraceptive use, and human immunodeficiency virus positivity as they have the highest HPV prevalence in this low-resource population.
Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the ...worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting.This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention.
The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment.
Over a quarter (28.6%) of the women (n = 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had 'at least one gynaecological complaint' (72.4%) and 'at least one surgical complaint' (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having 'at least one gynaecological complaint'. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal bleeding, and sexual dysfunction. In a multivariable analysis the age group of less than or equal to 44 years, being Catholic and having 'at least one gynaecological complaint' remained significantly associated with war related sexual violence.
The results from this study demonstrate that war related sexual violence is independently associated with the later development of specific gynaecological complaints.
Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide ...a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.
From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) dataset. Predictive performance was assessed for calibration, discrimination, and stratification capacity. The final miniPIERS model included: parity (nulliparous versus multiparous); gestational age on admission; headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic curve (AUC ROC) of 0.768 (95% CI 0.735-0.801) with an average optimism of 0.037. External validation AUC ROC was 0.713 (95% CI 0.658-0.768). A predicted probability ≥25% to define a positive test classified women with 85.5% accuracy. Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of pregnancy. This broad approach was used to optimize model generalizability.
The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal outcomes associated with the hypertensive disorders of pregnancy. It could be used in LMICs to identify women who would benefit most from interventions such as magnesium sulphate, antihypertensives, or transportation to a higher level of care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
To compare two cervical cancer screening methods: community‐based self‐collection of high‐risk human papillomavirus (HR‐HPV) testing and visual inspection with acetic acid (VIA).
Methods
...Pilot randomised controlled trial of 500 women aged 30–65 in the community of Kisenyi, Uganda. Women randomised to self‐collection‐based HR‐HPV testing provided a cervico‐vaginal swab for HR‐HPV, and results were provided by phone after laboratory testing. Women who tested HPV positive were referred for VIA at the local health unit. Women randomised to VIA underwent screening at the local health unit, where women who tested positive with VIA were provided cryotherapy at time of screening, as per local standard of care. Women were referred for colposcopy when indicated. Outcome measures were uptake of screening, HR‐HPV prevalence, VIA result and treatment rates.
Results
In the HR‐HPV arm, 248 of 250 (p < 0.01) women provided samples, while in the VIA arm, 121 of 250 (48.4%) women attended screening. Among the 73 of 248 HR‐HPV‐positive women, 45.2% (N = 33) attended VIA screening for follow‐up, 21.2% (N = 7) of whom screened positive; five received treatment and two were missing clinical follow‐up records. Of the 121 women in the VIA arm who attended screening, 13.2% (N = 16) screened positive; seven received cryotherapy, three refused treatment, five were referred to colposcopy; and one woman had suspected cervical cancer and received treatment after confirmatory testing.
Conclusions
This pilot study demonstrated trial feasibility and willingness of the women to participate and be randomised successfully into the two arms. Self‐collection‐based cervical cancer screening had a higher uptake than VIA.
Objectifs
Comparer deux méthodes de dépistage du cancer du col de l'utérus: test du papillomavirus humains à haut risque (PVH‐HR) basé sur l'auto‐prélèvement communautaire et l'inspection visuelle à l'acide acétique (IVA).
Méthodes
Essai pilot randomisé contrôlé sur 500 femmes âgées de 30 à 65 dans la communauté de Kisenyi, en Ouganda. Les femmes randomisées pour le test PVH‐HR basé sur l'auto‐prélèvement ont fourni un écouvillonnage cervico‐vaginal pour la détection du PVH‐HR et les résultats de laboratoire ont été transmis par téléphone. Les femmes testées positives pour le PVH ont été référées pour l’IVA à l'unité locale de santé. Les femmes randomisées pour l’IVA ont subi le dépistage à l'unité locale de santé, où les femmes testées positives par l’IVA ont reçu la cryothérapie au moment du dépistage, selon la norme locale des soins. Les femmes ont été référées pour la colposcopie lorsque cela était nécessaire. Les résultats mesurés étaient les suivants: l'utilisation du dépistage, la prévalence de l’HPV, les résultats de l’IVA et les taux de traitement.
