Fetal Infection Research Articles

Frequency of Fetal and Maternal Complications after C-Section in Vaginal Deliver

Objective: The purpose of this study was to evaluate the foetal and mother outcomes of attempting a vaginal delivery following a prior caesarean section. Study Design: Cross-sectional study Place and Duration: Gynaecology and Obstetrics Department Ghulam Mohammad Maher Medical College Sukker. January 2022-December 2022 Methods: Total 50 pregnant females had gestational age 37-42 weeks and had history of one c-section were included. During labor, the mother and baby were closely monitored for indicators of fetal distress, including changes in heart rate, discomfort, and tenderness in the lower abdomen. Written informed consent was obtained using a consent form, and data was collected using pre-designed Performa. Complications among all females were recorded. SPSS 23.0 was used to analyze all data. Results: There were 30 (60%) females had age 18-30 years, 16 (32%) patients had age 31-40 years and 4 (8%) had age 41-45 years. Mean gestational age of the females was 39.17±14.63 weeks. Majority 35 (70%) females had poor socioeconomic status. 21 (42%) cases were educated. Out of the 50 pregnant females, 16 (32%) had vaginal deliveries and 34 (68%) had emergency cesarean section. Frequency of fetal distress was higher in cases of c-section as compared to vaginal deliveries with p value <0.005. As per maternal complications, wound infection and post op fever was higher in c-section while perineal tear and UTI was higher in vaginal deliveries. Post-partum hemorrhage was found in 7 cases, cases in c-section and 3 cases in vaginal deliveries. Frequency of feto-maternal favorable outcomes in vaginal deliveries were higher but difference was insignificant. Conclusion: This research shows that CS is associated with a higher risk of fetal distress, wound infection, and mother fever than vaginal delivery. Future morbidity from CS can be reduced if pregnant patients are urged to have vaginal births. Keywords: C-sectional, vaginal delivery, Complications, Favorable outcomes

Genotype 4 Hepatitis E virus replicates in the placenta, causes severe histopathological damage, and vertically transmits to fetuses

Hepatitis E virus (HEV) infection in pregnant women causes adverse pregnancy outcomes, including maternal death, premature delivery, stillbirth, and fetal infection. However, the pathogenesis of maternal and fetal HEV infection is unclear. Placenta and placental appendixes were collected from HEV-4 infected pregnant women to explore the vertical transmission of HEV from mothers to fetuses. HEV-4 replicated in the placenta, placental membrane, and umbilical cord and was vertically transmitted from mothers to fetuses. HEV-4 placental infection resulted in serious histopathological damage, such as fibrosis and calcification, and severe inflammatory responses. Adverse maternal outcomes were observed in 38.5% of HEV-4 infected pregnant women. The distinct cytokine/chemokine expression patterns of HEV-infected pregnant women and nonpregnant women may contribute to the adverse pregnancy outcomes. Furthermore, the impaired maternal and fetal innate immune responses against HEV-4 facilitated viral replication during pregnancy. HEV-4 replicates in the placenta and is vertically transmitted from mothers to fetuses, causing severe histopathological damage.

Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study

BackgroundMaternal CMV infection during pregnancy, either primary or non-primary, may be associated with fetal infection and long-term sequelae. While guidelines recommend against it, screening for CMV in pregnant women is a prevalent clinical practice in Israel. Our aim is to provide updated, local, clinically relevant, epidemiological information about CMV seroprevalence among women at childbearing age, the incidence of maternal CMV infection during pregnancy and the prevalence of congenital CMV (cCMV), as well as to provide information about the yield of CMV serology testing.MethodsWe performed a descriptive, retrospective study of women at childbearing age who were members of Clalit Health Services in the district of Jerusalem and had at least one gestation during the study period (2013–2019). We utilized serial serology tests to determine CMV serostatus at baseline and at pre/periconception and identified temporal changes in CMV serostatus. We then conducted a sub-sample analysis integrating inpatient data on newborns of women who gave birth in a single large medical center. cCMV was defined as either positive urine CMV-PCR test in a sample collected during the first 3 weeks of life, neonatal diagnosis of cCMV in the medical records, or prescription of valganciclovir during the neonatal period.ResultsThe study population Included 45,634 women with 84,110 associated gestational events. Initial CMV serostatus was positive in 89% women, with variation across different ethno-socioeconomic subgroups. Based on consecutive serology tests, the detected incidence rate of CMV infection was 2/1000 women follow-up years, among initially seropositive women, and 80/1000 women follow-up years, among initially seronegative women. CMV infection in pregnancy was identified among 0.2% of women who were seropositive at pre/periconception and among 10% of women who were seronegative. In a subsample, which included 31,191 associated gestational events, we identified 54 newborns with cCMV (1.9/1000 live births). The prevalence of cCMV among newborns of women who were seropositive at pre/periconception was lower than among newborns of women who were seronegative (2.1 vs. 7.1/1000). Frequent serology tests among women who were seronegative at pre/periconception detected most primary CMV infections in pregnancy that resulted in cCMV (21/24). However, among women who were seropositive, serology tests prior to birth detected none of the non-primary infections that resulted in cCMV (0/30).ConclusionsIn this retrospective community-based study among women of childbearing age characterized by multiparity and high seroprevalence of CMV, we find that consecutive CMV serology testing enabled to detect most primary CMV infections in pregnancy that led to cCMV in newborns but failed to detect non-primary CMV infections in pregnancy. Conducting CMV serology tests among seropositive women, despite guidelines' recommendations, has no clinical value, while it is costly and introduces further uncertainties and distress. We thus recommend against routine CMV serology testing among women who were seropositive in a prior serology test. We recommend CMV serology testing prior to pregnancy only among women known to be seronegative or women whose serology status is unknown.

Comparison of Intravenous Oxytocin with Vaginal Prostaglandin E2 for Labor Induction in Pre-Labor Rupture of Membranes at Term

Background: Pre-labour rupture of membrane (PROM) at term is one of the most common demonstration for labour induction. PROM is the fissure of membrane before the arrival of orderly uterine shrinkage at term gestation. About 8% of the pregnant women have influence of this condition. PROM also occur when the amniotic sac ehich surround the fetus fissure before the onset of labour leading to the risk of maternal and fetal infection. Study design: It is a randomized and controlled study conducted at Obs and Gynae Department, Civil Hospital, LUMHS, Jamshoro and Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir for the duration of six months from February 2022 to July 2022. Material and Methods: The study comprised of two groups. Each group had 30 patients. The patients that were not fulfilling the inclusion criteria were excluded from the study. The average age of patients in group 1 that is oxytocin induced was 25.4±5.4 years. Patients with prostaglandin E2 induction were included in group2 with average age as 24.7±4.5 years. Group1 had 35.9±4.2 while the average value for group 2 was 36.7±5.3. Results: The induction active labor interval was 5.9±2.1 for Oxytocin induction group while for Prostaglandin E2 induction group the value was 6.3±2.2. Whereas the induction delivery was 14.3±1.9 for Oxytocin induction group and 15.1±2.1 for Prostaglandin E2 induction group. Conclusion: It is concluded that oxytocin is a better drug for labor pain induction as compared to the prostaglandin in case of Pre-labour rupture of membrane at term. To route oxytocin via an intravenous pathway leads to a shorter delivery time and reduced rate of different infections in the mother. Keywords: PROM at term, Intravenous oxytocin and vaginal prostaglandin.

A Virus Genetic System to Analyze the Fusogenicity of Human Cytomegalovirus Glycoprotein B Variants.

Viruses can induce the fusion of infected and neighboring cells, leading to the formation of syncytia. Cell-cell fusion is mediated by viral fusion proteins on the plasma membrane of infected cells that interact with cellular receptors on neighboring cells. Viruses use this mechanism to spread rapidly to adjacent cells or escape host immunity. For some viruses, syncytium formation is a hallmark of infection and a known pathogenicity factor. For others, the role of syncytium formation in viral dissemination and pathogenicity remains poorly understood. Human cytomegalovirus (HCMV) is an important cause of morbidity and mortality in transplant patients and the leading cause of congenital infections. Clinical HCMV isolates have broad cell tropism but differ in their ability to induce cell-cell fusions, and little is known about the molecular determinants. We developed a system to analyze HCMV glycoprotein B (gB) variants in a defined genetic background. HCMV strains TB40/E and TR were used as vectors to compare the fusogenicity of six gB variants from congenitally infected fetuses with those from three laboratory strains. Five of them conferred the ability to induce the fusion of MRC-5 human embryonic lung fibroblasts to one or both backbone strains, as determined by a split GFP-luciferase reporter system. The same gB variants were not sufficient to induce syncytia in infected ARPE-19 epithelial cells, suggesting that additional factors are involved. The system described here allows a systematic comparison of the fusogenicity of viral envelope glycoproteins and may help to clarify whether fusion-promoting variants are associated with increased pathogenicity.

