Routine Screening for Rubella and CMV Antibodies During Pregnancy: Is it Justifiable?

Background

Rubella and cytomegalovirus (CMV) screening during pregnancy is routinely carried out in India. However, its value has been questioned due to the absence of clearly effective intervention.

Objectives

This retrospective study evaluates the usefulness of rubella and CMV antibody screening during pregnancy.

Materials and Methods

Serum samples received from pregnant women and children were tested for rubella- and CMV-specific IgM antibodies by capture ELISA. The data were analyzed to determine the incidence of rubella and CMV infection during pregnancy and in congenital infections.

Results

In asymptomatic pregnant females (n = 505), rubella positivity was 3.16 % and in women with bad obstetric history (BOH) (n = 220), it was 7.72 %, while CMV positivity was 5.9 % in both asymptomatic pregnant women and in women with BOH. In children (n = 200), the overall positivity for rubella- and CMV-specific IgM antibodies was 15 and 25 %, respectively. A declining trend was observed in the incidence of both rubella and CMV infections in pregnant women and in women with BOH. In children, the incidence of congenital rubella syndrome has declined, but the incidence of CMV infection has remained almost the same in 5 years.

Conclusion

The incidence of rubella has reduced over the past 5 years and can further be prevented by providing direct protection to women and school girls with rubella vaccines. Primary CMV infection in pregnancy is the main problem, and due to the unavailability of efficient and safe treatment, routine antenatal screening for rubella and CMV should be reserved for women with obstetric complications only.     

Screening cytomegalovirus,rubella and toxoplasma infections in pregnant women with unknown pre-pregnancy serological status

Purpose

To determine the prevalence of acute cytomegalovirus (CMV), rubella and T. gondii infections among pregnant women who had no serological status tested for these microorganisms prior to pregnancy in a metropolitan area.

Methods

A cross-sectional study was undertaken between January 2009 and January 2013 in 1,258 women presenting for their first antenatal visit (between 6 and 11 weeks of gestation). All women were tested for IgG and IgM antibodies. Subsequently, avidity test was utilized for inconclusive results. They were followed until delivery and all newborns were examined by a pediatrician.

Results

Presence of IgM antibody positivity alone was not detected in any women. Avidity test excluded primary infection in 15 out of 16 (93.7 %) women who were positive for both IgG and IgM antibodies. Amniocentesis was performed in one case with borderline IgG avidity for T. gondii. No primary infections were detected in any newborn for the infections screened. The prevalences of IgG antibodies were 95 % for rubella, 84.1 % for CMV and 23.1 % for T. gondii.

Conclusions

Assessment of IgG and IgM antibodies followed by IgG avidity testing for inconclusive results may be an acceptable approach in pregnant women with unknown serological status prior to pregnancy. Utilization of IgG avidity as a supplemental test prevented unnecessary intervention in IgG and IgM antibodies positive patients. No primary infection was detected for CMV, rubella and T. gondii infections in the urban population screened.     

Immunity to varicella-zoster virus in Croatian women of reproductive age targeted for serology testing

Objective

The aim of this study was to determine the immunity to varicella-zoster virus (VZV) in Croatian pregnant and non-pregnant women of reproductive age.

Methods

During 2007–2011, a total of 638 women aged 16–45?years were tested for the presence of VZV IgM and IgG antibodies using commercial enzyme-linked immunosorbent assay. Samples positive for IgG antibodies with positive or equivocal IgM antibodies were tested for IgG avidity.

Results

The overall IgG seroprevalence was 84.3?%. There was a significant increase in IgG seropositivity with age (OR?=?1.04 for 1-year increase in age; 95?% CI 1.01–1.08). The lowest seroprevalence rate was reported in the 16–20 age groups (78.6?%), and the highest was in the 41–45 age groups (94.3?%). There was no significant difference in seroprevalence among women residing in urban and rural areas (83.6 vs. 87.0?%, OR 0.76, 95?% CI 0.43–1.34).

