Management Of Infections In Pregnancy Research Articles

Varicella-zoster virus infection and pregnancy

Varicella-zoster virus is a herpes virus that causes mild to moderate disease when primary infection (chickenpox) is acquired in childhood, but leading to great morbidity and mortality in adults, with even more complications in pregnant women. As a physiologic adaptation in pregnancy that diminishes the possibility of fetal rejection, the altered maternal immune system is the reason why complications are more frequent in this segment of adult population. Moreover, a great concern is represented by the risk of vertical transmission to the fetus that can lead to congenital varicella syndrome (CVS) in the first 2 trimesters or to neonatal varicella if the mother develops the illness perinatally. Antiviral treatment reduces the gravity of the clinical manifestations, but the existent data shows that it doesn’t influence the rate of fetal transmission. Immunoglobulin anti-VZV (VZIG) can be given as prophylaxis when there has been described contact with the virus. Vaccination should be offered to all non-immunized women at the prenatal visit to diminish the maternal and fetal risks in case of subsequent exposure. The purpose of this review is to update the current understanding regarding the best management of varicella infection in pregnancy, based on the latest data from literature and guidelines. An electronic research for relevant reviews and articles published in the last 5 years was made, using PubMed, Medline, Cochrane Data Base, and also the current international guidelines promoted by the Obstetrics and Gynecology Societies in Canada, United States, Ireland and United Kingdom. The importance of prenatal detection of non-immunized women by serologic testing for varicella antibodies should not be overlooked, and subsequent vaccination should be advised to lower the significant complications associated with developing the disease in pregnancy. In case of varicella infection in pregnancy, adequate treatment should be immediately initiated with immunoglobulin and antivirals. Careful follow-up with serial fetal echography should assess if there are abnormalities of fetal development consistent with congenital varicella syndrome. Future mothers need to be advised about the probability of vertical transmission and the associated fetal malformations. Future consideration must focus on identifying the woman at childbearing age at risk and facilitate the vaccination.

Toxoplasma gondii infection in pregnancy

Toxoplasmosis is a worldwide spread infection, caused by the parasite Toxoplasma gondii, acquired through ingestion of contaminated food or water, or consuming infected undercooked meat. Despite the fact that in healthy, non-pregnant population, this infection is predominantly asymptomatic and self-limited, in pregnancy it requires special care to minimize the risks to the fetus by vertical transmission. Congenital toxoplasmosis can result in permanent neurological impairment and even blindness. Once diagnosed in pregnancy, this infection needs prompt medical therapy to prevent fetal complications. Primary prevention of the toxoplasmosis consists of dietary and lifestyle changes with the purpose to limit the contact with the parasite. Secondary prevention includes the screening of the pregnant women. Screening programs are implemented in various countries depending on the prevalence of the parasite in the respective areas. The purpose of this article is to make a review of the medical literature concerning the management of Toxoplasma gondii infection in pregnancy. For this purpose, scientific research in databases and online medical publications such as Medline, PubMed, Elsevier and The Lancet was conducted.

Management of Chronic Hepatitis B in Pregnancy.

Chronic hepatitis B virus (HBV) infection due to mother-to-child transmission during the perinatal period remains an important global health problem. Despite standard passive-active immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine in neonates, up to 8.5% of newborns still acquire HBV infection. Thus, management of chronic HBV during pregnancy and strategies to prevent mother-to-child transmission are important steps in eradicating or reducing the global burden of chronic HBV infection. To date, the management of HBV infection in pregnancy still needs careful attention because of some controversial aspects, including the influence of pregnancy on the course of HBV replication, safety of antiviral prophylaxis with nucleus(t)ide analogs, postpartum flares of hepatitis after delivery, and the safety of breastfeeding. In this review, we highlight these important issues of preventive strategies in the perinatal period.

Management of common infections in pregnancy

Pregnant women are peculiarly vulnerable to infections – the mechanism for this is multi-factorial and includes immune tolerance to the fetus (and placenta) itself, and maternal physiological changes, such as urinary stasis and reduced lung reserve. Some infections are more severe in pregnancy, such as malaria, influenza, hepatitis E and measles. Other infections place the fetus and/or newborn infant at particular risk, such as herpes simplex virus, varicella, listeria and toxoplasmosis. This unique status is recognised by the NHS in the many infection prevention initiatives available to pregnant women: free NHS dental care, the infectious diseases in pregnancy screening programme (for human immunodeficiency virus, hepatitis B and syphilis infection), the vaccination programme, and in the general advice provided by midwives and their healthcare teams. In this article, we aim to cover issues that we, as pharmacists and microbiologists, are commonly asked about regarding pregnant women, including: antibiotic safety, management of common genitourinary infections, immunisation, rash exposures and rashes.

AKT answer relating to management of common infections in pregnancy

AKT answer relating to management of common infections in pregnancy

AKT question relating to management of common infections in pregnancy

AKT question relating to management of common infections in pregnancy

AKT answer relating to management of common infections in pregnancy

AKT answer relating to management of common infections in pregnancy

AKT question relating to management of common infections in pregnancy

AKT question relating to management of common infections in pregnancy

Managing infections in pregnancy.

The management of infection in pregnancy aims mainly at improving the diagnosis and prognosis of congenital infections. Over 400 publications have dealt with this issue over the last 2 years, taking advantage of progress made not only in the epidemiological knowledge of infections but also neonatal treatment and prenatal diagnosis and interventions. The focus remains largely on viral and parasitic infections, namely cytomegalovirus (CMV) and toxoplasmosis, with the appearance of influenza as part of recent and severe outbreaks. The prevalence of CMV infection is stable. The prediction of foetal infection from primary maternal infection is becoming more accurate and therapeutic approaches are promising, including the development of a vaccine in the near future. The prevalence of toxoplasmosis is decreasing markedly in Europe weakening the effect of preventive measures and questioning the rationale for screening. In addition, the efficacy of prenatal treatment is still under scrutiny, although no appropriate randomized controlled trial (RCT) has been undertaken. Accurate dating of maternal primary infection is key to prenatal management including foetal and perinatal surveillance and therapy. Heightened prenatal surveillance following influenza infection in early pregnancy is warranted by an apparent increased risk of nonchromosomal congenital malformations in large epidemiological studies, likely as an effect of maternal hyperthermia.

