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Lyme disease during pregnancy
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Citationsfrom the Literature
Lyme disease during pregnancy Markowitz LE; Steere AC; Benach JL; et al Respiratory and Spechl Pathogens Epidemiology Branch, Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333, USA J. AM. MED. ASSOC.; 255124 (3394-3396) 1986 Lyme disease is an increasingly recognized tick-borne illness caused by a spirochete, Borrelia burgdorferi. Because the etiologic agent of Lyme disease is a spirochete, there has been concern about the effect of maternal Lyme disease on pregnancy outcome. We reviewed cases of Lyme disease in pregnant women who were identified before knowledge of the pregnancy outcomes. Nineteen cases were identified with onset between 1976 and 1984. Eight of the women were affected during the first trimester, seven during the second trimester, and two during the third trimester; in two, the trimester of onset was unknown. Thirteen received appropriate antibiotic therapy for Lyme disease. Of the 19 pregnancies, five had adverse outcomes, including syndactyly, cortical blindness, intrauterine fetal death, prematurity, and rash in the newborn. Adverse outcomes occurred in cases with infection during each of the trimesters. Although B burgdorferi could not be implicated directly in any of the adverse outcomes, the frequency of such outcomes warrants further surveillance and studies of pregnant women with Lyme disease. Haemolytic disease of the newborn - the changing scene Tovey LAD Blood Transfusion Centre, Bridle Path, Leeds LS15 7TW, UK BR. J. OBSTET. GYNAECOL.; 93/9 (960-966) 1986 Between 1950 and 1970 there was a steady decline in the number of infant deaths from rhesus haemolytic disease of the newborn in the Yorkshire Region but no decrease in the number of pregnant women with antibodies. Following the introduction of Rh prophylaxis in 1970, the number of preg-
Int J Gynaecol Obstet 25
nant women sensitized has decreased by 70% and the number of infant deaths by 96%. The number of infants requiring exchange transfusion has also decreased by 70%. During the years 1980 to 1983 there were 163 new cases of maternal sensitization to the D antigen in the Yorkshire Region, 36 were due to failures of administration, 75 were failures of protection and 26 were in primigravidae. Eighteen of the failures of administration occurred after abortion, nine of which were surgical terminations. Antenatal prophylaxis may well have protected 64 (40%) of these 163 women. The number of pregnant women with antibodies other than anti-D now exceeds those with anti-D. The effect of these changes in incidence and clinical severity on the management of Rh D negative pregnant women is discussed.
Antenatal diagnosis of placental anastomosis in a twin pregnancy using Doppler ultrasound Erskine RLA; Ritchie JWK; Murnaghan GA Department of Midwifery and Gynaecology, Institute of ClinicalSciences, Royal VictoriaHospital, Belfast, UK BR. J. OBSTET. GYNAECOL.; 93/9 (955-959) 1986 Qualitative analysis of blood velocity in the umbilical arteries of twin fetuses detected by pulsed Doppler ultrasound revealed discordant patterns which permitted an accurate antenatal diagnosis of an artery-to-artery anastomosis. One twin was consistently larger than the other, had a normal umbilical artery impedance and survived; the other fetus was consistently smaller, had persistently high umbilical artery impedance and died in utero. The death of one fetus did not affect the blood flow patterns within the umbilical artery of the other up to delivery 24 h later. The case demonstrates that intrauterine morbidity due to vascular anastomoses is not confined to the transfusion of significant amounts of blood from one fetus to another.
Citationsfrom the Literature
Lyme disease during pregnancy Markowitz LE; Steere AC; Benach JL; et al Respiratory and Spechl Pathogens Epidemiology Branch, Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333, USA J. AM. MED. ASSOC.; 255124 (3394-3396) 1986 Lyme disease is an increasingly recognized tick-borne illness caused by a spirochete, Borrelia burgdorferi. Because the etiologic agent of Lyme disease is a spirochete, there has been concern about the effect of maternal Lyme disease on pregnancy outcome. We reviewed cases of Lyme disease in pregnant women who were identified before knowledge of the pregnancy outcomes. Nineteen cases were identified with onset between 1976 and 1984. Eight of the women were affected during the first trimester, seven during the second trimester, and two during the third trimester; in two, the trimester of onset was unknown. Thirteen received appropriate antibiotic therapy for Lyme disease. Of the 19 pregnancies, five had adverse outcomes, including syndactyly, cortical blindness, intrauterine fetal death, prematurity, and rash in the newborn. Adverse outcomes occurred in cases with infection during each of the trimesters. Although B burgdorferi could not be implicated directly in any of the adverse outcomes, the frequency of such outcomes warrants further surveillance and studies of pregnant women with Lyme disease. Haemolytic disease of the newborn - the changing scene Tovey LAD Blood Transfusion Centre, Bridle Path, Leeds LS15 7TW, UK BR. J. OBSTET. GYNAECOL.; 93/9 (960-966) 1986 Between 1950 and 1970 there was a steady decline in the number of infant deaths from rhesus haemolytic disease of the newborn in the Yorkshire Region but no decrease in the number of pregnant women with antibodies. Following the introduction of Rh prophylaxis in 1970, the number of preg-
Int J Gynaecol Obstet 25
nant women sensitized has decreased by 70% and the number of infant deaths by 96%. The number of infants requiring exchange transfusion has also decreased by 70%. During the years 1980 to 1983 there were 163 new cases of maternal sensitization to the D antigen in the Yorkshire Region, 36 were due to failures of administration, 75 were failures of protection and 26 were in primigravidae. Eighteen of the failures of administration occurred after abortion, nine of which were surgical terminations. Antenatal prophylaxis may well have protected 64 (40%) of these 163 women. The number of pregnant women with antibodies other than anti-D now exceeds those with anti-D. The effect of these changes in incidence and clinical severity on the management of Rh D negative pregnant women is discussed.
Antenatal diagnosis of placental anastomosis in a twin pregnancy using Doppler ultrasound Erskine RLA; Ritchie JWK; Murnaghan GA Department of Midwifery and Gynaecology, Institute of ClinicalSciences, Royal VictoriaHospital, Belfast, UK BR. J. OBSTET. GYNAECOL.; 93/9 (955-959) 1986 Qualitative analysis of blood velocity in the umbilical arteries of twin fetuses detected by pulsed Doppler ultrasound revealed discordant patterns which permitted an accurate antenatal diagnosis of an artery-to-artery anastomosis. One twin was consistently larger than the other, had a normal umbilical artery impedance and survived; the other fetus was consistently smaller, had persistently high umbilical artery impedance and died in utero. The death of one fetus did not affect the blood flow patterns within the umbilical artery of the other up to delivery 24 h later. The case demonstrates that intrauterine morbidity due to vascular anastomoses is not confined to the transfusion of significant amounts of blood from one fetus to another.