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Measles in pregnancy:
International Journal of Gynecology & Obstetrics 59 Ž1997. 109]113
Article
Measles in pregnancy: Maternal morbidity and perinatal outcome M. Elamin AliU , H.M. Albar Department of Obstetrics and Gynaecology, Abha Medical School, King Saud Uni®ersity, College of Medicine, Abha, Saudi Arabia Received 23 December 1996; received in revised form 12 August 1997; accepted 18 August 1997
Abstract Objecti®e: In this article, we studied the maternal morbidity and the perinatal outcome of 40 women who had measles in pregnancy and that was compared to 120 women who had pregnancy without measles and 37 women who had measles without pregnancy. Method: The medical records of all the case and control subjects were reviewed and significance was tested at the 5% level. Results: The 40 cases of measles with pregnancy had significantly more hospital admission for pneumonia and fever when compared to cases of measles with no pregnancy Ž P - 0.001.. The perinatal morbidity is significantly higher in cases of measles with pregnancy as expressed by the higher incidence of prematurity, neonatal hospital admission and length of stay in hospital Ž P- 0.003, P- 0.0005 and P- 0.0001, respectively.. Conclusion: Formulation of an appropriate strategy utilizing the available resources for measles vaccination is mandatory. Q 1997 International Federation of Gynecology and Obstetrics Keywords: Measles; Maternal morbidity; Perinatal outcome; Vaccination
1. Introduction Prior to the era of measles Žrubeola. vaccination, infection with measles during pregnancy was unusual w1,2x. Even in the post-vaccine era some
U
Corresponding author.
cases of measles occur in women at reproductive age and during pregnancy w3x. Measles during pregnancy is associated with a high incidence of maternal morbidity or even mortality w4]6x. Also it has a deleterious effect on the perinatal outcome characterized by frequent abortions and pre-term labors w7,8x. The catchment area of Abha Maternity Hospi-
0020-7292r97r$17.00 Q 1997 International Federation of Gynecology and Obstetrics PII S0020-7292Ž97.00196-3
110
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113
tal in south-west Saudi Arabia is mostly urban but includes a rural population living in small remote clusters of few houses and the inhabitants very rarely mix with other urban or rural counterparts. Due to the high prevalence of measles in pregnancy in this society, it was decided to study the effect of measles on pregnancy and the effect of pregnancy on measles. The aim was to develop a protocol for the management of measles and to formulate a strategy to vaccinate non-immune adults. 2. Subjects and methods Measles is a notifiable disease so all cases of measles irrespective of age or sex are being registered and it is very easy to trace the patients as long as they had reported to a health facility and were diagnosed to have had measles. Pregnant women report promptly whenever they catch any disease, as they fear for their babies. In the study period from the 1 January 1993 to the 31 December 1993, there were 49 women who had measles with pregnancy and the case notes of 45 of them could be traced at their local health facility at the primary care or the hospital. Five patients were excluded as they had other diseases which might have affected the pregnancy. To compare the effect of measles on pregnancy outcome, a control group of 120 normal pregnant women who live in the same area were matched for gestational age, gravidity and being free from diseases which might affect maternal or fetal health. To compare the effect of pregnancy on measles, another control group of 37 non-pregnant women with measles were recruited. They were living in the same area free from any other disease and of the same age and parity as those of the cases. The medical records of all the cases and controls were reviewed with respect to complications of measles like pneumonia, high temperature, hospital admission and length of stay in hospital. The charts of those who were pregnant were reviewed for occurrence of abortion, preterm labor, congenital malformation, neonatal measles and admission and stay in neonatal intensive care unit.