Management of Severe Odontogenic Infections in Pregnancy: Authors' Reply

Management of Severe Odontogenic Infections in Pregnancy: Authors' Reply

Management of Severe Odontogenic Infections in Pregnancy:

Management of Severe Odontogenic Infections in Pregnancy:

Pandemic H1N1 in Pregnancy

Pregnant women constitute a high risk group for disease-related morbidity and mortality during influenza season [1-3]. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality comparing to non-pregnant women. There have also been reports of an increased risk of miscarriage, birth defect and preterm delivery when pregnancy is associated with influenza infection [46]. The clinical presentation, diagnosis and management of H1N1 infection in pregnancy is described in this article.

Managing viral infections in pregnancy and the puerperium

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the author outlines the management of common viral infections in pregnancy. Copyright © 2011 Wiley Interface Ltd

Managing bacterial infections in pregnancy and the puerperium

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the author outlines the management of common bacterial infections in pregnancy.

Erythrovirus B19 as a potential cause of fetal hydrops: assessing awareness

Erythrovirus (previously parvovirus) B19 was discovered accidentally in 1975 while screening for hepatitis B surface antigen (Chan et al, 1998). It is a small ssDNA virus that targets erythroid progenitor cells. Infection with B19 virus during pregnancy may cause serious complications in the fetus such as fetal hydrops and intrauterine fetal death. Early diagnosis and treatment is essential in the management of these complications. We conducted a survey study to assess the awareness of both front and second-line obstetric staff(GPs, midwives, senior house officers, specialist registrars and consultants) of B19 as a potential and treatable cause of hydrops fetalis. Overall there was poor awareness particularly among the front-line carers compared to the second-line carers regarding the diagnosis and management of B19 infection in pregnancy. A total of 94% of the responders agreed there was a need for educational updates on the role of B19 infection during pregnancy.

A multi-district audit of the management of HIV infection in pregnant women and the prevention of mother-to-child transmission: Yorkshire HIV pregnancy audit

A regional audit was performed to compare clinical practice against the British HIV Association guidelines for the management of HIV infection in pregnancy. Data were collected from 2000 to 2002 from eight clinics across Yorkshire using a questionnaire. There were 22 live births to 22 HIV + pregnant women. There were no cases of transmission of HIV from mother to child. The majority (20/22) of mothers received therapy as recommended in the guidelines, with only two initially receiving inappropriate dual therapy. In all, 16/22 (73%) had elective caesarean sections, 5/22 (23%) emergency sections after the onset of labour and one had a vaginal delivery. Also, 12/22 (55%) definitely received intravenous zidovudine during delivery. Added to these, 19/22 infants received appropriate antiretroviral medication for four to six weeks after birth. No mothers were known to have breast-fed.

HIV testing in antenatal care: a cross-sectional study

Midwives' attitudes and practices regarding antenatal HIV testing, including integration of testing into routine antenatal care, were analysed using a self-administered structured questionnaire. This was completed by hospital and community-based midwives in an area of high HIV prevalence. In total, 162 responses were received. Most midwives (71%) agreed that HIV testing is an integral part of antenatal care but 61% also believed that only individuals with a counselling qualification should offer tests. Fifty seven per cent had attended a recent course about the management of HIV infection in pregnancy. Midwives who had attended a course were more likely to agree with integrated testing (odds ratio 5.2, 95% confidence interval 2.0–13.5). Midwives qualified between 5 and 9years ago were less likely than more recently qualified or more experienced midwives to offer tests, and this was not explained by differences in access to educational courses. Midwives' attitudes towards antenatal HIV testing are generally favourable. Despite an observed increase in uptake rates, many midwives continue to believe that only qualified counsellors should offer tests. All midwives should receive ongoing education that emphasizes the changing management of HIV infection in pregnancy and encourages testing.

Management of HIV infection during pregnancy.

Optimal management of HIV infection in pregnancy requires maternal use of potent antiretroviral therapy to prevent disease progression in the mother and vertical transmission to the newborn. Combination antiretroviral therapy substantially reduces the risk of perinatal HIV transmission and appears to be more effective than zidovudine monotherapy. The administration of single dose nevirapine to mother intrapartum and infant postpartum effectively reduces vertical HIV transmission and is less costly and cumbersome than zidovudine regimens. Elective cesarean section reduces vertical transmission of HIV but its benefit is less clear when antiretroviral therapy decreases maternal plasma HIV viral load to low levels at delivery. If possible, HIV-infected mothers should avoid breastfeeding. The present review discusses the importance of early identification of maternal HIV infection, strict adherence to combination antiretroviral regimens to prevent drug resistance, developing a better understanding of antiretroviral pharmacokinetics in pregnancy and short/long term safety of anti-HIV drugs.

Diagnosis and management of urinary tract infection in pregnancy

Diagnosis and management of urinary tract infection in pregnancy

The Management of Recurrent Genital Herpes Infection in Pregnancy

Objective To determine clinical practice amongst bstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection. Methods All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection. Results There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81)routinely examined the genitals for evidence of a recurrence. When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (χ2= 30.38, P < 0.0001). Five hundred and ninety-six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was onsidered an acceptable indication for operative delivery by 745 obstetricians (62%). Conclusions 1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.