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Resurgence of congenital rubella syndrome in the 1990s: Report on missed opportunities and failed prevention policies among women of childbearing age
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Citations from the Literature
defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated. Results: Fifty-seven of 69 fetuses (83%) were prenatally identified uhrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients. Conclusion: The four-chamber and outflow tract views done routinely in an uhrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk. ComIwehensIve fetal assessment with three ultrasonograpthic clmraWcs .James DK, Parker MJ; Smoleniec JS Division of Fetal Medicine, Univ. of Bristol Dept. of Obstetrics, Bristol Maternity Hospital, Bristol, GBR
AM J OBSTET GYNECOL 1992 166/S (1486-1495) Objectives: When three ultrasonographic characteristics udiicd artery Doppler recording, growth (abdominal circumference) and biophysical profile score - are used in combination in assessment of fetuses at risk of chronic asphyxia; (I) What are the order and time scale for the development of abnormality with each characteristic? (2) What is the short-term outcome associated with abnonnalities of the three characteristics? (3) Should we amend our fetal assessment protocol? Study design: An audit of 103 fetuses (100 mothers) referred to a tertiary center for fetal assessment because of suspected chronic fetal asphyxia was performed with three ultrasonographic characteristics, umbilical artery Doppler recording, measurement of abdominal circumference and documenting the biophysical profile score. Results: The order of deterioration (which had a very variable time scale) was umbilical artery Doppler recording, followed by abdominal circumference and finally biophysical profile score. Normal characteristics or an abnormal umbilical artery Doppler recording alone or an abnormal abdominal circumference alone was associated with an excellent prognosis. The worst outcome was found in 28 fetuses with abnormality of all three ultrasonographic features before delivery. Conclusions: The main suggested implications for management are avoidance of preterm delivery with nor&l ultrasonographic characteristics, an abnormal umbilical artery Doppler recording alone, or an abnormal abdominal circumference alone; delivery of fetuses at 34 weeks with abnormal umbilical artery Doppler recording and abdominal circumference before the biophysical profile score becomes abnormal; and implementation of specific measures to prevent necrotizing enterocolitis in newborns when all three characteristics are abnormal. Int J Gynecol Obstet 40
Resurgence of congenital rubella syndrome in the 1990s: Report on missed opportunities and failed prevention polich allWIg women of childbearing age Lee SH; Ewert DP; Frederick PD; Mascola L Acute Communicable Disease Control, 313 N Figueroa St, Los Angeles, CA 90012, USA
J AM MED ASSOC 1992 267/19 (2616-2620) Objective. - To assess previous missed opportunities for rubella screening and vaccination of women delivering infants with congenital rubella syndrome and to discuss prevention strategies. Design. - Descriptive analysis of data collected through interviews and review of medical records. Population Studied. -Twenty-one women who delivered infants with congenital rubella syndrome in four Southern California counties from January 1, 1990, through January 8, 1991. Results. Twelve (57%) of the women had a total of 22 known missed op portunities for rubella screening or vaccination. Of the 22 missed opportunities, three (14%) were missed screenings at the time of marriage, two (9%) were missed screenings during previous pregnancies, five (23%) were missed screenings during induced abortions and 12 (55%) were missed opportunities for vaccing tion postpartum or after induced abortions. Nine (43%) of the women had no known missed opportunities for rubella screening or vaccination. Of 12 women educated in California, only four (33%) were subject to the 1982 California school rubella immunization requirement. Conclusions. - Congenital rubella syndrome could have been prevented in more than half of the infants born to these women if missed opportunities for rubella testing and/or vaccination had not occurred. Because premarital rubella testing and school immunization requirements do not ensure that all women of childbearing age are immune to rubella, physicians and hospitals should establish procedures for postpartum rubella vaccination of susceptible women. Family planning and abortion clinics should implement routine rubella testing and follow-up vaccination of susceptible women. .