Infection of Mouse Neural Progenitor Cells by Toxoplasma gondii Reduces Proliferation, Migration, and Neuronal Differentiation in Vitro

Congenital toxoplasmosis constitutes a major cause of pre- and postnatal complications. Fetal infection with Toxoplasma gondii influences development and can lead to microcephaly, encephalitis, and neurologic abnormalities. Systematic studies concerning the effects of neural progenitor cell infection with T. gondii are unavailable. Cortical intermediate progenitor cells cultivated as neurospheres obtained from E16.5 Swiss Webster mice were infected with T. gondii (ME49 strain) tachyzoites to mimic the developing mouse cerebral cortex invitro. Infection was associated with decreased cell proliferation, detected by Ki-67 staining at 48 and 72 hours after infection in floating neurospheres, and reduced cellularity at 96 hours. Transient decreases in the expression of the neurogenesis-related transcription factors T-box brain protein 1, mouse atonal homolog protein 1, and hairy and enhancer of split protein 1 were found in infected cultures, while the level of transcription factor SOX-2 remained unaltered. Neurogenic potential, assessed in plated neurospheres, was impaired in infected cultures, as indicated by decreased late neuronal marker neurofilament heavy chain immunoreactivity. Infected cultures exhibited decreased overall migration rates at 48 and 120 hours. These findings indicate that T. gondii infection of neural progenitor cells may lead to reduced neurogenesis due to an imbalance in cell proliferation alongside an altered migratory profile. If translated to the invivo situation, these data could explain, in part, cortical malformations in congenitally infected individuals.

Effectiveness and safety of prenatal valacyclovir for congenital cytomegalovirus infection: systematic review and meta-analysis.

Universal screening for cytomegalovirus (CMV) infection in pregnancy is not recommended in most countries. One of the major deterrents is the lack of effective prenatal therapy. The role of valacyclovir therapy in reducing the risk of vertical transmission, symptomatic congenital CMV infection and adverse outcome is controversial. The main aim of this systematic review and meta-analysis was to investigate the safety and effectiveness of prenatal valacyclovir therapy in pregnancies with maternal CMV infection. MEDLINE, EMBASE and Cochrane databases and ClinicalTrials.gov were searched. The inclusion criteria were pregnancy with confirmed maternal CMV infection, treated or untreated with valacyclovir. The primary outcome was the incidence of congenital CMV infection confirmed by a positive CMV polymerase chain reaction result of the amniotic fluid. The secondary outcomes were symptomatic and asymptomatic infection, perinatal death, termination of pregnancy, anomalies detected on follow-up ultrasound, on fetal magnetic resonance imaging or at birth, severe and mild-to-moderate symptoms due to congenital CMV infection, neurological, visual and hearing symptoms, and adverse events related to valacyclovir. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) or Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool, as appropriate. Head-to-head meta-analyses were used to compare the risk of each of the explored outcomes according to whether pregnancies with maternal CMV infection were treated with prenatal valacyclovir therapy. Eight studies (620 women) were included. Pregnancies treated with valacyclovir had a significantly lower risk of congenital CMV infection compared with those not receiving valacyclovir (three studies; 325 fetuses; pooled odds ratio (OR), 0.37 (95% CI, 0.21-0.64); I2 = 0%; P < 0.001). When stratifying the analysis according to gestational age at maternal infection, the risk of vertical transmission was significantly lower in pregnancies receiving valacyclovir following first-trimester maternal infection (three studies; 184 fetuses; pooled OR, 0.34 (95% CI, 0.15-0.74); I2 = 20.9%; P = 0.001), while there was no significant difference between the two groups in those acquiring CMV infection in the periconceptional period or in the third trimester of pregnancy. Only one study reported on the risk of vertical transmission in women infected in the second trimester, demonstrating a lower risk of congenital infection in women taking valacyclovir, although this was based on a small number of cases. Pregnancies treated with valacyclovir therapy had an increased likelihood of asymptomatic congenital CMV infection compared with those not receiving valacyclovir (two studies; 132 fetuses; pooled OR, 2.98 (95% CI, 1.18-7.55); I2 = 0%; P = 0.021), while there was no significant difference between the two groups in the risk of perinatal death (P = 0.923), termination of pregnancy (P = 0.089), anomalies detected at follow-up imaging assessment during pregnancy or at birth (P = 0.934) and symptoms due to CMV infection in the newborn (P = 0.092). The occurrence of all adverse events in pregnant individuals taking valacyclovir was 3.17% (95% CI, 1.24-5.93%) (six studies; 210 women), with 1.71% (95% CI, 0.41-3.39%) experiencing acute renal failure, which resolved after discontinuation of the drug. On GRADE assessment, the quality of evidence showing that valacyclovir reduced the risk of congenital CMV infection and adverse perinatal outcome was very low. Prenatal valacyclovir administration in pregnancies with maternal CMV infection reduces the risk of congenital CMV infection. Further evidence is needed to elucidate whether valacyclovir can affect the course of infection in the fetus and the risk of symptomatic fetal or neonatal infection. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Assessing the risk of adverse pregnancy outcomes and birth defects reporting in women exposed to ganciclovir or valganciclovir during pregnancy: a pharmacovigilance study.

Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Reference anti-CMV treatment is valganciclovir/ganciclovir, which is contraindicated in pregnancy given questions about teratogenicity. We analysed reports from VigiBase, the world's largest safety database, and performed a disproportionality analysis of adverse pregnancy outcomes associated with (val)ganciclovir compared with any other drugs or with (val)aciclovir as comparators. Among 3 104 984 reports related to childbearing-age women or to pregnancy topics, 6186 were exposed to (val)ganciclovir or (val)aciclovir including 251 adverse pregnancy outcomes with (val)ganciclovir (n = 34) or (val)aciclovir (n = 217). We did not evidence any increased reporting of any adverse pregnancy outcome [miscarriage, stillbirth, small weight for gestational age, preterm birth (<37 weeks of gestation)] or birth defects with (val)ganciclovir compared with the use of (val)aciclovir during pregnancy. Four cases of oesophageal and anorectal atresia were identified with (val)ganciclovir, which may be related to concomitant drugs/medical conditions and require further analyses. These preliminary results require confirmation but suggest the possibility for trial evaluation of val(ganciclovir) in severe maternal or fetal CMV infections.

Effect of Spiramycin and Moringa leaf feeding in improving placenta, heart, histopathological neurons and glia in fetal models with toxoplasmosis

Background: Toxoplasmosis is a protozoan disease caused by Toxoplasma gondii that can cause fetal abortion, stillbirth, death, or fetal and neonatal abnormalities. Spiramycin prophylactic purpose is to prevent fetal infection in toxoplasmosis. While Moringa oleifera contains bioactive compounds that benefit from treating oxidative stress and infections. This study aims to evaluate the effect of Spiramycin and Moringa leaf extract in improving the placenta, heart, histopathological neurons and glia in fetal rat models with toxoplasmosis. Methods: An experimental study with a post-test-only control group design was done using 24 pregnant female rats divided into the control group receiving spiramycin therapy (P1) and two intervention groups that were given spiramycin and ethanol extract from Moringa leaves at a dose of 240 mg/kg body weight (P2) and combination of spiramycin and ethanol extract from moringa leaves at a dose of 420 mg/kgBW (P3). A histopathological examination was then performed. Results: Administration of spiramycin and ethanol extract of Moringa leaves at 420 mg/kg body weight had the same histopathological examination results as spiramycin administration. In a histopathological examination of toxoplasmosis pregnant rat placenta and toxoplasmosis fetal rat heart was effective in repairing gliosis in neurons and neuroglia of toxoplasmosis rat fetuses. Conclusion: Administration of spiramycin and ethanol extract from Moringa leaves was effective in repairing gliosis in neurons and neuroglia of toxoplasmosis rat fetuses.

