INTRODUCTIONInfluenza A H1N1 (2009) pandemic has affected countries worldwide including Singapore. Data on obstetric outcomes of women with H1N1 (2009) in pregnancy are lacking.

MATERIALS AND METHODSThis was an observational study analysing the obstetric outcomes of pregnant women with influenza A H1N1 (2009) infection who had delivered at a viable gestation (24 weeks or more) in our centre.

RESULTSBetween 23 June 2009 and 30 September 2009, 235 pregnant women were diagnosed with influenza A H1N1 (2009) at our centre, with 42 having delivered and comprising the study cohort. Median age was 27.5 years (range, 16 to 42). Multiparous women comprised 59.5% (25/42) whilst 40.5% (17/42) were primiparous. In terms of ethnicity, 61.9% were Malays, 26.2% Chinese, 4.8% Indians and 7.1% Others. All women received oseltamivir. All had shown recovery from the acute influenza infection. There were no respiratory complications. Twenty-nine women (69.0%) delivered at term. Twenty-fi ve women (59.5%) had spontaneous labour whilst 15 (35.7%) had labour induction. Two women (4.8%) did not labour. Thirty-six women (85.7%) had vaginal delivery, of whom 3 were instrumental deliveries. Apgar scores of greater than 8 at 1 min and 5 min were documented in babies of 95.2% (40/42) women, respectively. Thirty-two women (76.2%) delivered babies with birthweights greater than 2500 g. Compared with historical data from 2008, the H1N1 cohort had comparable mean birthweight and average gestational age at delivery of 38 weeks.

CONCLUSIONOur study suggested that obstetric outcomes were not adversely affected by influenza A H1N1 (2009) infection.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Apgar Score ; Birth Weight ; Female ; Gestational Age ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; drug therapy ; epidemiology ; Obstetrics and Gynecology Department, Hospital ; Oseltamivir ; therapeutic use ; Outcome Assessment (Health Care) ; Pregnancy ; Pregnancy Complications ; Singapore ; Young Adult

Introduction: Human papillomavirus (HPV) testing is used as a means of triaging cervico-vaginalsmears with low grade squamous abnormalities or as part of co-testing with cytology. While HPVtesting has a high sensitivity, it has a low specificity in detecting cervical intraepithelial neoplasiagrade 2 and above (CIN 2+) leading to unnecessary colposcopy referrals. We investigate the accuracyof the p16/Ki-67 dual immunocytochemical stain in determining the presence of CIN 2+ lesions onhistology and its potential as a superior biomarker for triage. Methods: Liquid based cervico-vaginalcytology specimens with squamous abnormalities and corresponding histology from 97 women withsubsequent colposcopy and biopsy were included. The specimens were then subjected to the dual stainand Roche Cobas 4800 multiplex real time PCR HPV DNA testing. The sensitivity and specificity ofthe dual stain and HPV testing were calculated using CIN 2+ on histology as a reference standard.Results: The sensitivity and specificity of the dual stain in detecting histology proven CIN 2+ was93.7% and 76.5% while HPV testing was 85.7% and 14.7% respectively. Of the 44 women withASCUS or LSIL on cytology, the dual stain also reduced the number of unnecessary colposcopyreferrals from 27 to 7 when used as a triage marker compared to HPV testing. Conclusion: p16/Ki-67dual stain was more sensitive and specific than HPV testing in determining the presence of CIN 2+on histology. It could triage low grade cervico-vaginal specimens more effectively and potentiallyhelp women avoid unnecessary colposcopies. Future studies are needed to further evaluate its rolein cervical cancer screening programmes.