Impact of the Israeli Ministry of Health Cytomegalovirus Guidelines on the Local Pregnancy Outcome

2020 ◽  
pp. 1-6
Author(s):  
Marina Pekar-Zlotin ◽  
Anat Alufi Naim ◽  
Perry Eliassi Revivo ◽  
Nadav Kugler ◽  
Yaakov Melcer ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Telephone Survey ◽  
Pregnancy Termination ◽  
Maternal Serum ◽  
Cmv Infection ◽  
Ministry Of Health ◽  
Newborn Outcomes ◽  
Fetal Infection ◽  
Postnatal Outcome

<b><i>Objective:</i></b> In 2011, the Israeli Ministry of Health (MOH) published standard guidelines for the follow-up of pregnant women infected by CMV, recommending that amniocentesis be performed in cases of maternal serum viral seroconversion or abnormal sonographic findings suggestive of CMV, in order to prove fetal infection before electing for pregnancy termination. <b><i>Methods:</i></b> A retrospective cohort study was performed, describing 448 pregnant women from 2006 to 2017. We collected data from all women that elected to continue their pregnancies after seroconversion and also of those who chose to undergo pregnancy termination. Subsequently, a telephone survey was then conducted to record outcomes of the newborns of women with CMV seroconversion during pregnancy. <b><i>Results:</i></b> 325 (73%) women chose to continue their pregnancy, while 123 (27%) opted for termination of pregnancy. We found that pregnancy termination due to CMV infection was reduced by 7%, from 72 cases (32%) to 51 cases (25%) after the implementation of the MOH guidelines in 2011. In addition, 182/305 (60%) of women responded to our telephone questionnaire regarding newborn outcomes. Of these women, 45/305 (14%) reported complications, and no correlation was found between the prenatal findings and postnatal outcome among those who have responded to our survey. <b><i>Conclusion:</i></b> Implementation of the new MOH guidelines has reduced the rate of pregnancy termination, without increasing the rate of neonatal complications in Israel with a similar outcome of complication rate as reported in the literature.

scholarly journals Arrangement of risk group with congenital fetus pathology using artificial neural nets

2003 ◽  
Vol 2 (2) ◽  
pp. 103-109
Author(s):  
O. S. Philippov ◽  
A. A. Kazantseva
Keyword(s):  
Pregnant Women ◽  
Risk Group ◽  
Pregnancy Termination ◽  
Maternal Serum ◽  
High Risk Group ◽  
Neural Nets ◽  
Congenital Defects ◽  
Artificial Neural Nets ◽  
Artificial Neural ◽  
Numeric Scale

The aim of the study is the evaluation of the significance of various risk factors for congenital fetus pathology (congenital defect – CD) and the development of risk numeric scale. 424 pregnant women with fetus CD and 520 pregnant women with fetus without congenital defects have been examined. Artificial neural nets have been used for investigation how various factors effect on pregnancy termination. It has been found that the important factors for congenital fetus defect risk are: age younger 18 years of an pregnant women, age older 35 years, noncarring of pregnancy in anamnesis, complicated clinical course of the first pregnancy trimester, CD cases in a family, ultrasonic markers of chromosome pathology in the first pregnancy trimester. Changes in maternal serum AFP, hCG and uE3 levels and blood flow disorders are important to forming high risk group. A numeric scale for CD risk has been developed on the basis of neuronic net analysis.

scholarly journals Enhanced Serum Levels of sFlt1: Impact on Materno–Fetal CMV Transmission

2020 ◽  
Vol 9 (5) ◽  
pp. 1258 ◽  
Author(s):  
Lukas Penka ◽  
Karl-Oliver Kagan ◽  
Klaus Hamprecht
Keyword(s):  
Primary Infection ◽  
Cytomegalovirus Infection ◽  
Predictive Biomarker ◽  
Serum Levels ◽  
Maternal Blood ◽  
Maternal Serum ◽  
Time Interval ◽  
Study Cohort ◽  
Cmv Infection ◽  
Fetal Infection

