scholarly journals Maternal, Fetal, and Neonatal Outcomes in Pregnant Dengue Patients in Mexico

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Carlos Machain-Williams ◽  
Eric Raga ◽  
Carlos M. Baak-Baak ◽  
Sungmin Kiem ◽  
Bradley J. Blitvich ◽  
...  
Keyword(s):  
Dengue Virus ◽  
Maternal Mortality ◽  
Low Birthweight ◽  
Fetal Distress ◽  
Warning Signs ◽  
Public Hospitals ◽  
Neonatal Outcomes ◽  
High Rate ◽  
Severe Dengue ◽  
Emergency Cesarean

To increase our understanding of the consequences of dengue virus infection during pregnancy, a retrospective analysis was performed on the medical records of all completed pregnancies (live births and pregnancy losses) at nine public hospitals in the Gulf of Mexico from January to October 2013. Eighty-two patients developed clinical, laboratory-confirmed dengue virus infections while pregnant. Of these, 54 (65.9%) patients were diagnosed with dengue without warning signs, 15 (18.3%) patients were diagnosed with dengue with warning signs, and 13 (15.9%) patients had severe dengue. Five (38.5%) patients with severe dengue experienced fetal distress and underwent emergency cesarean sections. Four patients delivered apparently healthy infants of normal birthweight while the remaining patient delivered a premature infant of low birthweight. Patients died of multiple organ failure during or within 10 days of the procedure. Severe dengue was also associated with obstetric hemorrhage (30.8%, four cases), preeclampsia (15.4%, two cases), and eclampsia (7.7%, one case). These complications were less common or absent in patients in the other two disease categories. Additionally, nonsevere dengue was not associated with maternal mortality, fetal distress, or adverse neonatal outcomes. In summary, the study provides evidence that severe dengue during pregnancy is associated with a high rate of fetal distress, cesarean delivery, and maternal mortality.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.Methods and Interventions: 474 women admitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences. 28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Rate and Neonatal Outcomes Among Instrument Assisted Vaginal Birth in 12 Public Hospitals in Nepal

2020 ◽  
Author(s):  
Nishant Thakur ◽  
Avinash K Sunny ◽  
Rejina Gurung ◽  
Omkar Basnet ◽  
Helena Litorp ◽  
...  
Keyword(s):  
Apgar Score ◽  
Small Volume ◽  
Neonatal Outcome ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
High Volume ◽  
Shoulder Dystocia ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Neonatal Outcomes

Abstract Background Instrument assisted vaginal birth (IVB) is an effective intervention for deliveries complicated by prolonged labour or fetal distress, but its use is declining in many low-resource settings. In this paper, we examined intra-hospital rates of IVB, factors associated, and neonatal outcomes after IVB in Nepal. Methods This is a prospective cohort study of all deliveries conducted in 12 public hospitals (4 high volume, 4 medium volume and 4 low volume) across Nepal for 18 months . We calculated the rate of IVB and used logistic regression to assess the association between IVB and neonatal morbidity (Apgar score < 7 at 5 minutes, shoulder dystocia) and mortality. Results A total of 81,581 deliveries were included in the study, of which 3001 (3.4%) were IVBs., while rates in high volume, medium volume, and small volume hospitals were 3.6%, 3.7% and 1.2% respectively. The odds of Apgar score < 7 at 5 minutes was almost three-fold (aOR 2.92, 95% CI, 2.49-3.42) with IVB compared to spontaneous vaginal birth (SVB). The odds of shoulder dystocia was three-fold (aOR 3.04, 95% CI, 2.19-4.22) with IVB compared to SVB. The odds of first day mortality was lower in medium volume (aOR-0.57, 95% CI, 0.42-0.78) hospitals compared to high volume hospitals. Conclusions The rate of IVB varied by volume of hospital. The neonatal outcome were poor among the babies born to IVB, and neonatal outcomes were worse after IVB at high-volume hospitals. Further studies to explore factors determining the rate of IVB and better neonatal outcomes.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their FHR and alert a midwife of changes detected.Methods and Interventions: 474 womenadmitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences.28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Dengue!!! A Current Threat with Previous Experience

2019 ◽  
pp. 1
Author(s):  
Sadia Choudhury Shimmi ◽  
Mohd Yusuf Ibrahim ◽  
Kamruddin Ahmed
Keyword(s):  
Dengue Virus ◽  
Rna Virus ◽  
Dengue Shock Syndrome ◽  
Warning Signs ◽  
Dengue Haemorrhagic Fever ◽  
Musculoskeletal Symptoms ◽  
Severe Dengue ◽  
Infected Person ◽  
Haemorrhagic Fever ◽  
Infected Female