HIV AND OTHER INFECTIOUS DISEASES Progoostlc factors aml survival in children with perinatal HIV-1 i&CtiOO
Tovo PA, De Martin0 M; Gabiano C, Cappello N; D’Elia R; Loy A; Plebani A, Zuccotti GV; Dallacasa P; Ferraris G, Caselli D, Fundaro’ C; D’Argenio P; Galli L; Principi N, Stegagno M; Ruga E; Palomba E Department of Paediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, ITA
LANCET 1992 33918804(1249-1253) The signs that may arise after perinatal infection with human immunodeticiency virus type 1 (HIV-l) have been classified by the Centers for Disease Control, but the clinical usefulness of the classification system and the prognostic importance of each disease pattern have not been established. We sought to address these issues by analysing data from the Italian Register for HIV infection in children. We studied 1887 children born to HIV-lseropositive mothers. One thousand and forty-five were iden-
Citations from the Literature
defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated. Results: Fifty-seven of 69 fetuses (83%) were prenatally identified uhrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients. Conclusion: The four-chamber and outflow tract views done routinely in an uhrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk. ComIwehensIve fetal assessment with three ultrasonograpthic clmraWcs .James DK, Parker MJ; Smoleniec JS Division of Fetal Medicine, Univ. of Bristol Dept. of Obstetrics, Bristol Maternity Hospital, Bristol, GBR
AM J OBSTET GYNECOL 1992 166/S (1486-1495) Objectives: When three ultrasonographic characteristics udiicd artery Doppler recording, growth (abdominal circumference) and biophysical profile score - are used in combination in assessment of fetuses at risk of chronic asphyxia; (I) What are the order and time scale for the development of abnormality with each characteristic? (2) What is the short-term outcome associated with abnonnalities of the three characteristics? (3) Should we amend our fetal assessment protocol? Study design: An audit of 103 fetuses (100 mothers) referred to a tertiary center for fetal assessment because of suspected chronic fetal asphyxia was performed with three ultrasonographic characteristics, umbilical artery Doppler recording, measurement of abdominal circumference and documenting the biophysical profile score. Results: The order of deterioration (which had a very variable time scale) was umbilical artery Doppler recording, followed by abdominal circumference and finally biophysical profile score. Normal characteristics or an abnormal umbilical artery Doppler recording alone or an abnormal abdominal circumference alone was associated with an excellent prognosis. The worst outcome was found in 28 fetuses with abnormality of all three ultrasonographic features before delivery. Conclusions: The main suggested implications for management are avoidance of preterm delivery with nor&l ultrasonographic characteristics, an abnormal umbilical artery Doppler recording alone, or an abnormal abdominal circumference alone; delivery of fetuses at 34 weeks with abnormal umbilical artery Doppler recording and abdominal circumference before the biophysical profile score becomes abnormal; and implementation of specific measures to prevent necrotizing enterocolitis in newborns when all three characteristics are abnormal. Int J Gynecol Obstet 40
Resurgence of congenital rubella syndrome in the 1990s: Report on missed opportunities and failed prevention polich allWIg women of childbearing age Lee SH; Ewert DP; Frederick PD; Mascola L Acute Communicable Disease Control, 313 N Figueroa St, Los Angeles, CA 90012, USA
J AM MED ASSOC 1992 267/19 (2616-2620) Objective. - To assess previous missed opportunities for rubella screening and vaccination of women delivering infants with congenital rubella syndrome and to discuss prevention strategies. Design. - Descriptive analysis of data collected through interviews and review of medical records. Population Studied. -Twenty-one women who delivered infants with congenital rubella syndrome in four Southern California counties from January 1, 1990, through January 8, 1991. Results. Twelve (57%) of the women had a total of 22 known missed op portunities for rubella screening or vaccination. Of the 22 missed opportunities, three (14%) were missed screenings at the time of marriage, two (9%) were missed screenings during previous pregnancies, five (23%) were missed screenings during induced abortions and 12 (55%) were missed opportunities for vaccing tion postpartum or after induced abortions. Nine (43%) of the women had no known missed opportunities for rubella screening or vaccination. Of 12 women educated in California, only four (33%) were subject to the 1982 California school rubella immunization requirement. Conclusions. - Congenital rubella syndrome could have been prevented in more than half of the infants born to these women if missed opportunities for rubella testing and/or vaccination had not occurred. Because premarital rubella testing and school immunization requirements do not ensure that all women of childbearing age are immune to rubella, physicians and hospitals should establish procedures for postpartum rubella vaccination of susceptible women. Family planning and abortion clinics should implement routine rubella testing and follow-up vaccination of susceptible women. .
HIV AND OTHER INFECTIOUS DISEASES Progoostlc factors aml survival in children with perinatal HIV-1 i&CtiOO
Tovo PA, De Martin0 M; Gabiano C, Cappello N; D’Elia R; Loy A; Plebani A, Zuccotti GV; Dallacasa P; Ferraris G, Caselli D, Fundaro’ C; D’Argenio P; Galli L; Principi N, Stegagno M; Ruga E; Palomba E Department of Paediatrics, University of Turin, Piazza Polonia 94, 10126 Turin, ITA
LANCET 1992 33918804(1249-1253) The signs that may arise after perinatal infection with human immunodeticiency virus type 1 (HIV-l) have been classified by the Centers for Disease Control, but the clinical usefulness of the classification system and the prognostic importance of each disease pattern have not been established. We sought to address these issues by analysing data from the Italian Register for HIV infection in children. We studied 1887 children born to HIV-lseropositive mothers. One thousand and forty-five were iden-