Background: Antenatal Cytomegalovirus infection (CMV) can be associated with severe fetal symptoms and newborn outcome. The current prenatal diagnosis is based on amniocentesis (AC). No reliable biomarker for fetal infection is available. Methods: We measured Placenta-derived growth factor (PlGF), and soluble fms-like tyrosine kinase 1 (sFlt1), concentrations in maternal serum and amniotic fluid (AF) in context of maternal CMV primary infection. Blood sampling was carried out at the time of AC for detection of fetal CMV infection. The study cohort was divided into four subcohorts according to the presence or absence of fetal infection and preemptive hyperimmunoglobulin (HIG) treatment during the time interval between diagnosis of the CMV primary infection and AC. Results: The study cohort involved 114 pregnancies. In the non-transmitting subcohorts (NT) with and without prior HIG treatment, the median sFlt1 concentrations were 1.5 ng/mL (NT, HIG+) and 1.4 ng/mL (NT, HIG−), respectively. In the two transmitting groups (T) the concentrations were 1.3 ng/mL (T, HIG+) and 2.3 ng/mL (T, HIG−), respectively (NT, HIG− vs. T, HIG−, p < 0.001). The corresponding PlGF levels and the sFlt1/PlGF ratios showed no significant differences between the cohorts. The empirical cut-off values <1504 pg/mL sFlt1 and <307 pg/mL PlGF, were associated with the exclusion of CMV transmission (p < 0.001). Conclusion: sFlt1 concentration in the maternal blood could be a predictive biomarker for maternofetal CMV transmission.

High-Dose Cytomegalovirus (CMV) Hyperimmune Globulin and Maternal CMV DNAemia Independently Predict Infant Outcome in Pregnant Women With a Primary CMV Infection

2019 ◽  
Vol 71 (6) ◽  
pp. 1491-1498 ◽  
Author(s):  
Giovanni Nigro ◽  
Stuart P Adler ◽  
Stefania Lasorella ◽  
Giulia Iapadre ◽  
Maria Maresca ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Odds Ratio ◽  
Fold Increase ◽  
High Dose ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Fetal Infection ◽  
Hyperimmune Globulin ◽  
Infant Outcome

Abstract Background After primary maternal cytomegalovirus (CMV) infection during pregnancy, infants are at risk for disease. Methods Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with primary infection. These women were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range, 1–8 years). One hundred fifty-seven women were treated with an average of 2 doses (range, 1–6 doses) of high-dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae; 31 covariates were tested. Results Four factors predicted fetal infection: a 1.8-fold increase (30% vs 56%) in the rate of congenital infection without HIG (adjusted odds ratio [AOR], 5.2; P &lt; .0001), a 1.8-fold increase (32% vs 56%) associated with maternal viral DNAemia prior to HIG administration (AOR, 3.0; P = .002), abnormal ultrasounds (AOR, 59; P = .0002), and diagnosis of maternal infection by seroconversion rather than avidity (AOR, 3.3; P = .007). Lack of HIG and abnormal ultrasounds also predicted symptoms (P = .001). Long-term sequelae were predicted by not receiving HIG (AOR, 13.2; P = .001), maternal infection in early gestation (odds ratio [OR], 0.9; P = .017), and abnormal ultrasounds (OR, 7.6; P &lt; .003). Prevalence and copy/number of DNAemia declined after HIG. Conclusions Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease and is associated with the resolution of DNAemia.

Therapeutics to prevent congenital cytomegalovirus during pregnancy: what is available now and in the future?

2015 ◽  
Vol 36 (4) ◽  
pp. 156 ◽  
Author(s):  
Stuart T Hamilton ◽  
Corina Hutterer ◽  
Manfred Marschall
Keyword(s):  
Pregnant Women ◽  
Developed Countries ◽  
Fetal Malformation ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus ◽  
Fetal Infection ◽  
Congenital Cmv Infection ◽  
Social Importance ◽  
Cmv Disease ◽  
Congenital Cmv

Human cytomegalovirus (CMV) is the leading non-genetic cause of fetal malformation in developed countries. Congenital CMV infection can cause serious clinical sequelae, and in severe cases result in fetal or neonatal death. Despite the clinical and social importance of congenital CMV there is currently no standardised management strategy to prevent or treat maternal/fetal CMV infection during pregnancy and no evidence-based therapeutic for prenatally diagnosed CMV infection or disease. For pregnant women with a primary CMV infection during pregnancy, standard medical practise remains to offer no treatment at all or the option to terminate pregnancy. If intervention is requested, pregnant women may be offered a narrow range of medical therapies with limited evidence for efficacy and some with high risks of toxicity. However, there are several experimental and novel anti-CMV therapeutics currently being investigated that may provide a safe and effective therapeutic for use during pregnancy to prevent both fetal infection and reduce the risk of congenital CMV disease developing in the fetus once infected in utero.

scholarly journals Follow-up of pregnant women with active cytomegalovirus infection

1999 ◽  
Vol 5 (5) ◽  
pp. 1049-1054
Author(s):  
H. Y. Al Ali ◽  
S. A. Yasseen ◽  
T. Y. Raof
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pregnant Women ◽  
Congenital Malformations ◽  
Cmv Infection ◽  
Serological Evidence ◽  
Congenital Cmv Infection ◽  
The Central Nervous System ◽  
Congenital Cmv