The x 2 , Fisher’s exact test and unpaired student’s t-test were used as tests of significance at 5% level. For this purpose EPIINFO System version 6 was utilized. 3. Results This study encompasses a large number of 50 000 women who delivered during the study period in the catchment area of Abha Maternity Hospital Southern Saudi Arabia, 49 women had measles with pregnancy which makes the incidence of measles during pregnancy to be 98 per 100 000. Table 1 summarizes the complications of measles with pregnancy in comparison to 37 cases who had measles without pregnancy and 120 women who had pregnancy without measles. When measles attacks during pregnancy it results in a higher incidence and maternal morbidity as expressed by fever, pneumonia, hospital admission and length of stay in the hospital. Thirty-two women who had measles during pregnancy were admitted to the hospital, in comparison to only three Ž8.14%. in the group of measles without pregnancy. The difference is statistically significant Ž P- 0.05.. The length of stay in days was 7 " 1.3 and 1 " 0.25 in measles during pregnancy and measles without pregnancy, respectively. The difference is statistically significant Ž P- 0.05.. In the group of measles with pregnancy there were 19 cases of upper respiratory tract infection presenting with nasal congestion, catarrhal inflammation of mucus membranes, conjunctivitis and low-grade fever. Four of this number developed pneumonia of whom two needed oxygen therapy and the third was intubated and ventilated because she became unconscious. There were only eight cases of respiratory tract infection in measles without pregnancy of whom two developed pneumonia Ž5.4%. and no intubation or oxygen therapy was needed. High-grade fever occurred in 13 cases Ž32.5%. and four cases Ž10.8%. in measles with pregnancy and without pregnancy, respectively and the difference is statistically significant Ž P- 0.05.. It seems that when measles occurs during pregnancy the patients and
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113
their doctors become more worried and doctors resort to more hospital admissions. The abortion rate was 15% in the measles group in comparison to 6.7% in the group of normal pregnancy. The difference is statistically significant Ž P- 0.05.. There were 10 Ž25%. and 8 Ž6.5%. cases of pre-term delivery in the groups of pregnancy with measles and pregnancy without measles, respectively. The difference is statistically significant Ž P- 0.05.. Seven of the neonates of mothers who had measles during pregnancy stayed in the neonatal intensive care unit for a period of 7 " 1.4 days in comparison to a period of 2 " 0.2 days for the neonates of normal pregnancy Ž P) 0.05.. Out of the seven neonatal admissions in the measles group four admitted because of prematurity and three had different problems not related to the maternal measles. There were three neonatal deaths, no congenital measles was diagnosed and the there were two still births Ž5%. in the measles group in compar-
ison to two Ž1.6%. in the normal pregnancy group ŽTable 1.. 4. Discussion The study showed the incidence of measles in pregnancy to be 98r100 000 which is very high in comparison to 4]6 cases per 100 000 women reported in the literature w1,4x. All those who had measles in pregnancy were dwellers of remote rural clusters excepts two cases. The social mixing especially among children and women in those areas is very rare so the chance of getting the measles during childhood is negligible and when they get it during adulthood the probability of them being pregnant is very high because of early marriage and high fertility. All of these women were born before the Ministry of Health adopted the extended program of immunization which aims at vaccinating all the children before school age. The resurgence of measles in recent years in
Table 1 Comparison of the three studied groups according to general characteristics, perinatal outcome and maternal complications Item
General characteristics: Age Žyears. Parity Gravidity G.A. Žweeks. Hospital admission Length of stay Ždays. Perinatal outcome: Abortion IUFD Prematurity Congenital malformation Neonatal mortality Neonatal admissions Length of stay NICU Ždays. Maternal complications: Fever Pneumonia Elevated liver enzymes U
Statistically significant.
Measles with pregnancy n s 40
Pregnancy only n s 120
Measles only n s 37
Significance
26 " 1.6 4"1 3"1 24 " 1.2 32 Ž80%. 7 " 1.3
26 " 1.6 4"1 3"1 25 " 1.6
26 " 1.8 4"1
F s 0 NS
6 Ž15%. 2 Ž5%. 10 Ž25%. 1 Ž2.5%. 3 Ž7.5%. 7 Ž17.5%. 7 " 1.4 13 Ž32.5%. 4 Ž10%. 26 Ž65%.
111
3 Ž8.11%. 1 " 0.25
P- 0.05 P- 0.001U P- 0.0001U
8 Ž6.7%. 2 Ž1.7%. 8 Ž6.7%. 3 Ž2.5%. 2 Ž1.7%. 2 Ž1.7%.
