- Email: [email protected]
Increased perinatal mortality among children of mothers exposed to measles during pregnancy
484
Citations from the Literature
with a thickened nuchal skin fold or shortened femurs on uhrasound examination be evaluated for Down’s syndrome by amniocentesis and cytogenetic analysis. Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis Daffos F; Forestier F; Capella-Pavlovsky M; et al Centre de Diagnostic Prenatal et de Foetologie, Hopital Notre Dame de Bon Secours. 75674 Parts Cedex 14, France NEW ENGL. J. MED.; 318/5 (Ul-275)/1988/ When infection with Toxoplasmosis gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxne or sulfadiaxine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during followup. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease. Incidence and aetiology of hydatidiform mole: An epidemiological review Bracken MB Department of Epidemiology and Public Health, Yale University Medical School, New Haven, CT 06510, USA BR. J. OBSTET. GYNAECOL.; 94/12 (1123-1135)/1987/ Epidemiological investigation of the incidence and aetiology of hydatidiform mole (HM) is receiving increasing attention. Recent, population-based studies suggest that earlier reports of a very high incidence of HM in Asia, Africa and South-Central America may have been exaggerated, due primarily to selection bias in patients studied at university hospitals. Japanese population studies indicate a two-fold higher rate of HM compared with Caucasian rates but Chinese rates appear to be similar. Population studies presently available suggest a worldwide range of HM somewhere between 0.5 and 2.5/lGQO pregnancies. When deliveries form the rate denominator the rates are somewhat higher, depending primarily on the national rate of induced abortions. The independent effects on incidence of geographic locale, ethnicity and socio-cultural Int J Gynecol Obstet 27
factors have not been adequately disentangled although the genetic studies suggest ethnicity might be the predominant variable. Maternal age is the most consistently demonstrated risk factor; teenagers and, especially, women over age 35 being at increased risk. The independent effects of paternal age and pregnancy history are not established. Women with a history of one HM seem to have a ten-fold risk of repeat HM compared with women who have no history of HM. Aetiological studies have not revealed any environmental risk factor for which there is unequivocal agreement about its influence on HM. New case-control studies of HM aetiology must classify HM according to genetic aetiology. Cohort studies are required to expore more fully the relation of HM to malignant sequelae. Increased pednatal mortality among children of mothers exposed to measles during pregnancy Aaby P; Bukh J; Lisse IM; et al Institute of Ethnology and Anthropology, University of Copenhagen, Copenhagen, Denmark LANCET; l/8584 (516-519)/1988/ A survey done after a severe epidemic of measles in an urban area of Guinea-Bissau has shown that children born to women exposed to measles during pregnancy had a perinatal mortality rate of IS%, compared with only 4% for other children in the community (OR = 4.2; 95% CI 2.1-8.5). None of the women had clinical evidence of measles. Adjusting for background variable, logistic regression analysis showed no tendency towards reduced risk of perinatal mortality among children of women exposed during pregnancy relative to controls. Both stillbirth and early neonatal mortality rates were increased. A similar tendency was found in a rural epidemic (OR = 9.5; 95% CI 2.6-35.1). Exposure during any trimester of fetal life increased the rate of perinatal mortality. The results suggest that exposure to measles virus or some concomitantly transmitted pathogen may contribute to the high perinatal mortality risk found in many developing countries. The possible long-term health consequences of exposure to measles virus should be considered when assessing the value of measles control programmes. Vaginal birth after cesarean Phelan JP; Clark SL; Diaz F; Paul RH Women’s Hospital, Los Angeles, CA 90033, United States of America AM. J. OBSTET. GYNECOL.; 157/6(1510--1515)/1987/ Allowing a woman with a previous cesarean birth a trial of labor rather than performing an elective repeat cesarean section continues to be a controversial area in obstetrics today. In an effort to evaluate the risks associated with a trial of labor, a prospective investigation was undertaken from July 1, 1982, through June 30, 1984. During the first year of the study, patients with a known vertical scar or more than one prior cesarean birth were excluded from an attempted trial of labor. Beginning July 1, 1983, patients with two prior cesarean births were no longer excluded and were studied prospectively. During this 2-year period, 32,854 patients were delivered of their infants at the Los Angeles County/University of Southern Cal-