SARS‐CoV‐2 placentitis and severe pregnancy outcome after maternal infection: A Danish case series

SARS-CoV-2 infection during pregnancy may cause viral inflammation of the placenta, resulting in fetal demise even without fetal or newborn infection. The impact of timing of the infection and the mechanisms that cause fetal morbidity and mortality are not well understood. To describe placental pathology from women with confirmed SARS-CoV-2 infection during pregnancy, a SARS-CoV-2 immunohistochemistry-positive placenta and late miscarriage, stillbirth, neonatal death, or medically indicated birth due to fetal distress. The triad of trophoblastic necrosis, inflammatory intervillous infiltrates, and increased perivillous fibrinoid deposition was present in all 17 placentas; the pregnancies resulted in eight stillbirths, two late miscarriages (19 and 21 weeks' gestation), and seven liveborn children, two of which died shortly after delivery. The severity of maternal COVID-19 was not reflected by the extent of the placental lesions. In only one case, SARS-CoV-2 was detected in lung tissue samples from the fetus. The majority events (miscarriage, stillbirth, fetal distress resulting in indicated birth, or livebirth, but neonatal death) happened shortly after maternal SARS-CoV-2 infection was diagnosed. Seven of eight sequenced cases were infected with the Delta (B.1.617.2) virus strain. We consolidate findings from previous case series describing extensive SARS-CoV-2 placentitis and placental insufficiency leading to fetal hypoxia. We found sparse evidence to support the notion that SARS-CoV-2 virus had infected the fetus or newborn.

Severe CMV pneumonitis and the resulting ARDS in a 28-year-old pregnant woman: a case report

BackgroundCytomegalovirus (CMV) is a common virus. In pregnant women, CMV infection is usually mildly symptomatic or asymptomatic but can lead to fetal infection. Here we present a rare case of severe CMV pneumonitis and acute respiratory distress syndrome in a healthy immunocompetent pregnant woman.Case presentationA previous healthy 28-year-old woman with spontaneous conception, was admitted to the General University Hospital of Patras at 29 weeks of gestation with a day history of fever, fatigue, pharyngitis, and cough. She was diagnosed with acute CMV infection and CMV pneumonitis. During her hospitalization she developed acute distress syndrome (ARDS). The patient was intubated and underwent emergency caesarean delivery. She was admitted to the intensive care unit and received intravenous ganciclovir. She was discharged at 20th day postpartum in a good clinical condition.ConclusionsThis case highlights the infrequent yet potential complexity of CMV infection in immunocompetent patients and in pregnancy.

Mpox (Monkeypox) Infection During Pregnancy.

An mpox (formerly "monkeypox") outbreak began in 2022, leading to infection in special populations, including pregnant individuals. We present a case of an individual who presented with a labial ulcer and subsequent papular rash at 31 weeks of gestation. She was diagnosed with mpox infection and was treated with tecovirimat. She had an uncomplicated induction of labor at 39 2/7 weeks of gestation and delivered a healthy neonate. The neonate had a positive immunoglobulin G test result for orthopoxvirus but did not have skin lesions or positive molecular test results suggestive of infection. Transplacental transmission of mpox is possible, but, in this case, the neonate did not have clinical findings suggestive of active or antenatal mpox infection. Treatment with tecovirimat in gestational cases of mpox may be beneficial.

Perinatal Loss as an Urgent Issue of Obstetrics and Perinatology

Perinatal losses are an urgent medical and socioeconomic problem of obstetrics and perinatology. Perinatal mortality in the world is about 30‰, varying widely across continents and countries. Perinatal losses are one of the main indicators of the level of medical care, characterize, on the one hand, the state of health of a woman and the fetoplacental system, and therefore the degree of viability of the fetus, and on the other, the quality of medical care for the mother during pregnancy, childbirth and the child before and during childbirth, as well as after birth. In numerous studies, the study of the structure of perinatal loss factors and adverse perinatal outcomes is of paramount importance. The most significant factors, according to some researchers, are intrauterine hypoxia and fetal asphyxia in childbirth, intrauterine anomaly of fetal development, respiratory disorders, intrauterine infections, placental and umbilical cord pathology, birth injuries, intraventricular hemorrhages, neonatal infections. Perinatal losses suggest a high risk of pregnancy. This dictates the need for a correct approach to assessing perinatal risk during pregnancy during the follow-up period with an obstetrician-gynecologist, in most cases there is an underestimation of the degree of risk, incorrect management of pregnancy. Women who have undergone COVID-19 in the first trimester of pregnancy may be at increased risk of adverse perinatal and maternal complications. The increase in the number of surgical interventions in obstetric practice over the past decades, noted in all countries of the world, is directly related to the expansion of the indications for the performance of caesarean section operations to prevent perinatal pathology. At the same time, being a unique measure of preserving the health and life of a mother or fetus, a global increase in its frequency is alarming. Currently, one of the main tasks remains the development of a clear multifactorial, highly differentiated system for predicting perinatal losses in order to prevent them.