Ps 0.2 Ps 0.5 Ps 0.003U Ps 0.6 Ps 0.2 Ps 0.0005U
2 " 0.3
t s 36.87, P - 0.0001U 4 Ž10.8%. 2 Ž5.4%. 12 Ž32.4%.
x2 s 5.26, Ps 0.04U Ps 0.4 x2 s 6.91, Ps 0.008U
112
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113
countries with poor vaccination coverage w9x resembles the above situation. Large numbers of non-immunized women were exposed to measles during pregnancy which led to a high maternal morbidity and perinatal mortality w4,10,11,2x. The studies showed that measles had a deleterious effect on pregnancy as evidenced by the increased number of abortions and pre-term labors. Also pregnancy increases the possibility of complications as there are more cases of fever and pneumonia in comparison to cases of measles without pregnancy w12x. This study reported a higher incidence of medical complications during pregnancy due to measles like pneumonia, prolonged hospital stay and also more obstetric complications ŽTable 1.. The study showed some elevation of liver enzymes but that was self limited, clinically insignificant and improved with the recovery. Similar findings were reported by other investigators w13,14x. The pre-natal outcome was affected by measles and there was an increased risk of abortion, preterm labor, neonatal deaths and prolonged stay of the neonate in the neonatal intensive care unit ŽTable 1.. Other studies reported similar findings of unfavorable fetal outcome w4,7,12,13x. In this study no congenital malformation was diagnosed. This is in agreement with what Jespersen and Siegel had found w10,11x. Some studies reported the occurrence of congenital measles w6,12x but clinically that could not be diagnosed and there were no facilities to do the serology in remote hospitals. Occurrence of measles during pregnancy is very common in this society with all its effects on the fetal outcome and maternal health. This high incidence should be reduced to the minimum. This objective can be achieved by immunizing all the non-immunized, however, non-immunized women and susceptible pregnant women exposed to measles should receive 1 g of g-globulin within 6 days of exposure to prevent or modify subsequent infection w15,16x. As pregnancy complicated by measles runs a stormy course, all cases should be evaluated for abortion, pre-term labor, dehydration and secondary bacterial pneumonitis. The complications of measles should be diagnosed promptly and the isolation of such patients is
important. Prevention of measles outbreaks during pregnancy requires intensive effort to increase pre-marital vaccination in the target population. This can be achieved by innovative vaccine delivery techniques and by appropriate utilization of the available health services. All infants born to mothers with active measles should receive 1 g of g-globulin w2x. Measles active vaccination should not be given to the nonimmunized during pregnancy but they should be given routine post-partum vaccination and there is no contraindication to breast-feeding. Vaccination on an already immune individual is not associated with an increased risk of adverse events w3x. There are some limitations to this study. The incidence of pregnancy with measles could be over-estimated as fear of congenital malformations make pregnant women to report very early. When they report to hospitals they are more prone to being well scrutinized and their complications are highlighted more than those with measles alone or pregnancy alone. Another limitation to this study is the incomplete follow-up of neonates after they had left the hospitals to know the long term sequelae of the maternal disease. 5. Conclusion The occurrence of measles in pregnancy resulted in high maternal and perinatal morbidity and mortality. It is hoped that by early detection of cases and proper institution management, the complications will be reduced. Appropriate immunization strategies designed to increase immunity in adolescents and young adults will decrease the incidence of maternal measles. References w1x Gernshon AA. Chickenpox, measles and mumps. In: Remington JS, Klein, editors. Infectious diseases of the fetus and the newborn infant. Philadelphia: WP Saunders, 1990:395]445. w2x Eberhart-Phillips JE, Frederick PD, Baron RC, Maseola L. Measles in pregnancy: A descriptive study of 58 cases. Obstet Gynecol 1993;82:797]801. w3x Center for Disease Control. Measles } United States, 1990. Morbid Mortal Wkly Rep 1991;40:369-372.
