Intrauterine infection in maternal rubella.
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OBJECTIVE: To determine whether diagnostic amniocentesis should be part of evaluations of women under consideration for rescue cerclage. METHODS: We reviewed the obstetric records of 25 candidates for rescue cerclage seen between June 30, 1995, and July 1, 1997. Rescue cerclage was defined as a procedure on a cervix with an internal os dilated at least 2 cm and 50% effaced, with membranes visible at the external os. Transabdominal amniocentesis was offered as part of the preoperative evaluation, and amniotic fluid (AF) was sent for glucose and lactate dehydrogenase level determinations, Gram staining, and culture for aerobic and anaerobic bacteria. Placentas were examined for histopathologic evidence of inflammation. The women were divided into three groups. Eleven women had rescue cerclage after amniocentesis, seven had rescue cerclage after declining amniocentesis, and seven had amniocentesis but were treated conservatively because of AF markers of infection. Analysis of variance and chi(2) statistics were used. RESULTS: The group that had rescue cerclage after amniocentesis had a significantly longer mean admission-to-delivery interval, higher mean gestational age at delivery, higher mean birth weight, and higher neonatal survival rate than did the group that had rescue cerclage without amniocentesis and the group that had no cerclage after amniocentesis (P <.001). CONCLUSION: Amniocentesis before rescue cerclage placement identified women with subclinical chorioamnionitis who would not benefit from cerclage.
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In a Swiss dairy farm (canton of Geneva) consisting of 73 animals 8 abortions were observed within 2 weeks. Serological and molecular biological analyses (PCR) on aborting dams, and abortion materials, respectively, revealed that the protozoan parasite Neospora caninum was the causative agent. Besides the 8 aborting animals, 12 other non-aborting heifers were found to be serologically positive for this parasite. All positive sera were further tested in an avidity-ELISA to elucidate the recency of infection. All seropositive animals but one showed low avidities at the time the abortion storm started. This indicated at a recent N. caninum-infection within the herd. Thus, the animals most probably were exposed to N. caninum-oocysts (e.g. by dog feces-contaminated forage) and the resulting abortion storm was due to an exogenous (formerly known as "horizontal") parasite transmission into a naive herd. This is the first documented record of such an event in Switzerland.
A fetus with the sonographic appearance of echogenic and enlarged lungs and dilated trachea and bronchi, indicating laryngotracheal obstruction, is reported. Additionally, the fetus had ascites and subcutaneous edema and the amniotic fluid volume was reduced. Doppler flow investigation of the systemic venous circulation revealed signs of heart failure, and color Doppler visualized possible increased pulmonary flow. Following termination of pregnancy, autopsy confirmed the sonographic observations and revealed a hypoplastic thymus. During the present pregnancy the mother suffered from sustained cough, and serological tests revealed acute pertussis infection. Polymerase chain reaction investigation for Bordetella pertussis in the amniotic fluid was negative. The possibilities of pertussis toxins as noxious factors and of an atypical presentation of DiGeorge anomaly are discussed.
The object of this study supported by the French Agency for AIDs Research (ANRS) was to assess knowledge and attitudes of pregnant women towards HIV infection and testing, and to compare them according to the outcome of the pregnancy (elective abortion vs delivery). Between March 22 and April 26, 1992, all women ending their pregnancy and attending one of the 72 medical centres located in South-Eastern France were asked to complete an anonymous questionnaire (n = 4303). 3,854 (89.6%) responded: 2,825 women at delivery (WD) and 764 who chose an elective abortion (WA). 61.7% of WD and 24.1% of WA declared having been tested for HIV during pregnancy (p < 0.001). Among women who reported not having been HIV tested, very few did so because they refused the test (1.7% among WD and 1.4% among WA-NS). Prior HIV testing was less frequent among WA than among WD (45.8% vs 58.8%--p < 0.001). 2.8% of women tested during prenatal care and 20% in the context of abortion did not know the result of their test (p < 0.001). Knowledge about HIV transmission declared by WD did not differ significantly from that declared by WA. However, risky behaviours were more frequent among WA than among WD (38.9% vs 17.7%--p < 0.001). This research shows that French screening HIV policy in the context of pregnancy remains mainly motivated by foetal concerns. Although women who abort voluntarily report risky behaviours more frequently, the opportunity of information and counselling towards them is relatively neglected in comparison with women who deliver.