Pregnant women [60]with and without serological evidence of active cytomegalovirus [CMV]infection were followed until delivery to detect the incidence and types of overt congenital CMV infection in neonates in Mosul, Iraq. Infection was diagnosed by the detection of CMV-IgM, using ELISA. CMV-IgM was detected in cord blood samples of six [10%]overtly sick infants [with different congenital malformations]born to mothers with active CMV infection. Central nervous system abnormalities were detected in all six cases [two with microcephaly and four with hydrocephaly]. Congenital CMV infection should be suspected in infants born with congenital malformations, especially those of the central nervous system. The detection of a significant number of hydrocephalus cases in our study is notable

TITLE Hepatitis B screening, outcomes and management of pregnant women and infants in the Cook Islands. SHORT TITLE Antenatal screening for hepatitis B in the Cook Islands

2015 ◽  
Vol 1 (2) ◽  
pp. 74 ◽  
Author(s):  
Yin Yin May Aung ◽  
Martin Sowter ◽  
Timthoy Kenealy
Keyword(s):  
Hepatitis B ◽  
Pregnant Women ◽  
Immune Globulin ◽  
Research Question ◽  
Antenatal Screening ◽  
Ministry Of Health ◽  
Cook Islands ◽  
Hepatitis B Immune Globulin ◽  
Hepatitis B Screening

<p align="left"><strong>TITLE</strong></p><p align="left"><strong> </strong></p><p>Hepatitis B screening, outcomes and management of pregnant women and infants in the Cook Islands.</p><p align="left"> </p><p align="left"> </p><p><strong>SHORT TITLE</strong></p><p>Antenatal screening for hepatitis B in the Cook Islands</p><p align="left"> </p><p align="left"> </p><p align="left">Dr. Yin Yin May Aung, Ministry of Health Cook Islands, Rarotonga, Cook Islands. Email <a href="mailto:[email protected]">[email protected]</a></p><p align="left"> </p><p align="left">Dr. Martin Sowter, Consultant Obstetrician and Gynaecologist, National women’s Health, Auckland New Zealand. Email [email protected]</p><p align="left"> </p><p align="left">Dr. Timothy Kenealy, Associate Professor of Integrated Care, University of Auckland.  Email [email protected]</p><p align="left"> </p><p align="left"> </p><p align="left">Funding</p><p align="left">Ministry of Health, Cook Islands.</p><p align="left"> </p><p align="left">Competing interests</p><p align="left">All authors declare they have no competing interest.</p><h1>ABSTRACT</h1><h2>Introduction</h2><p>To describe current Cook Islands practice for screening and management of Hepatitis B (HB) in pregnant women and their newborns and to consider the implications of an updated screening and management strategy.</p><h2>Methods</h2><p>Retrospective study of pregnant women booked for antenatal care in Cook Islands from January 2010 to December 2014 was conducted. Data were collected on maternal Hepatitis B serology status, timeliness of hepatitis B immune globulin given if indicated and the completion of hepatitis B immunisation for newborns who were due their vaccinations, special service referral and contact tracing from the electronic health information system. Simple descriptive statistics were used to report the data.</p><h2>Findings</h2><p>All women who attended the antenatal clinics accepted Hepatitis B screening in pregnancy. Data from 803 women were analysed. Hepatitis B surface antigen (HBsAg) was detected in 23 of 803 (2.9%) of women of which 21 were Antibody-HBs (Anti-HBs) positive and two were hepatitis B e antigen (HBeAg) positive. Hepatitis B DNA viral load was unable to be tested. Hepatitis B immune globulin was given to 21 of the 23 babies within one day, one was given on day 3 but one was missed. None of the 23 mothers and their babies had any ongoing follow up.</p><p>The first Hepatitis B vaccine, due within 24 hours of birth, was given within a day to 743 of the 803 (93%) of babies. The second, due at 6 weeks, was given by 8 weeks to 645 of the 778 babies due for their six week vaccination (83%). The third, due at 3 months, was given by 4 months to 648 of the 744 (87%). The fourth, due at 5 months was given by 6 months to 553 of the 712 (78%). Of the 712 babies over 6 months of age, 601 (84%) were recorded as having completed four HB vaccines at any time.</p><h2>Conclusion</h2><p>The hepatitis B screening and immunisation in the Cook Islands appears effective but this study indicates that the follow up of both the mother and their infants needs to be improved.</p><p> </p><p align="left">he research question, interpreted the data and revised the manuscript. TK reviewed the research question, analysed and interpret the data and revised the manuscript.</p>

scholarly journals Post-traumatic stress in pregnant women with primary cytomegalovirus infection and risk of congenital infection in newborns