Résultats
Dans le groupe PVH‐HR, 248/250 (99.2%) femmes ont fourni des échantillons, tandis que dans le groupe IVA, 121/250 (48.4%) des femmes se sont présentées au dépistage. Sur les 73/248 femmes positives au PVH‐HR, 45.2% (n = 33) ont pris part au dépistage IVA dans le suivi, dont 21.2% (n = 7) ont été dépistées positives; 5 ont reçu un traitement et pour 2, les dossiers de suivi clinique étaient absents. Sur les 121 femmes dans le groupe IVA qui ont pris part au dépistage, 13.2% (n = 16) ont été dépistées positives; 7 ont reçu la cryothérapie, 3 ont refusé le traitement, 5 ont été référées pour la colposcopie et une femme avec une suspicion du cancer du col a reçu un traitement après des tests de confirmation.
Conclusions
Cette étude pilote a démontré la faisabilité de l'essai et la volonté des femmes à participer et a être randomisées avec succès dans les deux bras de l’étude. Le dépistage du cancer du col de l'utérus basé sur l'auto‐prélèvement avait une utilisation plus élevée que celui basé sur l’IVA.
Objetivos
Comparar dos métodos de cribado de cáncer cervical: autorecogida de muestras para papiloma humano de alto riesgo (VPH‐AR) e inspección visual con ácido acético (IVAA).
Métodos
Ensayo piloto aleatorizado y controlado de 500 mujeres con edades entre 30‐65 en la comunidad de Kisenyi, Uganda. Las mujeres fueron aleatorizadas para recoger un frotis cervico‐vaginal en el hogar para realizar la prueba de VPH‐AR, y los resultados se entregaron por teléfono después de procesar la muestra en el laboratorio. Las mujeres que daban positivo para el VPH eran referidas al centro sanitario local para IVAA. Las mujeres aleatorizadas para IVAA eran sometidas al cribado en el centro sanitario local, en donde las mujeres que daban positivo recibían crioterapia en el momento del cribado, siguiendo los estándares locales. En los casos indicados, se refería a las mujeres para colposcopia. Los resultados medidos eran la aceptación del cribado, la prevalencia de VPH‐AR, el resultado del IVAA y la tasa de tratamientos.
Resultados
En el brazo de VPH‐AR 248/250 (99.2%) mujeres entregaron las muestras, mientras que en el brazo IVAA 121/250 (48.4%) se presentaron para la prueba. Entre las 73/248 mujeres VPH‐AR con resultado positivo, 45.2% (N = 33) se presentaron para seguimiento mediante cribado IVAA, 21.2% (N = 7) de las cuales dio positivo; 5 recibieron tratamiento y de 2 faltaban los registros médicos de seguimiento. De las 121 mujeres en el brazo IVAA que se presentaron a la prueba, 13.2% (N=16) dieron positivo; 7 recibieron crioterapia, 3 rehusaron el tratamiento, 5 fueron referidas a colposcopia y de una mujer se tenía sospecha de cáncer cervical y recibió tratamiento después de una prueba confirmatoria.
Conclusiones
Este estudio piloto demostró la factibilidad de ambos brazos del estudio y que había disposición entre las mujeres a la hora de participar y de ser aleatorizadas. La autorecolección de muestras para el cribado del cáncer cervical tenía una mayor aceptación que la IVAA.
Abstract Objective To examine the feasibility of a community-based screening program using human papillomavirus (HPV) self-sampling in a low-income country with a high burden of cervical cancer. ...Methods A pilot study was conducted among 205 women aged 30–69 years in the Kisenyi district of Kampala, Uganda, from September 5 to October 30, 2011. Women were invited to provide a self-collected specimen for high-risk oncogenic HPV testing by outreach workers at their homes and places of gathering in their community. Specimens were tested for HPV, Neisseria gonorrhoeae and Chlamydia trachomatis . Women who tested positive for HPV were referred for colposcopy, biopsy, and treatment at a regional hospital. Results Of the 199 women who provided a specimen, 35 (17.6%) tested positive for HPV. The outreach workers were able to provide results to 30 women (85.7%). In all, 26 (74.3%) of the women infected with HPV attended their colposcopy appointments and 4 (11.4%) women were diagnosed with grade 3 cervical intraepithelial neoplasia. Conclusion Self-collection of samples for community-based HPV testing was an acceptable option; most women who tested positive attended for definitive treatment. Self-sampling could potentially allow for effective recruitment to screening programs in limited-resource settings.
