Effect of Frequent Vaginal Saline Lavage On Maternal Infection Prevention During Mechanical Labor Induction

Background: Induction of labor is performed in up to 25% of pregnancies. The major concern in mechanical labor induction is that it increases the chance of infection when a foreign device is introduced into the cervix. The aim of the study is to test the effectiveness of a vagina saline lavage procedure on infection prevention during labor induction by transcervical double balloon catheter.Methods: Enrolled pregnant women were randomly divided into two groups. The control group received standard aseptic vaginal cleansing with 5% betadine solution. In addition to the standard aseptic preparation, the study group received vaginal lavage with 0.9% saline solution before the device placement and once every 4 hours after the insertion. Results: There was no statistical difference in the demographic characteristics or the indications for induction between the two groups (P > 0.1). The final delivery modes and complication rates were not significantly different (P > 0.05) between the two groups, except for the maternal infection rate (P < 0.05). The rate of infection dropped from 10.6% to 2.9% when the frequent vaginal lavage procedure was performed. Conclusions: Excessive vaginal aseptic preparation by saline solution is easy to apply, safe and effective in reducing maternal infection during mechanical labor induction.

Severe fetal symptomatic infection from human cytomegalovirus following non-primary maternal infection: report of two cases

Introduction Human cytomegalovirus (HCMV) is the most common congenital infection, expecially severe after a maternal primary infection; sequelae in neonates born to mothers experiencing a non-primary infection have been already reported. Hereby, two cases of severe fetal HCMV disease in seroimmune gravidas referred to our Unit are described. Cases presentation Case 1 A fetus at 21 weeks’ gestation with signs of anemia and brain abnormalities at ultrasound (US), described at magnetic resonance (MR) imaging as ependymal irregularity and bilateral asymmetric parenchimal thinning; amniotic fluid sample was positive for HCMV although the woman had a previous immunity; after termination of pregnancy, autopsy demonstrated a thicken layer of disorganized neurons on the right cortical plate, while on the left there was a morphological pattern coherent with polymicrogyria. Case 2 A fetus at 20 weeks’ gestation with anemia, moderate atrio-ventricular insufficiency, hepatosplenomegaly but no major cerebral lesions. Fetal blood was positive for HCMV, although unexpected for pre-pregnancy maternal immunity, and intrauterine transfusion was needed. A cesarean section at 34 weeks gestation was performed due to worsening condition of the fetus, who had a birthweight of 2210 grams, needed platelet transfusions but MR examination and clinical evaluation were normal. Conclusion The impact of non-primary maternal infection on pregnancy outcome is unknown and fetal brain damage in HCMV seroimmune transmitter-mothers can occur as a consequence of maternal re-infection or reactivation for a hypotetic different role of HCMV-primed CD4+ or CD8+ T-cells in fetal brain, with progressive brain lesions coexistent in the first case and with severe unexpected anemia in the second case. A previous maternal HCMV immunity should not exempt to test anemic fetuses for such infection, nor to consider a potential transplacental transmission.

Mapping the Aetiology and Antimicrobial Resistance Patterns of Maternal Bacterial Infection in Sub-Saharan Africa: A Systematic Review and Meta-Analysis Protocol

Background: Over two-thirds of global maternal deaths occur in Sub-Saharan Africa (SSA), with more than 200,000 deaths per year. Maternal sepsis causes 10% of these deaths, twice the proportion observed in high-income countries. In SSA, limited access to diagnostic microbiology facilities poses difficulties in promptly identifying and managing maternal infection and sepsis. This protocol describes a systematic review and meta-analysis that aims to summarize available data on the main bacterial agents causing maternal infections and their antibiotic susceptibility in SSA. Methods: Three electronic databases will be searched: MEDLINE, Embase and African Journals Online. Our search strategy will combine terms relating to laboratory-confirmed bacterial infection, pregnancy, postnatal period and SSA. We will include observational studies describing maternal bacterial infection's aetiology and antimicrobial resistance patterns in SSA. Two authors will perform study selection, data extraction and quality assessment. A third author will be consulted to resolve disagreements if they arise.We will summarize the proportion (and 95% confidence intervals) of samples testing positive for the most common bacteria and, depending on the data's availability and heterogeneity, examine results by country and/or region. If possible, we will describe trends over time and differentiate aetiological organisms and resistance/sensitivities by maternal infection sources. We will also undertake subgroup analyses based on HIV status, the invasive and non-invasive status of the infection, SSA sub-regions and mortality if there is adequate information to make such subgroup analysis feasible. Discussion: Data on the microbiologic outcomes for maternal infections in SSA are likely fragmented and not fully representative due to the limited availability of microbiology diagnostics and geographical differences in clinical and laboratory practices. If this is the case, policies and programme strategies to guide treatment and identify antimicrobial resistance threats in SSA settings will be challenging to target. Our systematic review aims to provide a comprehensive summary of the available data, describe the main organisms causing maternal infection and their sensitivities, and identify areas that require further research. Prospero ID: CRD42021238515

Milk From Women Diagnosed With COVID-19 Does Not Contain SARS-CoV-2 RNA but Has Persistent Levels of SARS-CoV-2-Specific IgA Antibodies

BackgroundLimited data are available regarding the balance of risks and benefits from human milk and/or breastfeeding during and following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).ObjectiveTo investigate whether SARS-CoV-2 can be detected in milk and on the breast after maternal coronavirus disease 2019 (COVID-19) diagnosis; and characterize concentrations of milk immunoglobulin (Ig) A specific to the SARS-CoV-2 spike glycoprotein receptor binding domain (RBD) during the 2 months after onset of symptoms or positive diagnostic test.MethodsUsing a longitudinal study design, we collected milk and breast skin swabs one to seven times from 64 lactating women with COVID-19 over a 2-month period, beginning as early as the week of diagnosis. Milk and breast swabs were analyzed for SARS-CoV-2 RNA, and milk was tested for anti-RBD IgA.ResultsSARS-CoV-2 was not detected in any milk sample or on 71% of breast swabs. Twenty-seven out of 29 (93%) breast swabs collected after breast washing tested negative for SARS-CoV-2. Detection of SARS-CoV-2 on the breast was associated with maternal coughing and other household COVID-19. Most (75%; 95% CI, 70-79%; n=316) milk samples contained anti-RBD IgA, and concentrations increased (P=.02) during the first two weeks following onset of COVID-19 symptoms or positive test. Milk-borne anti-RBD IgA persisted for at least two months in 77% of women.ConclusionMilk produced by women with COVID-19 does not contain SARS-CoV-2 and is likely a lasting source of passive immunity via anti-RBD IgA. These results support recommendations encouraging lactating women to continue breastfeeding during and after COVID-19 illness.