BJPsych Open ◽  
2016 ◽  
Vol 2 (6) ◽  
pp. 373-376 ◽  
Author(s):  
Francesco Vadini ◽  
Elisa Tracanna ◽  
Ennio Polilli ◽  
Monica Tontodonati ◽  
Elena Ricci ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Traumatic Stress ◽  
Congenital Infection ◽  
Dna Amplification ◽  
Post Traumatic Stress ◽  
Cmv Infection ◽  
Type D ◽  
Newborn Outcomes ◽  
Post Traumatic ◽  
Primary Cytomegalovirus Infection

BackgroundSubstantial evidence indicates that perinatal mental disturbances are associated with the risk for negative maternal-newborn outcomes. A neuroendocrine brain-placenta interaction has been described to explain the association between prenatal stress-related disorders and placental abnormalities. Whether these mechanisms may affect the likelihood of mother-to-child transmission (MTCT) of infections has never been investigated.AimsTo evaluate the role of psychological factors in cytomegalovirus (CMV) MTCT in pregnant women with primary CMV infection.MethodA cohort of 276 pregnant women with primary CMV infection underwent assessment of (a) reactive psychopathological symptoms, such as current depressive symptoms and ongoing symptoms of post-traumatic stress disorder; and (b) stable personality traits, such as alexithymia and Type D (distressed) personality. Congenital infection was diagnosed by CMV DNA amplification from blood and/or urine and saliva from newborn at birth.ResultsThe occurrence of congenital CMV disease in the newborn was independently predicted by post-traumatic stress symptoms during pregnancy.ConclusionsOur findings suggest that psychological stress-related disturbances may weaken the physical and immunological barrier against the mother-to-fetus transmission of viruses.

TERMINATION OF PREGNANCY LESS THAN 49 DAYS USING MIFEPRISTONE AND MISOPROSTOL

2011 ◽  
pp. 16-24
Author(s):  
Thi Kim Ngoc Do ◽  
Vu Quoc Huy Nguyen
Keyword(s):  
Abdominal Pain ◽  
Side Effects ◽  
Reproductive Health ◽  
Pregnant Women ◽  
Pregnancy Termination ◽  
Medical Abortion ◽  
Termination Of Pregnancy ◽  
Successful Pregnancy ◽  
Satisfaction Rate

Objectives: 1.To evaluate the effectiveness and safety of Mifepristone and Misoprostol in termination of pregnancy less than 49 days. 2. To evaluate the acceptability and side effects of that treatment scheme. Materials & Methods: 169 pregnant women less than <49 days demanding medical abortion at Can Tho Reproductive Health Center during the period of June 1st 2009 to May 30th 2010. Mifepristone 200mg was administered orally, followed by onsite monitoring during 30 minutes; Misoprostol 400 µg were administered orally 48 hours later by th facility at the center. Follow-up visit for 2 weeks was made after using Mifepristone. Results and Discussion: Rate of successful pregnancy termination was 95.3%. Mean duration between Mifepristone and Misoprostol use and abortion is 4.3 ± 3.7 hours. Satisfaction rate is 89.4%. Observed Mifepristone’s side effects include abdominal pain (35.8%), nausea (20.3%), and vomit (4.8%); Misoprostol’s side effects include abdominal pain (86.6%), nausea (33,7%), vomit (8,6%), fever/child, fatigue and diarrhea (7.5%). Conclusions: Mifepristone and Misoprostol are safe and highly effective for termination of pregnancy less than 49 days.

scholarly journals Screening for Cytomegalovirus during Pregnancy

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Stuart P. Adler
Keyword(s):  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Cmv Infection ◽  
Blood Samples ◽  
High Risk Women ◽  
Effective Interventions ◽  
Fetal Infection ◽  
Recent Developments ◽  
Serologic Screening

The epidemiology and pathogenesis of CMV infections among pregnant women have been intensely studied over the last three decades. This paper highlights recent developments that make either universal or limited serologic screening for CMV during pregnancy potentially attractive. The developments include an understanding of the pathogenesis of CMV infections, a knowledge of high-risk women, the availability of accurate methods for the serologic diagnosis of a primary CMV infection using either single or serial blood samples, accurate methods for the diagnosis of fetal infection via amniotic fluid, sensitive fetal and placental indicators for neonatal outcomes, and the availability of potentially effective interventions.

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