Objective To define embarrassment and develop an understanding of the role of embarrassment in relation to cervical cancer screening and self-collected human papillomavirus (HPV) DNA testing in ...Uganda. Design Cross-sectional, qualitative study using semistructured one-to-one interviews and focus groups. Participants 6 key-informant health workers and 16 local women, purposively sampled. Key informant inclusion criteria: Ugandan members of the project team. Focus group inclusion criteria: woman age 30–69 years, Luganda or Swahili speaking, living or working in the target Ugandan community. Exclusion criteria: unwillingness to sign informed consent. Setting Primary and tertiary low-resource setting in Kampala, Uganda. Results In Luganda, embarrassment relating to cervical cancer is described in two forms. ‘Community embarrassment’ describes discomfort based on how a person may be perceived by others. ‘Personal embarrassment’ relates to shyness or discomfort with her own genitalia. Community embarrassment was described in themes relating to place of study recruitment, amount of privacy in dwellings, personal relationship with health workers, handling of the vaginal swab and misunderstanding of HPV self-collection as HIV testing. Themes of personal embarrassment related to lack of knowledge, age and novelty of the self-collection swab. Overall, embarrassment was a barrier to screening at the outset and diminished over time through education and knowledge. Fatalism regarding cervical cancer diagnosis, worry about results and stigma associated with a cervical cancer diagnosis were other psychosocial barriers described. Overcoming psychosocial barriers to screening can include peer-to-peer education, drama and media campaigns. Conclusions Embarrassment and other psychosocial barriers may play a large role at the onset of a screening programme, but over time as education and knowledge increase, and the social norms around screening evolve, its role diminishes. The role of peer-to-peer education and community authorities on healthcare cannot be overlooked and can have a major impact in overcoming psychosocial and social barriers to screening.
Women living with HIV (WHIV) are disproportionately impacted by cervical dysplasia and cancer. The burden is greatest in low-income countries where limited or no access to screening exists. The goal ...of this study was to describe knowledge and intentions of WHIV towards HPV self-collection for cervical cancer screening, and to report on factors related to HPV positivity among women who participated in testing.
A validated survey was administered to 87 HIV positive women attending the Kisenyi Health Unit aged 30-69 years old, and data was abstracted from chart review. At a later date, self-collection based HPV testing was offered to all women. Specimens were tested for high risk HPV genotypes, and women were contacted with results and referred for care. Descriptive statistics, Chi Square and Fischer-exact statistical tests were performed.
The vast majority of WHIV (98.9%) women did not think it necessary to be screened for cervical cancer and the majority of women had never heard of HPV (96.4%). However, almost all WHIV found self-collection for cervical cancer screening to be acceptable. Of the 87 WHIV offered self-collection, 40 women agreed to provide a sample at the HIV clinic. Among women tested, 45% were oncogenic HPV positive, where HPV 16 or 18 positivity was 15% overall.
In this group of WHIV engaged in HIV care, there was a high prevalence of oncogenic HPV, a large proportion of which were HPV genotypes 16 or 18, in addition to low knowledge of HPV and cervical cancer screening. Improved education and cervical cancer screening for WHIV are sorely needed; self-collection based screening has the potential to be integrated with routine HIV care in this setting.
Abstract
Objectives
To compare two cervical cancer screening methods: community‐based self‐collection of high‐risk human papillomavirus (
HR
‐
HPV
) testing and visual inspection with acetic acid (
...VIA
).
Methods
Pilot randomised controlled trial of 500 women aged 30–65 in the community of
K
isenyi,
U
ganda. Women randomised to self‐collection‐based
HR
‐
HPV
testing provided a cervico‐vaginal swab for
HR
‐
HPV
, and results were provided by phone after laboratory testing. Women who tested
HPV
positive were referred for
VIA
at the local health unit. Women randomised to
VIA
underwent screening at the local health unit, where women who tested positive with
VIA
were provided cryotherapy at time of screening, as per local standard of care. Women were referred for colposcopy when indicated. Outcome measures were uptake of screening,
HR
‐
HPV
prevalence,
VIA
result and treatment rates.