Diagnostic Accuracy of Histological Chorioamnionitis and Funisitis in Neonatal Sepsis

Background Histological chorioamnionitis (HCA) is present not only in women with clinical chorioamnionitis (CCA) but also in a large subset with silent chorioamnionitis which has a risk of developing complications of preterm labor, fetal, and maternal infection. Objectives To assess HCA and funisitis, and their correlation with the early neonatal outcome. Methods Of 778 preterm babies born over a period of 1 year at ≤34 weeks gestation, 100 placentae were analyzed as per the inclusion criteria in this prospective study. Sections from the placenta, membranes, and umbilical cord were examined for histopathology. Clinical parameters in mother and neonate were recorded and correlation with HCA was estimated. Results The incidence of HCA, funisitis, CCA was 35%, 7%, and 24%, respectively. Sixteen of 24 (66.7%) CCA had HCA and 19/35 (54%) of HCA had no CCA. History of preterm premature rupture of membranes was there in 73/100 cases, of which 41 had HCA. HCA cases having duration of rupture of membranes (DROM) &lt;24 h were 22/41 (53.6%), 77.2% of which developed early onset neonatal sepsis (EONS). Odds of EONS with DROM &lt;12 and 24 h was 1.3 and 2.9, respectively. EONS was suspected in 28/35 (80%) of HCA versus 13/24 (54%) of CCA. Culture positive sepsis was seen in (9/28) 32% cases with HCA and funisitis. In the absence of HCA, EONS was suspected in 30.7% cases. Conclusion HCA has a better diagnostic ability to detect EONS. Sepsis screen on the basis of CCA alone can miss about 50% of cases.

Knowledge of cytomegalovirus and available prevention strategies in pregnancy: a cross-sectional study in Portugal

Objective Maternal and fetal congenital infection by cytomegalovirus (CMV) during pregnancy is the leading infectious cause of neurologic impairment and hearing loss. Efforts at limiting CMV exposure are based on hygienic measures. This study assessed the relationship between CMV knowledge and pregnant women’s time perspective as per the Zimbardo Time Perspective Inventory (ZTPI) scale. Methods We conducted a prospective descriptive study at a secondary-care Portuguese hospital between October to November 2021. All consecutive pregnant women in antenatal third-trimester appointments were included. The questionnaire included: sociodemographic data, knowledge about CMV, and the ZTPI scale, validated to our population. The number of correct answers in the knowledge section of the questionnaire was tallied to determine the individual knowledge score (KS). We investigated patients subjective perceptions of CMV infection during pregnancy, CMV knowledge, and CMV serologic status of pregnant women. Results We enrolled 96 pregnant women. 81.0% had not previously heard about CMV and only 8.8% had heard about it through their obstetrician. No significant association between awareness of CMV and education level was detected. 16.0% of pregnant women declared that they were aware of the hygienic measures for CMV. The CMV serology was performed in 21.3% of those enrolled in the preconception assessment, and 13.8% proved to be immune. From the time perspective, half of the women displayed a future-oriented attitude. Future-oriented women had significantly higher KS. No significant association was found between KS and education level, age, or previous pregnancy. There was a significant association between KS and women that work in health care. Conclusions Most patients had no knowledge of CMV. Being a medical professional and having a future-oriented outlook increases knowledge about CMV. Primary health care and obstetrics doctors may play a crucial role in informing pregnant women of antenatal appointments. The CMV serology coverage is scarce in this sample. This study constitutes a first step toward raising the awareness of the general population about CMV.