Monitoring of congenital rubella infection (CRI) involves measuring the assessable outcomes of infection of the pregnant woman. These assessable outcomes are infection itself, therapeutic abortion, and birth of infants with congenital rubella syndrome (CRS). The incidence of infections can be estimated with use of data on age-specific occurrence of acquired rubella or acquisition of antibody in females and on fertility rates. The incidence of CRS can be estimated from data on infections of pregnant women and reports in the literature of incidence rates of CRS among infants born of infected mothers. Surveillance of CRS can involve individual case detection or serosurveys among populations with defects characteristic of CRS, such as deafness, and among comparison groups. To assess the impact of CRI, countries without rubella control programs should estimate the frequency of infections in pregnant women from existing surveillance data or determine by serosurveys the susceptibility and/or age-specific acquisition of rubella antibody in postpubertal females. Countries with rubella control programs should monitor cases of acquired rubella and/or prevalence of seropositivity in postpubertal females, therapeutic abortions, and CRS to assess effectiveness of the program and to determine high-risk populations that should be targets of intense vaccination programs.
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A 27-year-old patient who became pregnant whilst fitted with an intrauterine contraceptive device developed an intrauterine Candida albicans infection and aborted. The diagnostic (and other inconspicuous) features of C. Albicans infection in the fetus are described. The presence of the intrauterine contraceptive device may have predisposed to the establishment of the infection.
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In a retrospective case-control study 64 women yielding a false positive result to a test for syphilis in pregnancy were compared with 128 controls individually matched for age, parity, hospital of delivery, and year of delivery. There were significantly more unsuccessful pregnancies, mainly spontaneous abortions during the first and second trimesters, among women with persistent false positive results. There was no significant difference between groups in the mean birth weights of liveborn infants. The antibodies responsible for the false positive result may indicate the presence of an immunological disturbance. Women who give a false positive result should be carefully managed throughout their pregnancy.
Actinomyces pyogenes from a case of endometritis was used to study the effects of infection of the bovine embryo between days 27 and 41 of pregnancy. From 10(9) to 10(10) washed organisms were introduced into the uterine lumen of four pregnant cows. Two pregnant cows were inoculated with sterile saline and four pregnant cows were treated with cloprostenol. Embryonic death and abortion followed 29 to 144 hours after the inoculation of the live bacteria. The aborted embryos were macerated or clearly degenerating and yielded profuse pure cultures of A pyogenes. Abortion was accompanied by a sustained increase in uterine tone, opening of the cervix, presence of vaginal pus and a vulval discharge and the persistence of the corpus luteum for at least eight days after abortion. Intrauterine inoculation with saline did not affect pregnancy, but embryonic death, abortion and regression of the corpus luteum occurred 66 to 72 hours after the treatment with cloprostenol. The results suggest that A pyogenes is a primary pathogen and is capable of causing embryonic death and abortion.
A case of reinfection with the wild rubella virus in the 8th gestational week is reported. The patient had preexisting hemagglutination inhibition antibodies of low titer following immunization with rubella vaccine. Reinfection was accompanied by clinical symptoms and the presence of rubella-specific immunoglobulin M (IgM) of high titer. Following termination of pregnancy no rubella virus could be isolated from the fetal tissues and the fetal blood contained no specific IgM antibodies. These results should encourage the use of cordocentesis before decision on interruption of pregnancy.
Campylobacter jejuni was inoculated intravenously into pregnant ewes on gestation days 114 and 123 to reproduce ovine abortion. All ewes aborted 7-12 days post-inoculation. High numbers of C. jejuni were isolated from ewe tissues (caruncle, bile, cecal feces), fetal tissues, and placenta. C. jejuni colonies were identified in caruncles and placenta by light microscopy and immunoperoxidase techniques. Histologically, inoculated ewes had a severe purulent endometritis with vasculitis. Placentas from inoculated ewes and field cases showed necrosis and purulent inflammation; however, placentas from inoculated ewes had large numbers of bacterial colonies compared to few bacteria found in field cases. Histologically, only one fetus from the inoculated ewes showed lesions (purulent bronchopneumonia), whereas all fetuses from field cases had a distinct bronchopneumonia, and one fetus showed multifocal hepatic necrosis. These results suggest that C. jejuni (serotypes Penner 1 and Lior 2) is an important abortifacient organism for sheep.
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