Cases Of Maternal Infection Research Articles

Protections and Social Support of Exclusive Breastfeeding for Mothers with COVID-19: Message for Health Promotion during The Pandemic

Introduction: The COVID-19 pandemic is a concern regarding the potential failure of exclusive breastfeeding in mothers with COVID-19. This study reviews previous research describing the protective and social support practices of exclusive breastfeeding in mothers with COVID-19.Methods: A systematic search was conducted in March-June 2021 using databases such as Scopus and PubMed with a deadline of 2020-2021 that met the inclusion criteria. 462 articles which were then entered in the elimination stage until the final 16 articles were eligible for a full text review. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).Results: We identified 16 studies reporting 1,865 cases of maternal infection with COVID-19. An overview of breastfeeding protection practices is carried out through rooming-in and post-delivery skin contact. This practice includes implementing strict precautions such as wearing a mask, social distancing, and maintaining hand and breast hygiene. All babies born to mothers who practice breastfeeding protection are not infected with COVID-19. Social support from health workers, families and health care management cannot be overlooked in ensuring breastfeeding continues and precautions are followed. Conclusion: In mothers with COVID-19 breastfeeding is still recommended but must be supported by strict health protocols. Social support cannot be neglected to protect exclusive breastfeeding practices and ensure that COVID-19 precautions are adhered to.

How mandatory is the mandatory reporting of children at risk?

Although mandatory reporting of suspected child abuse was first introduced over 50 years ago, there are no quantitative studies addressing whether or not it achieves better outcomes for children. We report two cases of maternal infection, one with tuberculosis (TB) and one with human immunodeficiency virus (HIV), where the mothers' failure to attend follow-up appointments raised the possibility of significant harm if their infants were infected. Some health professionals argued strongly that mandatory reporting meant the mothers should be reported to child protection authorities. Others argued that the risk was not critically imminent and an immediate report could seriously compromise maternal confidentiality, risked maternal disengagement and a worse outcome. An alternative was to make more vigorous efforts to contact the mothers and report only if these failed. In the TB case, reporting to child protection was deferred in favour of making more strenuous efforts at communication, which proved successful. In the HIV case, a case worker reported the case to child protection, but when the doctor contacted child protection authorities they agreed not to contact the mother unless the doctor's vigorous attempts to communicate with her failed. We do not advocate for breaking the law regarding mandatory reporting, but we do argue for a considered approach to the timing of reporting and for a collaborative approach with child protection services.

The use of fetal neurosonography and brain MRI in cases of cytomegalovirus infection during pregnancy: A retrospective analysis with outcome correlation.

To analyze ultrasound (US) and magnetic resonance imaging (MRI) results and developmental outcome in cases of maternal primary cytomegalovirus (CMV) infection during pregnancy. We retrospectively reviewed the results of fetal neurosonography and brain MRI of CMV-infected fetuses (Group 1). Cases of maternal infection in which the fetal status was unknown, and subsequently had a negative CMV postnatal urine analysis, were independently analyzed (Group 2). Imaging results were classified as follows: positive, negative, or inconclusive. Developmental landmarks were followed up. Eighty-one women were included in the study: 48 (59.2%) in Group 1 and 33 (40.8%) in Group 2. In Group 1, termination of pregnancy was performed in 8 cases (16.7%) following the diagnosis of brain abnormalities. Among the remaining cases, concordance rate between US and MRI was 78%. False negative rates for US and MRI were 5.5% and 6.4%, respectively (hearing deficits). For MRI, we found 17.5% of false positive/inconclusive results, while for the US, we found 5% of inconclusive results. In Group 2, false positive rates for US and MRI were 6.5% and 12.9%, respectively. Adding MRI in CMV-infected cases with a normal neurosonographic follow-up should be weighed against a nonnegligible rate of false positive and inconclusive findings.

Mild fetal cerebral ventriculomegaly: prevalence, characteristics, and utility of ancillary testing in cases presenting to a tertiary referral center.

