Obstetrical Ultrasound During Pregnancy

No relevant evidence was identified comparing the safety of frequent obstetrical ultrasounds compared to the routine use of obstetrical ultrasound during pregnancy. This review identified 10 evidence-based guidelines that provided recommendations regarding various indications for obstetrical ultrasound, as well as the frequency of obstetrical ultrasound; however, the methodological rigour of these guidelines is limited and recommendations should be interpreted with caution. One guideline recommended against obstetrical ultrasound for non-medical purposes and recommended that ultrasound exposure be as low as reasonably possible during pregnancy. These recommendations were based on moderate-quality evidence and expert opinion, and should be interpreted with caution. The guidelines made recommendations for specific patient populations for whom more frequent obstetrical ultrasound examinations may be required. These populations included pregnancies affected by certain congenital infections, people pregnant with twins, pregnant adolescents, and pregnant people at high risk for fetal anomalies or for whom mid-trimester transabdominal ultrasound would be challenging.

MCMV Centrifugal Enhancement: A New Spin on an Old Topic

Human cytomegalovirus (HCMV) is a ubiquitous pathogen infecting a majority of people worldwide, with diseases ranging from mild to life-threatening. Its clinical relevance in immunocompromised people and congenital infections have made treatment and vaccine development a top priority. Because of cytomegaloviruses’ species specificity, murine cytomegalovirus (MCMV) models have historically informed and advanced translational CMV therapies. Using the phenomenon of centrifugal enhancement, we explored differences between MCMVs derived in vitro and in vivo. We found centrifugal enhancement on tissue culture-derived virus (TCV) was ~3× greater compared with salivary gland derived virus (SGV). Using novel “flow virometry”, we found that TCV contained a distinct submicron particle composition compared to SGV. Using an inhibitor of exosome production, we show these submicron particles are not extracellular vesicles that contribute to centrifugal enhancement. We examined how these differences in submicron particles potentially contribute to differing centrifugal enhancement phenotypes, as well as broader in vivo vs. in vitro MCMV differences.

Prediction of Non-canonical Routes for SARS-CoV-2 Infection in Human Placenta Cells

The SARS-CoV-2 is the causative agent of the COVID-19 pandemic. The data available about COVID-19 during pregnancy have demonstrated placental infection; however, the mechanisms associated with intrauterine transmission of SARS-CoV-2 is still debated. Intriguingly, while canonical SARS-CoV-2 cell entry mediators are expressed at low levels in placental cells, the receptors for viruses that cause congenital infections such as the cytomegalovirus and Zika virus are highly expressed in these cells. Here we analyzed the transcriptional profile (microarray and single-cell RNA-Seq) of proteins potentially interacting with coronaviruses to identify non- canonical mediators of SARS-CoV-2 infection and replication in the placenta. Despite low levels of the canonical cell entry mediators ACE2 and TMPRSS2, we show that cells of the syncytiotrophoblast, villous cytotrophoblast, and extravillous trophoblast co-express high levels of the potential non-canonical cell-entry mediators DPP4 and CTSL. We also found changes in the expression of DAAM1 and PAICS genes during pregnancy, which are translated into proteins also predicted to interact with coronaviruses proteins. These results provide new insight into the interaction between SARS-CoV-2 and host proteins that may act as non-canonical routes for SARS-CoV-2 infection and replication in the placenta cells.

The Role of Certain Congenital Infections in Aplastic Anemia and Prognostic Value of Fetal Hemoglobin as a Follow-Up Marker

Background: TORCH infection has a role in aplastic anemia (AA). Fetal hemoglobin may be high in certain acquired hematological conditions such as aplastic anemia. We conducted this study to evaluate the correlation between certain congenital infections and severity of aplastic anemia and to study fetal Hb as a follow up marker during treatment of aplastic anemia. The aim of study was to correlation between certain congenital infection and severity of aplastic anemia and to study of hemoglobin F (HbF) as a follow up marker during treatment of aplastic anemia. Methods: Our prospective study was conducted on 20 children aged up to 18 years diagnosed with aplastic anemia following either bone marrow aspiration or biopsy that proves bone marrow hypocellularity with absence infiltrative BM disease or inherited BM disease recruited from Pediatric Hematology-Oncology Unit of Tanta University Hospital. Patients were classified according to level of HbF in to high HbF group and normal HbF group. Results: TORCH infections were detected in certain numbers of patients . HbF decreased in high HbF group after treatment. There was significant increase in CBC parameters in high HbF group than normal HbF group after treatment. There was insignificant decrease in mortality in high HbF group than normal HbF group. Mild to moderate cases were significantly higher with TORCH IgM +ve cases Conclusions: Acquired AA is associated with TORCH infection. In treated cases of AA, improvement of hematological parameters is associated with high HbF and from these results, it can be used as a prognostic marker to monitor the successful response of these cases to the used line of treatment.

Dosage escalation of antenatal steroids in preterm twin pregnancies does not improve long-term outcome

Objectives To analyze long-term effects of antenatal betamethasone (≤16 mg, =24 mg and >24 mg) in preterm twins on infant and childhood morbidity. Methods Retrospective cohort study among 198 preterm twins. Three follow up time points, including a total of 84 outcomes, were evaluated: first neonatal examination after birth and in the neonatal period up to 10 days after birth using data from the clinic charts; examination from the 21st to the 24th month of life and examination from the 60th to the 64th months, using data from copies of the children’s examination booklets sent back by the parents. Dosage-dependent and sex-specific long-term effects of antenatal betamethasone treatment on neonatal, infant and early childhood development and morbidity up to 5.3 years of age were analyzed. Results Dosage escalation of >24 mg was not associated with improved neonatal, infant or early child hood outcome, independent of twin pair structure. In contrast, higher doses >24 mg were significantly linked to increased rates of congenital infections (OR 5.867, 95% CI 1.895–18.167). Male sex as a factor was obvious for lower rates of apnea-bradycardia-syndrome in neonates, higher rates of no free steps after 15 months in infancy and highest rates of motor clumsiness in early childhood. Conclusions Betamethasone dosage escalation >24 mg in twins born between 23+5 and 33+6 weeks of gestation did not improve neonatal, infant or early childhood morbidity. In contrast, higher doses >24 mg total dose resulted in significantly higher rates of congenital infections and are not recommended. For males, 24 mg betamethasone appears to be the preferable dose.