Conclusions

The results of this study have shown that a high proportion of Croatian childbearing-aged women (15.7?%) who were referred to the laboratory for VZV serology testing are susceptible to VZV and, thus, at risk for contracting varicella during pregnancy. Serology testing of adolescent girls and adult women who do not have a documented history of varicella is encouraged with the aim of vaccinating seronegative girls and women against VZV before pregnancy. In addition, testing of pregnant women is advised to identify susceptible women and vaccinate them after delivery.     

Association of Helicobacter pylori positivity with the symptoms in patients with hyperemesis gravidarum

Purpose

To investigate the relationship between Helicobacter pylori (Hp) positivity and the severity of symptoms of nausea and vomiting in patients diagnosed with hyperemesis gravidarum (HG).

Design

Prospective controlled.

Methods

Ninety patients with the diagnosis of HG below the 20th week gestation, who had no additional disease and 50 pregnant women with no complaints were enrolled in the study. According to the severity of symptoms, the patients were divided into three groups as group I, II and III (mild, moderate and severe, respectively). The Rhode's scoring system was used to determine the severity of HG symptoms. HpIgG and IgM levels were determined in the blood samples and Hp DNA positivity with PCR was investigated in the saliva.

Results

In accordance with the Rhode's scoring system, 15.5 % of the pregnant women had mild, 58.9 % had moderate, and 25.6 % had severe symptoms (group I, II and III, respectively). HpIgG was determined as positive in 78.6, 84.9 and 82.6 % in groups I, II and III, respectively. HpIgM positivity was determined as 26.1 % only in group III (p = 0.847). HpDNA was determined as 7.2, 3.8, and 91.3 % in group I, II, and III, respectively (p<0.01). While HpIgG was positive in 60 %, HpDNA was found to be positive in 2 % and HpIgM was found to be negative in all the pregnant women in the control group.

Conclusion

A positive relationship between the symptoms of HG and Hp positivity was determined using PCR.     

Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Back ground

Exposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.

Aims

This study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.

Methods

A total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.

Results

Pregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th–27th week or/and history of preterm labor which occurred within 28th–36th weeks of gestation, demonstrated higher cortisol level (1.0201?±?0.1855?ng/ml) compared to control group 0.9757?±?0.2860?ng/ml (P?=?0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714?±?1.7639?ng/ml) than women with miscarriage and preterm births (0.9889?±?0.5498?ng/ml).

Conclusion

The results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.     

Bone mineral density changes during pregnancy in actively exercising women as measured by quantitative ultrasound

Objective

To evaluate whether bone mineral density (BMD) changes in women engaged in active exercises during pregnancy would be different from non-exercising women.

Methods

Consecutive patients with singleton pregnancies who were engaged in active exercise training during pregnancy were prospectively recruited over a period of 6?months. Quantitative USG measurements of the os calcis BMD were performed at 14?C20?weeks and at 36?C38?weeks. These patients were compared to a control cohort of non-exercising low-risk women.

Results

A total of 24 physically active women undergoing active physical training of over 10?h per week at 20?weeks gestation and beyond (mean 13.1?h, SD 3.3) were compared to 94 non-exercising low-risk women. A marginal fall in BMD of 0.015?g/cm² (SD 0.034) was demonstrable from early to late gestation in the exercising women, which was significantly lower than that of non-exercising women (0.041?g/cm²; SD 0.042; p?=?0.005). Logistic regression models confirmed that active exercises in pregnancy were significantly associated with the absence of or less BMD loss in pregnancy.

Conclusion

In women actively engaged in physical training during pregnancy, the physiological fall in BMD during pregnancy was apparently less compared to those who did not regularly exercise.     

IVF/ICSI outcomes of the OCP plus GnRH agonist protocol versus the OCP plus GnRH antagonist fixed protocol in women with PCOS: a randomized trial

Objective

To compare the IVF/ICSI outcomes of the long GnRH agonist and the fixed GnRH antagonist protocol in women with PCOS.

Design

Randomized controlled trial.

Setting

Baskent University Department of Obstetrics and Gynecology.

Patients

Three hundred women with PCOS.