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113 w4x Altmar RL, Englund JA, Hammill H. Complications of measles during pregnancy. Clin Infect Dis 1992;14: 217]226. w5x Christensen PE, Schmidt H, Bang HO et al. An epidemic of measles in Southern Greenland 1951, Measles in virgin soil. II The epidemic proper. Acta Med Scand 1953;44:430]449. w6x Dyer L. Measles complicating pregnancy } Report of twenty-four cases with three instances of congenital measles. South Med J 1940;33:601]604. w7x Packer AD. The influence of maternal measles on the urban child. Med J Aust 1950;1:835]838. w8x Madinger NE, Greenspoon JS, Ellrodt AG. Pneumonia during pregnancy: Has modern technology improved maternal and fetal outcome? Am J Obstet Gynecol 1989;161:657]662. w9x Stein JS, Greenspoon SJ. Rubeola during pregnancy. Obstet Gynecol 1991;5:78. w10x Jespersen CS, Littaver J, Sagild U. Measles as a cause of fetal defects. A retrospective study of ten measles epidemics in Greenland. Acta Paediatr Scand 1977;66: 367]378.
113
w11x Siegel M, Fuerst HT, Peres NS. Comparative fetal mortality in maternal virus disease: A retrospective study on Rubella, measles, mumps, chicken pox and hepatitis. N Engl J Med 1966;274:768]771. w12x Gremillion DH, Crawford GE. Measles pneumonia is young adults. An analysis of 166 cases. Am J Med 1981;71:539]542. w13x Weinstein L, Franklin W. The pneumonia of measles. Am J Med Sci 1949;217:314]324. w14x Berry TJ. Hepatic damage associated with measles. Pa Med J 1960;63:995]999. w15x ACPT Task Force on Adult Immunization of Infectious Disease Society of America. Guide of adult immunization. 2nd ed. Philadelphia: American College of Physicians, 1990:84. w16x Centers for Disease Control Measles Prevention. Recommendation of the Immunization Practices Advisory Committee ŽACIP ., Morbid Mortal Wkly Rep 1989;38:1]15.
Article
Measles in pregnancy: Maternal morbidity and perinatal outcome M. Elamin AliU , H.M. Albar Department of Obstetrics and Gynaecology, Abha Medical School, King Saud Uni®ersity, College of Medicine, Abha, Saudi Arabia Received 23 December 1996; received in revised form 12 August 1997; accepted 18 August 1997
Abstract Objecti®e: In this article, we studied the maternal morbidity and the perinatal outcome of 40 women who had measles in pregnancy and that was compared to 120 women who had pregnancy without measles and 37 women who had measles without pregnancy. Method: The medical records of all the case and control subjects were reviewed and significance was tested at the 5% level. Results: The 40 cases of measles with pregnancy had significantly more hospital admission for pneumonia and fever when compared to cases of measles with no pregnancy Ž P - 0.001.. The perinatal morbidity is significantly higher in cases of measles with pregnancy as expressed by the higher incidence of prematurity, neonatal hospital admission and length of stay in hospital Ž P- 0.003, P- 0.0005 and P- 0.0001, respectively.. Conclusion: Formulation of an appropriate strategy utilizing the available resources for measles vaccination is mandatory. Q 1997 International Federation of Gynecology and Obstetrics Keywords: Measles; Maternal morbidity; Perinatal outcome; Vaccination
1. Introduction Prior to the era of measles Žrubeola. vaccination, infection with measles during pregnancy was unusual w1,2x. Even in the post-vaccine era some
U
Corresponding author.