Post-infectious vasculitis secondary to Campylobacter coli infection

•Vascular inflammation may be linked to Campylobacter coli infection.•Post-infectious vasculitis may cause relapsing fever after an acute infection.•18F-fluorodeoxyglucose positron emission tomography/computed tomography may be helpful for the diagnosis of post-infectious vasculitis. A 56-year-old male with no comorbidity was admitted for relapsing fever at 40°C with diarrhea and night sweats, 3 weeks after initial onset without microbiological screening in December 2020. Blood analysis showed C-reactive protein of 251.5 mg/l and negative cultures. A 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed hypermetabolism highly suggestive of vasculitis affecting large and medium size arteries from upper and lower limbs, associated with highly hypermetabolic pan-colitis (Figure 1a). Stool culture was positive for Campylobacter coli. Temporal artery biopsy showed lymphocytic arteritis associated with eosinophils infiltrate, without any granuloma. A single dose of azithromycin allowed diarrhea resolution in 2 days and the inflammatory syndrome decreased after introduction of corticosteroids. The patient was treated for over 1 year, without relapse. FDG-PET/CT control after 2 years showed clear hypermetabolism regression (Figure 1b). Vascular involvements are rarely described in Campylobacter species infection but need specific follow-up to detect secondary aneurysm or stenosis. To our knowledge, diffuse vasculitis has never been previously described with Campylobacter coli [1Boissonneau S Graillon T Meyer M Brunel H Fuentes S Dufour H. Intracranial giant mycotic aneurysm without endocarditis and vasculitis: report of rare entity and review of literature.World Neurosurg. 2018; 119: 353-357https://doi.org/10.1016/j.wneu.2018.08.086Crossref PubMed Scopus (4) Google Scholar, 2Charbonnel A Carmoi T Lecoules S Bonnefoy S Algayres JP. Vascular manifestations due to Campylobacter fetus subsp. fetus infection: report of two cases.Rev Med Interne. 2012; 33: 643-645https://doi.org/10.1016/j.revmed.2012.08.011Crossref Scopus (2) Google Scholar, 3Torphy DE Bond WW. Campylobacter fetus infections in children.Pediatrics. 1979; 64: 898-903https://doi.org/10.1542/peds.64.6.898Crossref PubMed Google Scholar]. Clinical and histological findings were not suggestive of giant cell arteritis, the main differential diagnosis for large size vessels vasculitis after 50 years. FDG-PET/CT may help diagnose post-infectious vasculitis in case of relapsing fever after an acute infection. The authors have no competing interests to declare.

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. · Induction of labor is frequently used in the obstetrics field.. · We assessed vaginal washing impact before prostaglandin insertion for labor induction.. · Vaginal washing is an easily applicable method for labor induction with good outcomes..

Diagnosis and management of syphilis infection in pregnancy: a literature review

Treponema pallidum, which causes the infectious disease syphilis, has a high rate of vertical transfer from mother to kid. Untreated maternal infection increases the risk of perinatal morbidity and mortality and unfavorable pregnancy outcomes, notably congenital syphilis. It is necessary to check for gestational syphilis during the prenatal period, and its diagnosis is straightforward. Nevertheless, this illness still affects two million pregnant women globally, indicating its significant prevalence. Congenital syphilis clinical symptoms are regulated by gestational age, maternal syphilis stage, maternal therapy, and fetus immune response. Early and late congenital syphilis have historically been used to describe it. The direct identification of treponemes, serological tests, and clinical signs all contribute to the diagnosis of maternal infection. Penicillin is typically used in the treatment, which also includes sexual partners. Fetal infection can be treated and prevented from spreading from the mother to the fetus with proper maternal infection management. To lower the prevalence of congenital syphilis, screening, early detection, and appropriate care are crucial during pregnancy and the preconception period.

Correlation of sFlt/PlGF ratio with severity of preeclampsia in an Indian population

