Epidemiologic predictors of hepatitis C virus infection in pregnant women

Citations from the literature /International Journal of Gvnecology & Obstetrics 50 (1995) 111-121 zidovudine (100 mg orally live times daily), intrapartum zidovudine (2 mg per kilogram of body weight given intravenously over a one-hour period, then I mg per kilogram per hour until delivery), and zidovudine for the newborn (2 mg per kilogram orally every six hours for six weeks). Infants with at least one positive HIV culture of peripheral-blood mononuclear cells were classified as HIV-infected. Results. From April 1991 through December 20, 1993, the cutoff date for the first interim analysis of efficacy, 477 pregnant women were enrolled; during the study period, 409 gave birth to 415 live-born infants. HIV-infection status was known for 363 births (180 in the zidovudine group and 183 in the placebo group). Thirteen infants in the zidovudine group and 40 in the placebo group were HIV-infected. The proportions infected at 18 months, as estimated by the Kaplan-Meier method, were 8.3”/ (95”/ conlidence interval, 3.9 to 12.8%) in the zidovudine group and 25.5% (95% confidence interval, 18.4 to 32.5%) in the placebo group. This corresponds to a 67.5% (95% confidence interval, 40.7 to 82.1%) relative reduction in the risk of HIV transmission (Z=4.03, P= 0.00 006). Minimal short-term toxic effects were observed. The level of hemoglobin at birth in the infants in the zidovudine group was significantly lower than that in the infants in the placebo group. By 12 weeks of age, hemoglobin values in the two groups were similar. Conclusions. In pregnant women with mildly symptomatic HIV disease and no prior treatment with antiretroviral drugs during the pregnancy, a regimen consisting of zidovudine given ante partum and intra partum to the mother and to the newborn for six weeks reduced the risk of maternal-infant HIV transmission by approximately two thirds. Epidemiologic predictors of hepatitis C virus infection in pregnant women Leikin E.L.; Reinus J.F.; Schmell E.; Tjani N.

USA OBSTET. GYNECOL. 1994 8414 I (529-534) Objective: To identify sensitive epidemiologic predictors of a positive hepatitis C virus antibody test in asymptomatic persons, and to compare the cost of testing only persons with an epidemiologic predictor to that of universal screening. Methods: Seventeen hundred consecutive pregnant women were tested by enzyme-linked immunosorbent assay for antibody to hepatitis C virus. Seventy-five subjects tested positive and were compared with 257 pregnant women who tested negative. Cohort and control patients were interviewed and their medical records were reviewed to identify those with chosen predictors of a positive hepatitis C virus antibody test. Results: Seventy-four of 75 cohort patients and 108 of 257 controls had one or more predictors of a positive antibody test. Cohort patients were significantly more likely (P < 0.001) to have the following: human immunodeficiency virus infection, a sex partner with a risk factor for hepatitis, age greater than 30 years, and a history of drug use, blood transfusion, sexually transmitted disease, hepatitis, or incarceration. The sensitivity and specificity of a single predictor in identifying a person with a positive test were 99 and 58%, respectively. The cost of finding a single individual with a positive antibody test by universal

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screening was $674, compared to $303 by selectively screening persons with one or more predictors of a positive antibody test. Conclusions: Most individuals with positive hepatitis C virus antibody tests can be identified on the basis of epidemiologic predictors, reducing the cost of testing by 55%. These patients may receive appropriate medical therapy, and their children may be evaluated for possible infection by vertical transmission of hepatitis C virus. Peripartum infection associated with vaginal group B streptococcd colonization Yancey M.K.; Duff P.; Clark P.; Kurtzer T.; Horn Frentzen B.; Kubilis P.

USA OBSTET. GYNECOL. 1994 84/5 (816-819) Objective: To determine the frequency of peripartum infection in parturients colonized with group B streptococci. Methods: We screened 915 obstetric patients for group B streptococcal colonization using selective broth media; 823 had vaginal cultures performed within 2 weeks preceding delivery and received complete follow-up. Vaginal group B streptococcal colonization and other risk factors for peripartum maternal infection were assessed using univariate and multivariate logistic modeling. Results: Two hundred sixteen women (26%, 95% confidence interval [Cl] 23-29) were colonized with group B streptococci. Chorioamnionitis or endometritis occurred in 45 of 216colonized women (21%, 95% CI 15.6-26.4) and 72 of 607 women who were not colonized (l2%, 95%) Cl 9-15; P (0.01). When confounding variables were controlled in a multivariate analysis, the association between group B streptococcal colonization and chorioamnionitis, but not endometritis, was confirmed (odds ratio 3.6, 95% CI 2.1-6.2). The risk of chorioamnionitis increased in a stepwise fashion with light (odds ratio 1.9,95% Cl I .O-3.7), moderate (odds ratio 2.6, 95% Cl 1.3-5.2). and heavy (odds ratio 3.2, 95% Cl 1.5-6.6) colonization. Conclusion: Intrapartum vaginal colonization with group B streptococci is an important independent risk factor for chorioamnionitis. The intrapartum platelet count in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: Is it predictive of later hemorrhagic complications? Roberts W.E.; Perry K.G. Jr.; Woods M.B.; Files J.C.; Blake P.G.; Martin J.N. Jr.

USA AM. J. OBSTET. GYNECOL. 1994 l71/3 (799-804) Objective: We wished to determine in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) whether (I) there is an intrapartum threshold platelet count that is predictive of immediate or delayed hemorrhagic complications and (2) whether prophylactic platelet transfusion at delivery prevents these outcomes. Study Design: In this retrospective, descriptive study, the peripartal courses of 132 patients with class I (5 50 OOO/~l platelet nadir) and I60 patients with class 2 (> 50 000 but 5 100 OOO/plplatelet nadir) HELLP syndrome were reviewed with special attention to laboratory data, evidence of hemorrhage, end details of platelet