cases of measles occur in women at reproductive age and during pregnancy w3x. Measles during pregnancy is associated with a high incidence of maternal morbidity or even mortality w4]6x. Also it has a deleterious effect on the perinatal outcome characterized by frequent abortions and pre-term labors w7,8x. The catchment area of Abha Maternity Hospi-
0020-7292r97r$17.00 Q 1997 International Federation of Gynecology and Obstetrics PII S0020-7292Ž97.00196-3
110
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113
tal in south-west Saudi Arabia is mostly urban but includes a rural population living in small remote clusters of few houses and the inhabitants very rarely mix with other urban or rural counterparts. Due to the high prevalence of measles in pregnancy in this society, it was decided to study the effect of measles on pregnancy and the effect of pregnancy on measles. The aim was to develop a protocol for the management of measles and to formulate a strategy to vaccinate non-immune adults. 2. Subjects and methods Measles is a notifiable disease so all cases of measles irrespective of age or sex are being registered and it is very easy to trace the patients as long as they had reported to a health facility and were diagnosed to have had measles. Pregnant women report promptly whenever they catch any disease, as they fear for their babies. In the study period from the 1 January 1993 to the 31 December 1993, there were 49 women who had measles with pregnancy and the case notes of 45 of them could be traced at their local health facility at the primary care or the hospital. Five patients were excluded as they had other diseases which might have affected the pregnancy. To compare the effect of measles on pregnancy outcome, a control group of 120 normal pregnant women who live in the same area were matched for gestational age, gravidity and being free from diseases which might affect maternal or fetal health. To compare the effect of pregnancy on measles, another control group of 37 non-pregnant women with measles were recruited. They were living in the same area free from any other disease and of the same age and parity as those of the cases. The medical records of all the cases and controls were reviewed with respect to complications of measles like pneumonia, high temperature, hospital admission and length of stay in hospital. The charts of those who were pregnant were reviewed for occurrence of abortion, preterm labor, congenital malformation, neonatal measles and admission and stay in neonatal intensive care unit.
The x 2 , Fisher’s exact test and unpaired student’s t-test were used as tests of significance at 5% level. For this purpose EPIINFO System version 6 was utilized. 3. Results This study encompasses a large number of 50 000 women who delivered during the study period in the catchment area of Abha Maternity Hospital Southern Saudi Arabia, 49 women had measles with pregnancy which makes the incidence of measles during pregnancy to be 98 per 100 000. Table 1 summarizes the complications of measles with pregnancy in comparison to 37 cases who had measles without pregnancy and 120 women who had pregnancy without measles. When measles attacks during pregnancy it results in a higher incidence and maternal morbidity as expressed by fever, pneumonia, hospital admission and length of stay in the hospital. Thirty-two women who had measles during pregnancy were admitted to the hospital, in comparison to only three Ž8.14%. in the group of measles without pregnancy. The difference is statistically significant Ž P- 0.05.. The length of stay in days was 7 " 1.3 and 1 " 0.25 in measles during pregnancy and measles without pregnancy, respectively. The difference is statistically significant Ž P- 0.05.. In the group of measles with pregnancy there were 19 cases of upper respiratory tract infection presenting with nasal congestion, catarrhal inflammation of mucus membranes, conjunctivitis and low-grade fever. Four of this number developed pneumonia of whom two needed oxygen therapy and the third was intubated and ventilated because she became unconscious. There were only eight cases of respiratory tract infection in measles without pregnancy of whom two developed pneumonia Ž5.4%. and no intubation or oxygen therapy was needed. High-grade fever occurred in 13 cases Ž32.5%. and four cases Ž10.8%. in measles with pregnancy and without pregnancy, respectively and the difference is statistically significant Ž P- 0.05.. It seems that when measles occurs during pregnancy the patients and
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113
their doctors become more worried and doctors resort to more hospital admissions. The abortion rate was 15% in the measles group in comparison to 6.7% in the group of normal pregnancy. The difference is statistically significant Ž P- 0.05.. There were 10 Ž25%. and 8 Ž6.5%. cases of pre-term delivery in the groups of pregnancy with measles and pregnancy without measles, respectively. The difference is statistically significant Ž P- 0.05.. Seven of the neonates of mothers who had measles during pregnancy stayed in the neonatal intensive care unit for a period of 7 " 1.4 days in comparison to a period of 2 " 0.2 days for the neonates of normal pregnancy Ž P) 0.05.. Out of the seven neonatal admissions in the measles group four admitted because of prematurity and three had different problems not related to the maternal measles. There were three neonatal deaths, no congenital measles was diagnosed and the there were two still births Ž5%. in the measles group in compar-
ison to two Ž1.6%. in the normal pregnancy group ŽTable 1.. 4. Discussion The study showed the incidence of measles in pregnancy to be 98r100 000 which is very high in comparison to 4]6 cases per 100 000 women reported in the literature w1,4x. All those who had measles in pregnancy were dwellers of remote rural clusters excepts two cases. The social mixing especially among children and women in those areas is very rare so the chance of getting the measles during childhood is negligible and when they get it during adulthood the probability of them being pregnant is very high because of early marriage and high fertility. All of these women were born before the Ministry of Health adopted the extended program of immunization which aims at vaccinating all the children before school age. The resurgence of measles in recent years in
Table 1 Comparison of the three studied groups according to general characteristics, perinatal outcome and maternal complications Item
General characteristics: Age Žyears. Parity Gravidity G.A. Žweeks. Hospital admission Length of stay Ždays. Perinatal outcome: Abortion IUFD Prematurity Congenital malformation Neonatal mortality Neonatal admissions Length of stay NICU Ždays. Maternal complications: Fever Pneumonia Elevated liver enzymes U
Statistically significant.