Results
In the
HR
‐
HPV
arm, 248 of 250 (p < 0.01) women provided samples, while in the
VIA
arm, 121 of 250 (48.4%) women attended screening. Among the 73 of 248
HR
‐
HPV
‐positive women, 45.2% (
N
= 33) attended
VIA
screening for follow‐up, 21.2% (
N
= 7) of whom screened positive; five received treatment and two were missing clinical follow‐up records. Of the 121 women in the
VIA
arm who attended screening, 13.2% (
N
= 16) screened positive; seven received cryotherapy, three refused treatment, five were referred to colposcopy; and one woman had suspected cervical cancer and received treatment after confirmatory testing.
Conclusions
This pilot study demonstrated trial feasibility and willingness of the women to participate and be randomised successfully into the two arms. Self‐collection‐based cervical cancer screening had a higher uptake than
VIA
.
Objectifs
Comparer deux méthodes de dépistage du cancer du col de l'utérus: test du papillomavirus humains à haut risque (
PVH
‐
HR
) basé sur l'auto‐prélèvement communautaire et l'inspection visuelle à l'acide acétique (
IVA
).
Méthodes
Essai pilot randomisé contrôlé sur 500 femmes âgées de 30 à 65 dans la communauté de Kisenyi, en Ouganda. Les femmes randomisées pour le test
PVH
‐
HR
basé sur l'auto‐prélèvement ont fourni un écouvillonnage cervico‐vaginal pour la détection du
PVH
‐
HR
et les résultats de laboratoire ont été transmis par téléphone. Les femmes testées positives pour le
PVH
ont été référées pour l’
IVA
à l'unité locale de santé. Les femmes randomisées pour l’
IVA
ont subi le dépistage à l'unité locale de santé, où les femmes testées positives par l’
IVA
ont reçu la cryothérapie au moment du dépistage, selon la norme locale des soins. Les femmes ont été référées pour la colposcopie lorsque cela était nécessaire. Les résultats mesurés étaient les suivants: l'utilisation du dépistage, la prévalence de l’
HPV
, les résultats de l’
IVA
et les taux de traitement.
Résultats
Dans le groupe
PVH
‐
HR
, 248/250 (99.2%) femmes ont fourni des échantillons, tandis que dans le groupe
IVA
, 121/250 (48.4%) des femmes se sont présentées au dépistage. Sur les 73/248 femmes positives au
PVH
‐
HR
, 45.2% (
n
= 33) ont pris part au dépistage
IVA
dans le suivi, dont 21.2% (
n
= 7) ont été dépistées positives; 5 ont reçu un traitement et pour 2, les dossiers de suivi clinique étaient absents. Sur les 121 femmes dans le groupe
IVA
qui ont pris part au dépistage, 13.2% (
n
= 16) ont été dépistées positives; 7 ont reçu la cryothérapie, 3 ont refusé le traitement, 5 ont été référées pour la colposcopie et une femme avec une suspicion du cancer du col a reçu un traitement après des tests de confirmation.
Conclusions
Cette étude pilote a démontré la faisabilité de l'essai et la volonté des femmes à participer et a être randomisées avec succès dans les deux bras de l’étude. Le dépistage du cancer du col de l'utérus basé sur l'auto‐prélèvement avait une utilisation plus élevée que celui basé sur l’
IVA
.
Objetivos
Comparar dos métodos de cribado de cáncer cervical: autorecogida de muestras para papiloma humano de alto riesgo (
VPH
‐
AR
) e inspección visual con ácido acético (
IVAA
).
Métodos
Ensayo piloto aleatorizado y controlado de 500 mujeres con edades entre 30‐65 en la comunidad de Kisenyi, Uganda. Las mujeres fueron aleatorizadas para recoger un frotis cervico‐vaginal en el hogar para realizar la prueba de
VPH
‐
AR
, y los resultados se entregaron por teléfono después de procesar la muestra en el laboratorio. Las mujeres que daban positivo para el
VPH
eran referidas al centro sanitario local para
IVAA
. Las mujeres aleatorizadas para
IVAA
eran sometidas al cribado en el centro sanitario local, en donde las mujeres que daban positivo recibían crioterapia en el momento del cribado, siguiendo los estándares locales. En los casos indicados, se refería a las mujeres para colposcopia. Los resultados medidos eran la aceptación del cribado, la prevalencia de
VPH
‐
AR
, el resultado del
IVAA
y la tasa de tratamientos.