Interventions

IVF/ICSI following the long GnRH agonist down-regulation or the fixed GnRH antagonist protocols.

Main outcome measures

Ongoing pregnancy rates.

Results

Ongoing pregnancy rates were 36.4?% in the OCP?+?GnRH agonist group and 35.9?% in the OCP?+?GnRH antagonist group (p?>?0.05). Progesterone levels on the day of hCG (0.76?±?0.71 vs. 0.58?±?0.50), endometrial thickness on the day of hCG (11.57?±?2.50 vs. 10.50?±?2.01), total gonadotropin used (1388.71?±?482.39 vs. 1253.25?±?415.81), and duration of COH (9.07?±?1.96 vs. 8.39?±?1.75) were significantly lower in the OCP?+?GnRH antagonist group.

Conclusion

The OCP?+?long GnRH agonist and the OCP?+?fixed GnRH antagonist protocols yield similar ongoing pregnancy rates in women with PCOS. Although this study consisting three hundred patients, seems to be large enough in a single center, we were not able to reach to the actual size of power analysis which was approximately 3,000.     

Placental histopathological findings in obese and nonobese women with complicated and uncomplicated pregnancies

Purpose

To investigate the role of placental abnormalities in complicated and uncomplicated pregnancies in obese women.

Methods

Placentas from patients with complicated or uncomplicated pregnancies and a pregravid body mass index (BMI) of ≥30?kg/m² were analyzed histopathologically for lesions consistent with maternal and fetal circulation abnormalities and inflammatory lesions related to the maternal or fetal response. Findings were compared with a normal-weight control group matched by mode of delivery and presence/type of pregnancy complications.

Results

The obese group consisted of 28 women of whom 46?% had a complicated pregnancy. The obese group had a higher rate of maternal inflammatory lesions than the normal-weight control group (43 vs. 3.6?%, p?<?0.001). There was no difference between the obese women with complicated and uncomplicated pregnancies in mean placental weight or lesions associated with fetal or maternal vascular supply.

Conclusion

Placental inflammatory lesions may underlie the worse pregnancy course of obese women relative to normal-weight women.     

Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetric cholestasis: An Indian scenario

Objective

To determine the prevalence of liver disease in pregnant Indian women and the risk of adverse pregnancy outcomes resulting from intrahepatic cholestasis.

Methods

We analyzed 5947 pregnant women, A total of 79(1.32%) patients had abnormal liver tests. 47 (0.79%) women who gave birth at Sant Parmanand Hospital from January 1997 to August 2008 had pregnancy complicated by cholestasis. Fisher’s exact 2-Tail p-value analysis was used to compare pregnancy characterstics of this group with those of the general obstetric population (n = 5300).

Results

Obstetric cholestasis started at a mean ± SD of 31 ± 4 weeks’ gestation, with pruritus as the leading symptom.. Affected pregnant women had meconium stained liquor significantly more often (40.4%) than the general obstetric population (18.86%). Intrahepatic cholestasis increased the low basic risk of preterm delivery, thereby increasing the need for neonatal care in the general population. Increased incidence of postpartum hemorrhage was also significant(29.78%) p<0.0004.

Conclusion

Intrahepatic cholestasis of pregnancy has an adverse effect on maternal and fetal prognosis, and affected pregnancies merit closer surveillance.     

Effect of epidural block on 24-hour urine protein in pregnant rat models with preeclampsia

Objective

To investigate the effects of epidural block on 24-hour urine protein in rat with preeclampsia (PE).

Methods

Thirty healthy pregnant Wistar rats were randomly divided into three groups (each group with 10 rats). From the 14th day of pregnancy, the rats in Group A were given subcutaneous normal saline (0.5?ml) every day in a total of 7?days; the rats in Group B were given subcutaneous l-nitroarginomethyl ester (l-NAME) (50?mg) every day in a total of 7?days; and the rats in Group C both were given subcutaneous l-NAME (50?mg) every day and underwent epidural block with 25???l of 0.125?% bupivacaine twice every day all in a total of 7?days. The 24-hour urine protein and systolic blood pressure on the 13th and 20th day of pregnancy were measured.