Measles with pregnancy n s 40
Pregnancy only n s 120
Measles only n s 37
Significance
26 " 1.6 4"1 3"1 24 " 1.2 32 Ž80%. 7 " 1.3
26 " 1.6 4"1 3"1 25 " 1.6
26 " 1.8 4"1
F s 0 NS
6 Ž15%. 2 Ž5%. 10 Ž25%. 1 Ž2.5%. 3 Ž7.5%. 7 Ž17.5%. 7 " 1.4 13 Ž32.5%. 4 Ž10%. 26 Ž65%.
111
3 Ž8.11%. 1 " 0.25
P- 0.05 P- 0.001U P- 0.0001U
8 Ž6.7%. 2 Ž1.7%. 8 Ž6.7%. 3 Ž2.5%. 2 Ž1.7%. 2 Ž1.7%.
Ps 0.2 Ps 0.5 Ps 0.003U Ps 0.6 Ps 0.2 Ps 0.0005U
2 " 0.3
t s 36.87, P - 0.0001U 4 Ž10.8%. 2 Ž5.4%. 12 Ž32.4%.
x2 s 5.26, Ps 0.04U Ps 0.4 x2 s 6.91, Ps 0.008U
112
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113
countries with poor vaccination coverage w9x resembles the above situation. Large numbers of non-immunized women were exposed to measles during pregnancy which led to a high maternal morbidity and perinatal mortality w4,10,11,2x. The studies showed that measles had a deleterious effect on pregnancy as evidenced by the increased number of abortions and pre-term labors. Also pregnancy increases the possibility of complications as there are more cases of fever and pneumonia in comparison to cases of measles without pregnancy w12x. This study reported a higher incidence of medical complications during pregnancy due to measles like pneumonia, prolonged hospital stay and also more obstetric complications ŽTable 1.. The study showed some elevation of liver enzymes but that was self limited, clinically insignificant and improved with the recovery. Similar findings were reported by other investigators w13,14x. The pre-natal outcome was affected by measles and there was an increased risk of abortion, preterm labor, neonatal deaths and prolonged stay of the neonate in the neonatal intensive care unit ŽTable 1.. Other studies reported similar findings of unfavorable fetal outcome w4,7,12,13x. In this study no congenital malformation was diagnosed. This is in agreement with what Jespersen and Siegel had found w10,11x. Some studies reported the occurrence of congenital measles w6,12x but clinically that could not be diagnosed and there were no facilities to do the serology in remote hospitals. Occurrence of measles during pregnancy is very common in this society with all its effects on the fetal outcome and maternal health. This high incidence should be reduced to the minimum. This objective can be achieved by immunizing all the non-immunized, however, non-immunized women and susceptible pregnant women exposed to measles should receive 1 g of g-globulin within 6 days of exposure to prevent or modify subsequent infection w15,16x. As pregnancy complicated by measles runs a stormy course, all cases should be evaluated for abortion, pre-term labor, dehydration and secondary bacterial pneumonitis. The complications of measles should be diagnosed promptly and the isolation of such patients is
important. Prevention of measles outbreaks during pregnancy requires intensive effort to increase pre-marital vaccination in the target population. This can be achieved by innovative vaccine delivery techniques and by appropriate utilization of the available health services. All infants born to mothers with active measles should receive 1 g of g-globulin w2x. Measles active vaccination should not be given to the nonimmunized during pregnancy but they should be given routine post-partum vaccination and there is no contraindication to