Preeclampsia affects 2% to 8% of pregnant women and significantly increases the risk for maternal and perinatal morbidity, especially in low- and middle-income countries. There is increasing evidence to support the use of biochemical markers such as placental growth factor and soluble fms-like tyrosine kinase-1 in predicting the severity of preeclampsia and to rule out severe disease in clinical conditions masquerading as severe preeclampsia. This study aimed to assess the role of the sFlt-1/PlGF ratio in predicting adverse perinatal and maternal outcomes in women with preeclampsia in a South Asian population with a higher rate of the disease and its associated complications. This was a prospective cohort study of women diagnosed with preeclampsia or suspected to have preeclampsia who underwent biophysical and biochemical investigations to measure the severity, including determining maternal hemodynamic indices, mean arterial pressure, fetal biometric and Doppler parameters, and soluble fms-like tyrosine kinase-1 and placental growth factor levels. The performance of these markers, individually or in combination, in predicting adverse perinatal and maternal outcomes was then assessed using receiver operating characteristic curve analysis. An adverse maternal outcome was defined as 1 or more of severe hypertension; admission to the intensive care unit; eclampsia; placental abruption; hemolysis, elevated liver enzymes, low-platelet count syndrome; disseminated intravascular coagulation; platelets <100×109/L; creatinine >1.1 mg/dL; and alanine aminotransferase >100 U/L. An adverse perinatal outcome was defined as 1 or more of preterm birth ≤34+0 weeks' gestation, neonatal intensive care unit admission for >48 hours, respiratory distress syndrome, intraventricular hemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, retinopathy of prematurity, and confirmed fetal infection. We recruited 91 women with preeclampsia with a mean gestational age of 30.63±2.86 weeks. Women who had adverse maternal events had higher median maternal concentrations of soluble fms-like tyrosine kinase (11,500.0 pg/mL vs 3051.0 pg/mL; P<.001), lower concentrations of placental growth factor (44.88 pg/mL vs 148.50 pg/mL; P<.001), and a higher sFlt-1/PlGF ratio (306.22 vs 30.63; P<.001) than women who did not. Pregnancies with an adverse perinatal outcome also had a higher soluble fms-like tyrosine kinase concentration (12,100.0 pg/mL vs 3051.0 pg/mL; P<.001), lower placental growth factor concentration (27.2 pg/mL vs 148.50 pg/mL; P<.001), and higher sFlt-1/PlGF ratio (378.45.4 vs 30.63; P<.001). The area under the receiver operating characteristic curve showed that soluble fms-like tyrosine kinase and placental growth factor were the best biomarkers when compared with other biochemical markers to predict adverse maternal (area under the curve, 0.81; 95% confidence interval, 0.72-0.90) and fetal (area under the curve, 0.88; 95% confidence interval, 0.80-0.96) outcomes in preeclampsia. The sFlt-1/PlGF ratio correlates better with adverse maternal and perinatal outcomes than any other biochemical marker in an Indian population. The incorporation of the sFlt-1/PlGF ratio in women with preeclampsia can help in predicting the severity of the condition and the timings of the delivery.

Neonatal and long-term outcomes of infants with congenital cytomegalovirus infection and negative amniocentesis: systematic review and meta-analysis.

Cytomegalovirus (CMV) DNA is detectable in the amniotic fluid collected by amniocentesis in cases in which the fetus has been infected. However, cases of congenital neonatal CMV infection with a negative amniocentesis result have also been reported in the literature. The aim of the present study was to compare pregnancies with a negative amniocentesis result to those with a positive amniocentesis result in terms of incidence of fetal insult and long-term sequelae. Observational studies that included pregnant women with CMV infection who underwent amniocentesis and that reported their results together with neonatal and/or long-term outcomes of the offspring were included. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale. The rate of severe symptoms at birth, defined as neurological symptoms or multiorgan involvement at birth, and the rate of severe sensorineural hearing loss (SNHL) and/or neurodevelopmental impairment at follow-up were the main outcomes of the study. The secondary outcome was the rate of pregnancy termination due to the presence of CMV-associated central nervous system (CNS) findings or multiorgan involvement on ultrasound/magnetic resonance imaging (MRI). Seven studies were included in the systematic review and meta-analysis. The pooled false-negative rate of amniocentesis was 8.0% (95% CI, 5.0-13.0%). The pooled rate of severe symptoms at birth was 0.0% (95% CI, 0.0-1.0%; I2 = 0%) in fetuses with a negative amniocentesis result and 22.0% (95% CI, 11.0-38.0%; I2 = 75%) in those with a positive amniocentesis result. The pooled odds ratio (OR) was 0.03 (95% CI, 0.01-0.10; I2 = 0%). The pooled rate of severe SNHL and/or neurodevelopmental impairment at follow-up in fetuses with a negative amniocentesis result was 0.0% (95% CI, 0.0-1.0%; I2 = 0%) and, in those with a positive amniocentesis result, it was 14.0% (95% CI, 7.0-26.0%; I2 = 64%). The pooled OR was 0.04 (95% CI, 0.01-0.14; I2 = 0%). The pooled rate of pregnancy termination due to the presence of CMV-associated CNS findings or multiorgan involvement on ultrasound/MRI was 0.0% (95% CI, 0.0-2.0%; I2 = 0%) in fetuses with a negative amniocentesis result and 20.0% (95% CI, 10.0-36.0%; I2 = 82%) in those with a positive amniocentesis result. The pooled OR was 0.03 (95% CI, 0.01-0.08; I2 = 0%). A subgroup analysis including only pregnancies with primary CMV infection and a sensitivity analysis including only prospective studies were carried out, showing very similar results to those of the main analysis. A negative amniocentesis result in pregnant women with CMV infection ensures lack of fetal insult and long-term sequelae to the child, even if transmission has occurred. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.