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B Stray-Pedersen

Publications and source records attributed to B Stray-Pedersen.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Toxoplasmosis and pregnancy].

The ongoing national project for prevention of congenital toxoplasmosis has created a need for general information on both toxoplasmosis in relation to pregnancy and on congenital toxoplasmosis. This paper presents an up-to-date survey of these facts. It briefly describes the clinical picture and what can happen to the foetus after primary maternal infection. Special emphasis is placed on diagnosis, and recommendations are made for the treatment of infected mothers and babies. Prevention of congenital toxoplasmosis is discussed from both an individual point of view and in a social perspective.

Anti-Bacterial Agents↗
PubMed1993

Toxoplasmosis in pregnancy.

Primary infection with Toxoplasma gondii in pregnant women occurs all over the world with frequencies between 0.1-1%. In approximately 40% of the cases, the unborn child is infected. The risk of fetal infection increases during pregnancy, while at the same time the risk of severe disease decreases. As a result, infants with congenital toxoplasmosis are mostly asymptomatic at birth, but long-term studies indicate that up to 85% of them will develop sequelae including chorioretinitis (leading to severe impairment of vision), hearing loss or mental retardation. Early recognition of maternal infection and treatment with spiramycin or pyrimethamine-sulphadiazine will reduce the parasitic colonization of the placenta by more than 60% and prevent infection in the fetus. If fetal infection has already occurred, maternal treatment modifies the fetal disease. Therapy during the first year of life improves the prognosis. It is possible today to identify infected fetuses by prenatal diagnosis based on detection of the parasite in cord blood, amniotic fluid and placental tissue. Specific antibodies and non-specific signs of infection in fetal blood give additional information. Advances in laboratory techniques have made it feasible to consider serological surveillance of pregnant women. The present recommendation is that each country should provide data on the incidence of toxoplasma infection in pregnancy and thereby decide whether it represents a problem and what measures should be adopted. This paper summarizes the present knowledge of the parasite and its implication for the mother and unborn child. The effect and problems of primary and secondary prevention in pregnancy are discussed as well as the efficacy of treatment. The need for future research including long-term follow-up studies are emphasized.

Female↗
PubMed1992

Treatment of toxoplasmosis in the pregnant mother and newborn child.

The paper presents a review of different treatment regimens employed for 25 years to prevent and treat congenital toxoplasmosis. Unfortunately, no well-controlled, randomized trials have been performed to evaluate the efficacy of different therapies of pregnant women or infected neonates. Treatment in pregnancy may be effective since transplacental passage of parasites is delayed. Spiramycin, a complete safe drug which concentrates in the placenta, may reduce the risk of materno-fetal transmission by 60%, but is in the present doses without influence on an already infected fetus. Pyrimethamine in combination with sulfonamides erradicates more effectively parasites in the placenta, and also in the fetus. Today a combination of both regimens is recommended in pregnancy. As for the infected neonates, intensive treatment of pyrimethamine/sulfonamides alternating with spiramycin until one year of age seems to prevent development of late appearing sequelae. There is obviously a need for international multicenter studies to settle the optimal schedules and duration of therapy which again is highly dependent on the performance of an appropriate serological screening during pregnancy.

Abortion, Therapeutic↗
PubMed1992

Current status of toxoplasmosis in pregnancy in Norway.

The paper reports previous epidemiologic data obtained in Norway and describes briefly the design of a prospective study of primary toxoplasma infection which will be carried out among pregnant women in Norway in the period 1992-1994.

Adult↗
PubMed1992

Economic evaluation of preventive programmes against congenital toxoplasmosis.

Benefit-cost analysis are applied to different strategies aimed at preventing congenital toxoplasmosis. The first strategy involves health education of pregnant women on how to avoid toxoplasma infection. The second strategy comprise serological surveillance in pregnancy combined with prenatal diagnosis and chemotherapy. The cost of health education is less than the cost of the serological screening, but health education will most likely lead to a haphazard testing of individuals and thereby increasing the cost. The best and most rational approach, and the programme which will prevent most cases and save most money for the society, is a combination of both programmes. Compared with the results of any of the two strategies alone, the benefits of the combined programme will increase significantly, while the cost (NOK 165 per participating woman) will only add fractions to that of the serological screening programme. The benefits of the strategies are influenced by many uncertain factors such as the discount rate, the incidence of infection, the intrauterine transmission rate, the outcome of pregnancy, the prognosis of the offspring, the sensitivity of the screening tests and the effectiveness of the programme. After applying a sensitivity analysis, both programmes were found to be of economic benefit to society at an incidence of maternal toxoplasmosis of 1-1.5 per 1000. Thus the pilot screening initiated in Norway to determine the incidence of infection, seems justified.