Results

On the 13th day of pregnancy, there was no statistical significant difference in 24-hour urine protein and systolic blood pressure between the three groups (P?>?0.05). On the 20th day of pregnancy, 24-hour urine protein and systolic blood pressure all were higher in Group B and C than in Group A (P?P?P?P?Conclusion Epidural block can decrease 24-hour urine protein and systolic blood pressure in pregnant rat models with PE. This study provides a potential strategy for treatment of PE.     

Polycystic ovary syndrome resembling histopathological alterations in ovaries from prenatal androgenized female rats

Background

The polycystic ovary syndrome (PCOS) affects approximately 6-10% of women of reproductive age and is characterized by chronic anovulation and hyperandrogenism. However, a comprehensive understanding of the mechanisms that dictate androgen overproduction is lacking, which may account for inconsistencies between measures of androgen excess and clinical presentation in individual cases.

Methods

A rat model of PCOS was established by injecting dehydroepiandrosterone sulfoconjugate (DHEAS) into pregnant females. Rats were administered with DHEAS (60?mg/kg/d) subcutaneously (s.c.) for all 20?days of pregnancy (Group A), or for the first 10?days (Group B), or from day 11 to day 20 (Group C). Controls were administered with injection oil (0.2?ml/day) s.c. throughout pregnancy (Group D). The litter rate, abortion rate, and offspring survival rate in each group were recorded. Serum androgen and estrogen were measured and the morphological features of the ovaries were examined by light and electron microscopy in the offspring of each group.

Results

We found that rats injected with DHEAS throughout pregnancy (group A) lost fertility. Rats injected with DHEAS during early pregnancy (group B) exhibited more serious aberrations in fertility than both Group C, in which rats were injected with DHEAS during late pregnancy (P?Conclusions Our results indicate that androgen excess during pregnancy can decrease rat fertility. Excess androgen at the early stage of pregnancy causes high reproductive toxicity, leading to abnormality of ovarian morphology and functions in female offspring.     

Congenital cytomegalovirus infection in Central Germany: an underestimated risk

Purpose

This is the first study to determine the cytomegalovirus (CMV) seronegativity rate for women of childbearing age in Saxony-Anhalt and to determine the prevalence of clinically relevant congenital CMV (cCMV) infection in Central Germany, because there are no valid data available.

Methods

The retrospective study was undertaken between January 2005 and December 2015. For the first time in Germany, the following seven data sources were used to analyze the prevalence of clinically relevant cCMV infection and the rate of CMV seronegative women of childbearing age: CMV Screening in maternity unit, University Women’s Hospital, Social Paediatrics Centre (SPC), Malformation Monitoring Centre (MMC), Newborn Hearing Screening (NHS), Neonatal Intensive Care Unit (NICU), and In-house Doctor Department. Key parameters were anti-CMV IgG and IgM, CMV PCR of urine, and clinically relevant symptoms caused by CMV.

Results

Between 46 and 52% of women of childbearing age were CMV seronegative. The prevalence of clinically relevant cCMV infection was between 0.008 and 0.04%.

Conclusions

The CMV seronegativity rate of women of childbearing age was confirmed to be in the middle range of estimated data from other sources in Germany. Data from the NICU, SPC, NHS, and MMC show the prevalence of clinically relevant cCMV infection. The risk of all cCMV infections is underestimated. Thus, the true prevalence of clinically relevant and subclinical cCMV infections is >0.04%.

     

Obstructive sleep apnea screening and perinatal outcomes in Korean pregnant women

Purpose

This study was intended to evaluate the attributable risk of obstructive sleep apnea (OSA) by a sleep questionnaire to adverse pregnancy outcomes.

Methods

This was a prospective, cohort study in Korean pregnant women. Berlin questionnaire was employed for symptom-based OSA screening during the third trimester and obstetric outcome data were obtained in 276 deliveries. The relationship between symptom-based OSA and outcomes were explored using SPSS version 18.0 and stratified by obesity (BMI strata <30 and ≥30). Our primary outcome was the compound occurrence of SGA (fetal) or preeclampsia (maternal). Multivariate models were applied in controlling for potential confounders.