Dengue is a global health problem. Some countries describe it as ‘endemic’ where other countries as 'epidemic' according to the prevalence of the disease1. Dengue virus transmitted by the infected female Aedes aegypti and Aedes albopictus mosquitoes, belongs to the genus Flavivirus which is an envelope positive-sense single-stranded RNA virus. Rainy season (June to October) is the prime time of spreading the infection in Southeast Asia. Four serotypes of dengue viruses (DEN1, DEN-2, DEN-3 and DEN-4) are able to infect humans and cause dengue haemorrhagic fever/dengue shock syndrome like severe infections. Moreover, cross-reactive antibodies (IgM and IgG) produce against other serotype when infection occurs with one serotype. This is one of the diagnostic problem for acute dengue2. Some researchers experienced that without warning signs and mild symptoms were found in DEN-1, severe dengue was found in DEN-2 patients as compared to other serotypes and musculoskeletal symptoms were prominent in DEN-3 infected patients. So that different receptors or organs are targeted to establish infection by different dengue serotypes3. This virus circulates in the blood of an infected person for 2 – 7 days, at that time the infected person develops a fever. After appearance of the first symptoms (for 4 – 5 days; maximum 12 days), infected patients can transmit the infection via Aedes mosquitoes1 dengue virus infection in humans ranging from clinically asymptomatic or transient nonspecific febrile illness to classical dengue fever (DF) and dengue haemorrhagic fever/ dengue shock syndrome (DHF/ DSS). Fever, headache, rash, bone and muscle pains with or without abdominal pain are the general clinical presentation of patients with DF and early DHF/DSS. Haemorrhagic manifestations such as haematuria, bleeding gums, epistaxis, hematemesis, melena, and ecchymosis develop in DHF. DHF patients develop thrombocytopaenia and haemoconcentration. Some patients may progress into DSS, leading to profound shock and death if not diagnosed or treated properly2.

scholarly journals Dengue Virus Serotype 2 Intrahost Diversity in Patients with Different Clinical Outcomes

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 349
Author(s):  
Maria Celeste Torres ◽  
Marcos Cesar Lima de Mendonça ◽  
Cintia Damasceno dos Santos Rodrigues ◽  
Vagner Fonseca ◽  
Mario Sergio Ribeiro ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Clinical Outcome ◽  
Dengue Virus ◽  
Warning Signs ◽  
Viral Population ◽  
Severe Dengue ◽  
Clinical Samples ◽  
Pathogenic Potential ◽  
Virus Serotype ◽  
Dengue Virus Serotype 2

Intrahost genetic diversity is thought to facilitate arbovirus adaptation to changing environments and hosts, and it might also be linked to viral pathogenesis. Dengue virus serotype 2 (DENV-2) has circulated in Brazil since 1990 and is associated with severe disease and explosive outbreaks. Intending to shed light on the viral determinants for severe dengue pathogenesis, we sought to analyze the DENV-2 intrahost genetic diversity in 68 patient cases clinically classified as dengue fever (n = 31), dengue with warning signs (n = 19), and severe dengue (n = 18). Unlike previous DENV intrahost diversity studies whose approaches employed PCR, here we performed viral whole-genome deep sequencing from clinical samples with an amplicon-free approach, representing the real intrahost diversity scenario. Striking differences were detected in the viral population structure between the three clinical categories, which appear to be driven mainly by different infection times and selection pressures, rather than being linked with the clinical outcome itself. Diversity in the NS2B gene, however, showed to be constrained, irrespective of clinical outcome and infection time. Finally, 385 non-synonymous intrahost single-nucleotide variants located along the viral polyprotein, plus variants located in the untranslated regions, were consistently identified among the samples. Of them, 124 were exclusively or highly detected among cases with warning signs and among severe cases. However, there was no variant that by itself appeared to characterize the cases of greater severity, either due to its low intrahost frequency or the conservative effect on amino acid substitution. Although further studies are necessary to determine their real effect on viral proteins, this heightens the possibility of epistatic interactions. The present analysis represents an initial effort to correlate DENV-2 genetic diversity to its pathogenic potential and thus contribute to understanding the virus’s dynamics within its human host.

scholarly journals Title: Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.Methods: 474 women admitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences. 28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2019 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Poor Outcomes

Abstract Background: In low-resource settings with few health workers, the Fetal Heart Rate (FHR) in women in labour can be inadequately monitored contributing to poor outcomes. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia with extremely limited health workforces, to assess the feasibility of educating women in labour to monitor their FHR and alert their attending midwife of any changes which might indicate fetal distress. Methods and Interventions: Over 15 months, 474 women admitted in labour without obstetric complications were approached. After informed consent, 461 agreed (97%) and 13 refused. Those consented were trained to monitor the FHR using a sonicaid for approximately one minute immediately after the end of every uterine contraction and inform her midwife of changes. If relevant changes were confirmed, standard clinical interventions for possible fetal distress (lateral tilt and intravenous fluids and glucose) and, when appropriate, accelerated delivery by vacuum or Caesarean section were undertaken. Participants provided views on their monitoring experience; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded. Results: 461 out of 474 women gave consent, of whom 426 (92%) completed the monitoring themselves. 386 (97%) of 400 who gave comments, reported positive experiences and 14 reported only negative experiences. 28 participants identified FHR changes, confirmed in 26 cases. Meconium stained liquor accompanied FHR changes in 18 of these 26 (69%). 13 of these 26 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes. One (birth weight 1.3 Kg) could not be resuscitated. There were no intrapartum stillbirths or maternal deaths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience positive and empowering. The absence of intrapartum stillbirths and low number of poor neonatal outcomes are promising but warrant further research.