Ventriculomegaly is the most common fetal brain anomaly identified during prenatal anatomy ultrasound. The aim of our study was to characterize cases of mild ventriculomegaly and investigate the utility of ancillary tests. We reviewed 121 cases of mild ventriculomegaly, defined as lateral ventricle diameter of 10 to 15mm. Characteristics of the ventricular dilation as well as each pregnancy were investigated. Ancillary tests performed included follow-up magnetic resonance imaging (MRI), chromosomal abnormality testing, and maternal serologic infection screening. The utility of each test was analyzed. We identified 56 cases of isolated and 65 cases of complex ventriculomegaly. Seventy-two (59.5%) were unilateral, and 49 (40.5%) were bilateral, with a mean gestational age at diagnosis of 24.5weeks. MRI provided additional information in 3/24 (12.5%) cases of isolated ventriculomegaly compared with 18/23 (78.2%) cases of complex ventriculomegaly. Chromosomal abnormality testing identified 4/9 (44.4%) genetic abnormalities compared with 8/30 (26.7%) in cases of isolated and complex mild ventriculomegaly, respectively. Finally, maternal serology infection screening was negative in all cases. Ancillary testing is useful in isolated mild ventriculomegaly. Follow-up MRI and chromosome abnormality testing specifically provided clinically useful information. Although there were no cases of maternal infection, screening may be an important component in management. © 2017 John Wiley & Sons, Ltd.

A comparative study between the pioneer cohort of waterbirths and conventional vaginal deliveries in an obstetrician-led unit in Singapore

ObjectiveWaterbirth has been increasing in popularity in Asia (Lea W. Water babies. The Straits Times 17 February 2011. Available at http://www.nuh.com.sg/news/media-articles_1504.html). National University Hospital, Singapore, is the pioneer hospital offering waterbirths to women since 2006 in a unique setting of a consultant-led service and continuous foetal monitoring. To date, no studies have been done on the conduct of waterbirths in an Asia. This study aims to evaluate if water immersion during delivery is associated with increased rates of adverse maternal and foetal outcomes as compared with conventional vaginal deliveries. Materials and MethodsClinical records of women who birthed underwater at National University Hospital between 2010 and 2013 were retrospectively reviewed. Outcomes of interest were estimated blood loss, third- or fourth degree tears, incidence of postpartum infections or haemorrhage, neonatal Apgars at 1 and 5 min, and neonatal complications requiring intensive care unit admission. Outcomes were compared against a matched control group of women who had conventional vaginal deliveries within ≤1 month. ResultsRecords of 118 women who birthed underwater were accrued. There was no significant difference in estimated blood loss and postpartum haemorrhage between groups, and there were no cases of maternal infection, third- or fourth-degree perineal tears, or adverse neonatal outcomes in either group. Women in the control group were more likely to have episiotomies (63.6% vs. 0.85%; p < 0.01). Three cases of retained placenta were reported in the waterbirth group (0.03%). ConclusionWaterbirth at our centre does not appear to be associated with an increased incidence of adverse neonatal and maternal outcomes. The results of this study supported waterbirth as a birthing option to groups of low-risk women in an obstetrician-led setting with good midwifery support.

Comparaison historique de deux types de prises en charge de placenta accreta: radicale versus conservatrice

To compare the impact of conservative and radical strategies for placenta accreta on maternal morbidity and mortality. We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through October 2005. Two consecutive periods, A and B, were compared: during period A (january 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to October 2005), we changed our policy and attempted to treat patients with a placenta accreta conservatively. The following outcomes over the two periods were compared: need for blood product transfusion, hysterectomy, intensive care admission, duration of stay in intensive care unit, sepsis and disseminated intravascular coagulation. Fifty-one cases of placenta accreta were observed among 40281 deliveries (1.3/1000). Period B saw a reduction in the hysterectomy rate (11/13 versus 10/38; P < 0.01), the mean red blood cells transfused (3230+/-2170 versus 1081+/-1370 ml; P < 0.01) and disseminated intravascular coagulation (5/13 versus 1/38; P < 0.01) compared with period A. Seven cases of maternal infection were recorded during period B and none during period A (p = 0.22). Conservative management of placenta accreta appears to be a safe alternative to radical management.