Results

The overall prevalence of OSA was 32.2 % and it was significantly related with the higher maternal BMI, more body weight at delivery, and weight gain during pregnancy (p = 0.007, p = 0.003, p = 0.005, respectively). There were no significant differences in the primary outcomes according to the positivity of OSA by screening, regardless of the stratification by obesity. The cesarean delivery rate was significantly higher in the OSA positive group (36.0 vs 22.5 %, p = 0.018), but it was not significant in the each strata of obesity. In multivariate analysis, the outcomes of birth weight, preeclampsia, cesarean delivery, and small for gestational age were also not different according to the positivity of OSA.

Conclusions

It seems that the prevalence of OSA by a sleep questionnaire is overestimating OSA in Korean pregnant women. Polysomnography might be needed to diagnose OSA and to evaluate the relationship between OSA and the occurrence of SGA or preeclampsia.     

c-kit/CD 117 positive cells in the myometrium of pregnant women and those with uterine endometriosis

Purpose

Abnormal myometrial motility may play a role in the pathogenesis of endometriosis. Uterine contractility is a major contribution to labour. Myometrial motility might be controlled by CD 117-positive uterine smooth muscle cells.

Methods

Myometrial tissues from 8 cases with uterine endometriosis, 9 pregnant uteri (31.1?±?8.7?weeks of gestation), 10 cases from non-pregnant pre-menopausal and 9 cases from post-menopausal women were immunohistochemically evaluated using a polyclonal antibody against c-kit/CD 117. The number of CD 117 positive cells was counted within 10 microscopic high power fields (×400) and compared with the clinical diagnoses.

Results

Overall, a mean number of 15.7 (range 0?C43) CD 117-positive cells within the myometrium was seen. Significant highest count occurred in the myometrium of non-pregnant pre-menopausal women without uterine endometriosis (30.78?±?9.52), followed by post-menopausal women (15.5?±?8.37) and those with uterine endometriosis (9.98?±?4.9; p????0.01). The lowest count of CD 117-positive cells was seen in pregnant uteri (4.09?±?2.33; p?Conclusions The lowest count of CD 117-positive cells was seen in the myometrium of pregnant women suggesting a role of preventing premature uterine contractility. There is no increase of CD 117-positive cells in the myometrium of women affected by uterine endometriosis.     

Obstetric outcomes and prognostic factors of lupus pregnancies

Purpose

To determine maternal and fetal outcomes in pregnancies with Systemic Lupus Erythematosus (SLE), and to evaluate the prognostic factors that may affect obstetrical outcomes.

Methods

Sixty-five consecutive cases of SLE and pregnancy were included in this retrospective clinical study, performed in a university hospital which is also a reference center for SLE. Lupus pregnancies followed and delivered during the period from 2002 to 2011 in our department are evaluated. Obstetric outcomes and prognostic factors were main outcome measures.

Results

The mean patient age was 28.8 years and the nulliparity rate was 43.1 %. Disease flare-up occurred in 7.7 % of patients. Lupus anticoagulants, anticardiolipin IgG and IgM antibodies were positive in 27.6, 15.3 and 13.8 % of patients, respectively. Mean gestational age at delivery was 36.6 ± 4.2 and mean birth weight was 2,706 ± 927 g. Stillbirth, fetal growth restriction, preeclampsia and preterm delivery rates were 4.6, 18.5, 9.2 and 27.6 %, respectively. Cases with uterine artery Doppler abnormalities had significantly poorer obstetric outcomes.

Conclusions

Multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes. Uterine artery Doppler seems to be a good prognostic factor for adverse obstetric outcomes.     

Efficacy of cryoanalgesia in decreasing pain during second trimester genetic amniocentesis: a randomized trial

Objective

To evaluate the effectiveness of cryoanalgesia in decreasing the degree of pain sensation during second trimester genetic amniocentesis.