Cost-Benefit Analysis↗
PubMed1991

[Diagnoses among sick-listed pregnant women].

51% of 710 women in paid employment and resident in the municipality of Baerum were certified as sick during their gestationel period. In 1/3 of the cases the medical certificate referred to musculoskeletal/connective tissue diseases, a problem which increased with duration of pregnancy. 208 women (29%) were incapacitated from work for more than two weeks and in 36% of these women, the sickness certificate was obtained on grounds of threatened well-being of the foetus. According to the current Norwegian legislation, morbidity of the mother is the only indication for granting certification of illness to a pregnant woman. The paper indicates that the law should be updated to include morbidity of the foetus as a justifiable reason for certifying the mother as sick. In addition, the perinatal audit should be expanded to include cases of foetal morbidity as well as cases of foetal mortality.

Absenteeism↗
PubMed1991

Perinatal mortality in Norway: experience with perinatal audit.

In order to improve perinatal service, special committees have been established in every county in Norway. These committees are responsible for making local guidelines and performing inquiries (audits) of all perinatal deaths. The focusing upon avoidable and possibly avoidable factors and identification of suboptimal care seems to be valuable in improving the quality of medical work. In 1989 the perinatal mortality was 7.8 per 1000 births.

Female↗
PubMed1989

Postpartum bacteriuria. A multicenter evaluation of different screening procedures and a controlled short-course treatment trial with amoxycillin.

A total of 10,909 puerperal women from 6 different hospitals were screened for bacteriuria by culture of voided midstream urine (MSU), and a significant growth was found in 881 patients (8.1%). In 731 cases the urine was reexamined by using suprapubic aspiration (SPA), and in only 354 (48%) of the samples the diagnosis of bacteriuria was confirmed. The contamination rate of the MSU samples varied from 46 to 69% between the different hospitals, indicating that in the postpartum period positive MSU findings would necessitate more thorough examination in order to confirm the diagnosis of urinary tract infection. In our study, suprapubic aspiration was found to be a simple and acceptable method without any side effects. Confirmed bacteriuria occurred in 3.2% of the women. Operative delivery (Cesarean section, forceps and vacuum extractor delivery), epidural anesthesia and bladder catheterization increased the risk of bacteriuria in the postpartum period. Only 27% of the women with positive bladder urine complained of dysuria and this symptom was significantly more common in women who had been catheterized. 230 patients with confirmed bacteriuria with amoxycillin-sensitive bacterias participated in a randomized short-course treatment trial: 114 women received 3 days treatment with amoxycillin (1.5 g/day), 116 received the traditional 10 days therapy (750 mg amoxycillin/day). Both antibiotic regimens were observed to be effective with a cure rate of 96 and 98%, respectively. Short-course antibiotic treatment should thus be recommended to puerperal women with urinary tract infections since this avoids prolonged drug exposure to the lactating mother.

Amoxicillin↗
PubMed1984

Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion.

A diagnostic screening program was applied to 195 couples with a prior history of habitual abortion (i.e., three or more consecutive abortions). Abnormalities were identified in 110 (56%) of the couples. Such identification was significantly more frequent in couples with primary habitual abortion than in couples with secondary habitual abortion (p less than 0.001) and also more frequent in couples with second-trimester abortions than in those with first-trimester abortions (p approximately equal to 0.01). The abnormalities most commonly observed were anomalies of the uterine body (15%), endometrial infections (15%), and cervical incompetence (13%). Hormonal dysfunctions were detected in 5%, and there were chromosomal aberrations in 3% of the couples. The women in the group showing abnormalities were offered surgical or medical treatment, and 80% of those who subsequently conceived carried their pregnancies to term. Among the couples with no abnormal findings, women receiving specific antenatal counseling and psychological support had a pregnancy success rate of 86%, as compared to a success rate of 33% observed in women who were given no specific antenatal care (p less than 0.001).

Abortion, Habitual↗