Perinatal exposure to measles virus is not associated with the development of inflammatory bowel disease.

It has been suggested that early exposure to measles virus, including perinatal exposure via maternal infection, may lead to persistent measles virus infection and the subsequent development of inflammatory bowel disease (IBD). We sought to examine this association in our patient population. Maternal measles infection was identified through the Mayo Clinic diagnostic index, and cases were verified by chart review. Cases were included if infection occurred between the second trimester and 6 months postpartum. The offspring, or a first degree family member, were then interviewed regarding a history of IBD or symptoms which might suggest IBD. Seven cases of maternal infection were identified out of 67,912 pregnancies between 1935 and 1985. One offspring was lost to follow-up through adoption, and the remaining six have no evidence of Crohn's disease or ulcerative colitis after a mean of 38 years of follow-up (range 12-62 years). Evidence for an association between perinatal exposure to measles virus via maternal infection and the subsequent development of IBD was not found in our patient population.

Active-Phase Labor Arrest

To determine whether leaving the membranes intact in active-phase arrest would affect the cesarean delivery rate or the incidence of maternal morbidity secondary to infection. We conducted a randomized trial of healthy, spontaneously laboring women at term with an intact chorioamnion and active-phase arrest (defined as 1 cm or less of cervical change over 2 hours in the active phase of labor). Patients were assigned to either oxytocin augmentation with intact chorioamnion or oxytocin augmentation with amniotomy and internal monitoring of the fetal heart rate and uterine contractions. The intact group (n = 58) and the amniotomy group (n = 60) were similar with respect to maternal age, race, parity, labor epidural usage, gestational age, cervical dilatation at randomization, number of vaginal examinations, and infant birth weight. Four patients in the intact group and five in the amniotomy group underwent cesarean delivery (P = 1.0). No patient in the intact group and three in the amniotomy group were diagnosed with chorioamnionitis (P = .24). Endometritis did not occur in the intact group, whereas four cases occurred in the amniotomy group (P = .12). There were no cases of maternal infection in the intact group, versus seven in the amniotomy group (P = .01). The interval between randomization and vaginal delivery was 44 minutes longer in the intact group than in the amniotomy group (P = .11). In women with active-phase arrest of labor and intact membranes, oxytocin augmentation with elective amniotomy and internal monitoring increases maternal infectious morbidity.

Maternal mumps infection during gestation: Observations on the progeny

Three cases of maternal infection with mumps virus were serologically documented during gestation. The resultant three progeny failed to exhibit elevated levels in immunoglobulin cord sera. No hemagglutinating antibodies were demonstrable in the sera obtained 9 to 14 months after delivery. In one infant, a skin test for delayed hypersensitivity to mumps virus was positive. All three infants produced specific antibody after the intramuscular injection of 1 c.c. of formalin-killed mumps virus.

THE CORRELATION OF MATERNAL CYTOMEGALOVIRUS INFECTION DURING VARYING STAGES IN GESTATION WITH NEONATAL INVOLVEMENT

An obstetric population was prospectively followed for evidence of primary maternal cytomegalovirus infection during gestation. The cord serum of infants whose mothers had serologic evidence of infection was analyzed for the level of IgM and for the presence of specific anticytomegalovirus IgM antibodies. The progeny were cultured for cytomegalovirus. In the four cases of maternal infection identified, the cord sera were found to be positive by immunofluorescence for anticytomegalovirus IgM immunoglobulins and correlated with recovery of virus in the immediate neonatal period or beyond. There was a direct correlation between severity of neonatal infection and presumed duration of disease in utero. These observations suggest that cytomegalovirus is capable of infecting the products of conception irrespective of gestational age, and that the clinical manifestations of congenital cytomegalovirus infection appear to be primarily a reflection of the duration of infection in utero.