breast-feeding. Vaccination on an already immune individual is not associated with an increased risk of adverse events w3x. There are some limitations to this study. The incidence of pregnancy with measles could be over-estimated as fear of congenital malformations make pregnant women to report very early. When they report to hospitals they are more prone to being well scrutinized and their complications are highlighted more than those with measles alone or pregnancy alone. Another limitation to this study is the incomplete follow-up of neonates after they had left the hospitals to know the long term sequelae of the maternal disease. 5. Conclusion The occurrence of measles in pregnancy resulted in high maternal and perinatal morbidity and mortality. It is hoped that by early detection of cases and proper institution management, the complications will be reduced. Appropriate immunization strategies designed to increase immunity in adolescents and young adults will decrease the incidence of maternal measles. References w1x Gernshon AA. Chickenpox, measles and mumps. In: Remington JS, Klein, editors. Infectious diseases of the fetus and the newborn infant. Philadelphia: WP Saunders, 1990:395]445. w2x Eberhart-Phillips JE, Frederick PD, Baron RC, Maseola L. Measles in pregnancy: A descriptive study of 58 cases. Obstet Gynecol 1993;82:797]801. w3x Center for Disease Control. Measles } United States, 1990. Morbid Mortal Wkly Rep 1991;40:369-372.
M. Elamin Ali, H.M. Albar r International Journal of Gynecology & Obstetrics 59 (1997) 109]113 w4x Altmar RL, Englund JA, Hammill H. Complications of measles during pregnancy. Clin Infect Dis 1992;14: 217]226. w5x Christensen PE, Schmidt H, Bang HO et al. An epidemic of measles in Southern Greenland 1951, Measles in virgin soil. II The epidemic proper. Acta Med Scand 1953;44:430]449. w6x Dyer L. Measles complicating pregnancy } Report of twenty-four cases with three instances of congenital measles. South Med J 1940;33:601]604. w7x Packer AD. The influence of maternal measles on the urban child. Med J Aust 1950;1:835]838. w8x Madinger NE, Greenspoon JS, Ellrodt AG. Pneumonia during pregnancy: Has modern technology improved maternal and fetal outcome? Am J Obstet Gynecol 1989;161:657]662. w9x Stein JS, Greenspoon SJ. Rubeola during pregnancy. Obstet Gynecol 1991;5:78. w10x Jespersen CS, Littaver J, Sagild U. Measles as a cause of fetal defects. A retrospective study of ten measles epidemics in Greenland. Acta Paediatr Scand 1977;66: 367]378.
113
w11x Siegel M, Fuerst HT, Peres NS. Comparative fetal mortality in maternal virus disease: A retrospective study on Rubella, measles, mumps, chicken pox and hepatitis. N Engl J Med 1966;274:768]771. w12x Gremillion DH, Crawford GE. Measles pneumonia is young adults. An analysis of 166 cases. Am J Med 1981;71:539]542. w13x Weinstein L, Franklin W. The pneumonia of measles. Am J Med Sci 1949;217:314]324. w14x Berry TJ. Hepatic damage associated with measles. Pa Med J 1960;63:995]999. w15x ACPT Task Force on Adult Immunization of Infectious Disease Society of America. Guide of adult immunization. 2nd ed. Philadelphia: American College of Physicians, 1990:84. w16x Centers for Disease Control Measles Prevention. Recommendation of the Immunization Practices Advisory Committee ŽACIP ., Morbid Mortal Wkly Rep 1989;38:1]15.