Citations from the Literature
with a thickened nuchal skin fold or shortened femurs on uhrasound examination be evaluated for Down’s syndrome by amniocentesis and cytogenetic analysis. Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis Daffos F; Forestier F; Capella-Pavlovsky M; et al Centre de Diagnostic Prenatal et de Foetologie, Hopital Notre Dame de Bon Secours. 75674 Parts Cedex 14, France NEW ENGL. J. MED.; 318/5 (Ul-275)/1988/ When infection with Toxoplasmosis gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxne or sulfadiaxine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during followup. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease. Incidence and aetiology of hydatidiform mole: An epidemiological review Bracken MB Department of Epidemiology and Public Health, Yale University Medical School, New Haven, CT 06510, USA BR. J. OBSTET. GYNAECOL.; 94/12 (1123-1135)/1987/ Epidemiological investigation of the incidence and aetiology of hydatidiform mole (HM) is receiving increasing attention. Recent, population-based studies suggest that earlier reports of a very high incidence of HM in Asia, Africa and South-Central America may have been exaggerated, due primarily to selection bias in patients studied at university hospitals. Japanese population studies indicate a two-fold higher rate of HM compared with Caucasian rates but Chinese rates appear to be similar. Population studies presently available suggest a worldwide range of HM somewhere between 0.5 and 2.5/lGQO pregnancies. When deliveries form the rate denominator the rates are somewhat higher, depending primarily on the national rate of induced abortions. The independent effects on incidence of geographic locale, ethnicity and socio-cultural Int J Gynecol Obstet 27
factors have not been adequately disentangled although the genetic studies suggest ethnicity might be the predominant variable. Maternal age is the most consistently demonstrated risk factor; teenagers and, especially, women over age 35 being at increased risk. The independent effects of paternal age and pregnancy history are not established. Women with a history of one HM seem to have a ten-fold risk of repeat HM compared with women who have no history of HM. Aetiological studies have not revealed any environmental risk factor for which there is unequivocal agreement about its influence on HM. New case-control studies of HM aetiology must classify HM according to genetic aetiology. Cohort studies are required to expore more fully the relation of HM to malignant sequelae. Increased pednatal mortality among children of mothers exposed to measles during pregnancy Aaby P; Bukh J; Lisse IM; et al Institute of Ethnology and Anthropology, University of Copenhagen, Copenhagen, Denmark LANCET; l/8584 (516-519)/1988/ A survey done after a severe epidemic of measles in an urban area of Guinea-Bissau has shown that children born to women exposed to measles during pregnancy had a perinatal mortality rate of IS%, compared with only 4% for other children in the community (OR = 4.2; 95% CI 2.1-8.5). None of the women had clinical evidence of measles. Adjusting for background variable, logistic regression analysis showed no tendency towards reduced risk of perinatal mortality among children of women exposed during pregnancy relative to controls. Both stillbirth and early neonatal mortality rates were increased. A similar tendency was found in a rural epidemic (OR = 9.5; 95% CI 2.6-35.1). Exposure during any trimester of fetal life increased the rate of perinatal mortality. The results suggest that exposure to measles virus or some concomitantly transmitted pathogen may contribute to the high perinatal mortality risk found in many developing countries. The possible long-term health consequences of exposure to measles virus should be considered when assessing the value of measles control programmes. Vaginal birth after cesarean Phelan JP; Clark SL; Diaz F; Paul RH Women’s Hospital, Los Angeles, CA 90033, United States of America AM. J. OBSTET. GYNECOL.; 157/6(1510--1515)/1987/ Allowing a woman with a previous cesarean birth a trial of labor rather than performing an elective repeat cesarean section continues to be a controversial area in obstetrics today. In an effort to evaluate the risks associated with a trial of labor, a prospective investigation was undertaken from July 1, 1982, through June 30, 1984. During the first year of the study, patients with a known vertical scar or more than one prior cesarean birth were excluded from an attempted trial of labor. Beginning July 1, 1983, patients with two prior cesarean births were no longer excluded and were studied prospectively. During this 2-year period, 32,854 patients were delivered of their infants at the Los Angeles County/University of Southern Cal-