Materials and methods

We performed a prospective randomized study comparing the anticipated and actual pain before and after second trimester genetic amniocentesis between pregnant women who received and did not receive cryoanalgesia. The pain was measured using the visual analog score (VAS), ranging from 0 to 10.

Results

Three hundred and seventy-two pregnant women participated in our study. One hundred and eighty-four and 188 pregnant women were randomized to cryoanalgesia received and non-cryoanalgesia received groups, respectively. The pre-procedure anxiety mean VAS scores and the anticipated pain mean VAS scores between the groups were not significantly different (P?=?0.25 and 0.18, respectively). The pre-procedure anxiety and the anticipated pain mean?±?SD VAS scores in the cryoanalgesia and non-cryoanalgesia groups were 5.7?±?0.37 vs. 8.0?±?0.82 and 5.4?±?1.34 vs. 5.6?±?1.42, respectively. The post-procedure pain and anxiety mean VAS scores in the cryoanalgesia group were statistically less significant than those from the non-cryoanalgesia group (mean?±?SD?=?3.2?±?1.60 and 3.8?±?1.58, respectively, P?=?0.004). Most pregnant women claimed to have experienced moderate pain and accepted to undergo a second trimester genetic amniocentesis again if indicated.

Conclusion

Cryoanalgesia is effective in decreasing the pain sensation and could be routinely applied to all pregnant women before the second trimester genetic amniocentesis.     

A Paradigm Shift in the Epidemiology of HIV in Pregnancy at ICTC of a Medical College

Objectives

To study the present status and effect of paradigm shift in the epidemiology of HIV amongst pregnant women in urban set up.

Aims

The purpose of the study is to evaluate the paradigm shift in overall screening and management strategy of HIV in antenatal women for last four and half years in an urban medical college.

Methods

The study was conducted from 1st January 2004 to 30th June 2008 and all registered and unregistered pregnant women who attended ICTC clinic and also for emergency admission (unregistered) were counseled and blood samples were tested as per NACO guidelines with cafeteria choice of opt in and opt out strategy. Reactive women in antenatal period were counseled and discussed about anti-retroviral therapy (ART) and universal treatment regime. Seroprevalent women were counseled about their spouse, personal habits and demographic status. Marked improvement was seen in the use of contraceptive and drug abuse. During labor mother and baby were given nevirapine as per NACO guidelines.

Results

The seroprevalence of HIV reactive women in our Centre was 0.23, 0.19, 0.14 and 0.12% in the year 2004, 2005, 2006, 2007 and zero prevalence in 2008 till date. Spouse positivity was noted in 80, 58.33, 72.72 and 70% in the set period from 2004 to 2008.

Conclusion

Marked improvement was noticed in all the strategic points from registration, counseling, screening and availability of improved diagnostic kits for screening HIV 1 and HIV 2.     

Thyroid (dys-)function in normal and disturbed pregnancy

Introduction

During pregnancy, physiologic changes in maternal thyroid function take place especially due to hormonal as well as metabolic processes. Human chorionic gonadotropin activates the maternal thyroid gland leading to increased thyroid hormone production. A sufficient availability of maternal thyroid hormones is essential for fetal development, especially during the first trimester of pregnancy, when the fetal thyroid gland is not yet functional.

Materials and Methods

Current knowledge of thyroid dysfunction including thyroid autoimmunity, hypothyroidism or hyperthyroidism is summarized with special focus on miscarriage and pregnancy disorders. Therefore, a Medline research as well as an analysis of current guidelines on thyroid function and pregnancy was performed.

Results

A study focusing on TSH levels in normal and disturbed pregnancies, the risk of miscarriage in association with thyroid autoantibodies, and (subclinical) hypothyroidism in infertile and fertile women were included.

Conclusion

Maternal thyroid dysfunction negatively affects pregnancy outcome. Besides a routine iodine supplementation in pregnant women and treatment of hypo as well as hyperthyroidism, TSH levels should routinely be measured in women during childbearing years and adjusted to concentrations <2.5 mIU/l in order to optimize maternal health and fetal development.