Resultados
En el brazo de
VPH
‐
AR
248/250 (99.2%) mujeres entregaron las muestras, mientras que en el brazo
IVAA
121/250 (48.4%) se presentaron para la prueba. Entre las 73/248 mujeres
VPH
‐
AR
con resultado positivo, 45.2% (
N
= 33) se presentaron para seguimiento mediante cribado
IVAA
, 21.2% (
N
= 7) de las cuales dio positivo; 5 recibieron tratamiento y de 2 faltaban los registros médicos de seguimiento. De las 121 mujeres en el brazo
IVAA
que se presentaron a la prueba, 13.2% (N=16) dieron positivo; 7 recibieron crioterapia, 3 rehusaron el tratamiento, 5 fueron referidas a colposcopia y de una mujer se tenía sospecha de cáncer cervical y recibió tratamiento después de una prueba confirmatoria.
Conclusiones
Este estudio piloto demostró la factibilidad de ambos brazos del estudio y que había disposición entre las mujeres a la hora de participar y de ser aleatorizadas. La autorecolección de muestras para el cribado del cáncer cervical tenía una mayor aceptación que la
IVAA
.
Affecting 2–4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine ...learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia.
We used health system, demographic, and clinical data from the day of first assessment with pre-eclampsia to predict a Delphi-derived composite outcome of maternal mortality or severe morbidity within 2 days. Machine learning methods, multiple imputation, and ten-fold cross-validation were used to fit models on a development dataset (75% of combined published data of 8843 patients from 11 low-income, middle-income, and high-income countries). Validation was undertaken on the unseen 25%, and an additional external validation was performed in 2901 inpatient women admitted with pre-eclampsia to two hospitals in south-east England. Predictive risk accuracy was determined by area-under-the-receiver-operator characteristic (AUROC), and risk categories were data-driven and defined by negative (–LR) and positive (+LR) likelihood ratios.
Of 8843 participants, 590 (6·7%) developed the composite adverse maternal outcome within 2 days, 813 (9·2%) within 7 days, and 1083 (12·2%) at any time. An 18-variable random forest-based prediction model, PIERS-ML, was accurate (AUROC 0·80 95% CI 0·76–0·84 vs the currently used logistic regression model, fullPIERS: AUROC 0·68 0·63–0·74) and categorised women into very low risk (–LR <0·1; eight 0·7% of 1103 women), low risk (–LR 0·1 to 0·2; 321 29·1% women), moderate risk (–LR >0·2 and +LR <5·0; 676 61·3% women), high risk (+LR 5·0 to 10·0, 87 7·9% women), and very high risk (+LR >10·0; 11 1·0% women). Adverse maternal event rates were 0% for very low risk, 2% for low risk, 5% for moderate risk, 26% for high risk, and 91% for very high risk within 48 h. The 2901 women in the external validation dataset were accurately classified as being at very low risk (0% with outcomes), low risk (1%), moderate risk (4%), high risk (33%), or very high risk (67%).
The PIERS-ML model improves identification of women with pre-eclampsia who are at lowest and greatest risk of severe adverse maternal outcomes within 2 days of assessment, and can support provision of accurate guidance to women, their families, and their maternity care providers.
University of Strathclyde Diversity in Data Linkage Centre for Doctoral Training, the Fetal Medicine Foundation, The Canadian Institutes of Health Research, and the Bill & Melinda Gates Foundation.
Background Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model ...to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications. Methods and Findings From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) dataset. Predictive performance was assessed for calibration, discrimination, and stratification capacity. The final miniPIERS model included: parity (nulliparous versus multiparous); gestational age on admission; headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic curve (AUC ROC) of 0.768 (95% CI 0.735-0.801) with an average optimism of 0.037. External validation AUC ROC was 0.713 (95% CI 0.658-0.768). A predicted probability ≥25% to define a positive test classified women with 85.5% accuracy. Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of pregnancy. This broad approach was used to optimize model generalizability. Conclusions The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal outcomes associated with the hypertensive disorders of pregnancy. It could be used in LMICs to identify women who would benefit most from interventions such as magnesium sulphate, antihypertensives, or transportation to a higher level of care. Please see later in the article for the Editors' Summary
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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