scholarly journals Rate and Neonatal Outcomes Among Instrument Assisted Vaginal Birth in 12 Public Hospitals in Nepal

2020 ◽  
Author(s):  
Nishant Thakur ◽  
Avinash K Sunny ◽  
Rejina Gurung ◽  
Omkar Basnet ◽  
Helena Litorp ◽  
...  
Keyword(s):  
Apgar Score ◽  
Small Volume ◽  
Neonatal Outcome ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
High Volume ◽  
Shoulder Dystocia ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Neonatal Outcomes

Abstract Background Instrument assisted vaginal birth (IVB) is an effective intervention for deliveries complicated by prolonged labour or fetal distress, but its use is declining in many low-resource settings. In this paper, we examined intra-hospital rates of IVB, factors associated, and neonatal outcomes after IVB in Nepal. Methods This is a prospective cohort study of all deliveries conducted in 12 public hospitals (4 high volume, 4 medium volume and 4 low volume) across Nepal for 18 months . We calculated the rate of IVB and used logistic regression to assess the association between IVB and neonatal morbidity (Apgar score < 7 at 5 minutes, shoulder dystocia) and mortality.Results A total of 81,581 deliveries were included in the study, of which 3001 (3.4%) were IVBs., while rates in high volume, medium volume, and small volume hospitals were 3.6%, 3.7% and 1.2% respectively. The odds of Apgar score < 7 at 5 minutes was almost three-fold (aOR 2.92, 95% CI, 2.49-3.42) with IVB compared to spontaneous vaginal birth (SVB). The odds of shoulder dystocia was three-fold (aOR 3.04, 95% CI, 2.19-4.22) with IVB compared to SVB. The odds of first day mortality was lower in medium volume (aOR-0.57, 95% CI, 0.42-0.78) hospitals compared to high volume hospitals. Conclusions The rate of IVB varied by volume of hospital. The neonatal outcome were poor among the babies born to IVB, and neonatal outcomes were worse after IVB at high-volume hospitals. Further studies to explore factors determining the rate of IVB and better neonatal outcomes.

scholarly journals A 23bp Indel Polymorphism in TLR2 Gene Enhances Inflammation and Disease Severity in Dengue

2017 ◽  
Author(s):  
A. Raj Kumar Patro ◽  
Sriprasad Mohanty ◽  
Aditya K. Panda ◽  
Birendra K. Prusty ◽  
Diwakar K. Singh ◽  
...  
Keyword(s):  
Dengue Virus ◽  
Dengue Fever ◽  
Disease Severity ◽  
Warning Signs ◽  
Severe Dengue ◽  
Healthy Controls ◽  
Indel Polymorphism ◽  
Rt Pcr ◽  
Tlr2 Gene ◽  
Indel Mutation

AbstractBackgroundDengue is the most rapidly spreading viral disease transmitted by the bite of infectedAedesmosquitos. Pathogenesis of dengue is still unclear; although host genetic factors, immune responses and virus serotypes have been proposed to contribute to disease severity. The development of high-throughput methods have allowed to scale up capabilities of identifying the key markers of inflammation. Since NS1 protein of dengue virus has been reported to activate immune cells towards enhanced inflammation through TLR2, we examined the role of a polymorphism, a 23bp deletion in 5’UTR region of TLR2 gene in patients with dengue (with and without warning signs) and correlated with plasma levels of inflammatory mediators with disease severity and viral serotypes.MethodsEighty nine patients classified as per WHO 2009 criteria during dengue outbreak in Odisha, India in 2016 were included in the current study. Presence of dengue virus (DENV) was demonstrated by detecting NS1 antigen, IgM capture ELISA and serotypes in circulation were discriminated by type-specific RT-PCR and/or sequencing. Sixty-one confirmed dengue cases were typed for TLR2 indel polymorphism and compared with 485 disease free controls. Plasma samples were assayed for 41-plex cytokine/ chemokines using Luminex bead based immunoassay.ResultsPresence of 23bp deletion allele of TLR2 gene was significantly more in patients with severe dengue in comparison to dengue fever cases (p= 0.03; Odds ratio 4.05) although the frequency of insertion (Ins) allele of TLR2 was comparable in healthy controls and dengue cases (82.4 and 87.9 % respectively). Seventy-three (82%) samples were found to be positive by NS1/IgM capture ELISA/ RT-PCR. DENV-2 was predominant (58%) during the outbreak. Among the host inflammatory biomarkers 9 molecules were significantly altered in dengue patients when compared to healthy controls. The increased levels of IFN-γ, GM-CSF, IL-10, IL-1Rα and MIP-1β correlated significantly with severe dengue.ConclusionsThe frequency of 23bp Indel mutation of TLR2 was comparable between healthy controls and dengue fever (with and without warning signs), suggesting that this indel mutation does not contribute significantly to susceptibility/ resistance to dengue; however, del allele of TLR2 gene was significantly more associated in patients with severe dengue symptoms when compared to dengue fever cases.

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