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We report the results of prenatal diagnosis in 15 cases of primary cytomegalovirus infection during pregnancy. Sixteen fetuses (one twin pregnancy) were examined by ultrasonography, amniocentesis, and fetal blood sampling. Prenatal diagnosis was positive in eight cases as evidenced by positive amniotic fluid cultures in eight, positive immunoglobulin M (IgM) in six, and abnormal ultrasound in two. Among infected fetuses, abnormal laboratory findings included anemia, thrombocytopenia, and elevated liver function tests. Three pregnancies were terminated because of ultrasound abnormality or abnormal laboratory indices. In cases of fetal infection with normal ultrasound and normal laboratory findings, the pregnancies were allowed to proceed, leading to the birth of four infants (three with subclinical infections, one with bilateral hearing loss). The relation between anemia, thrombocytopenia, altered liver function tests, and subsequent handicap remains unknown, but the abnormalities observed in utero correspond to those described at birth in cases of cytomegalic inclusion disease. Amniocentesis alone allowed the diagnosis of infection in all cases, but fetal blood sampling provided additional information about the fetal condition.
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PMID:Cytomegalovirus fetal infection: prenatal diagnosis. 165 49

Women in India and AIDS prevention and control are discussed in terms of vulnerability, victimization, required knowledge, reproductive impact, care and prevention after birth, and the demands of the prevailing situation. A WHO world estimate is that 3 million women of childbearing age are infected with HIV out of 8-10 million. Indian women are vulnerable because of their reduced status and lack of power in private and marital life. Also, pregnant women receive blood transfusions, which may be inadequately screened, for anemia. The use of oral contraceptives with estrogen reduces immunity. The use of IUDs may cause inflammation or injury which provides a point of entry for HIV into the bloodstream. Prostitution is an outlet for lack of money, education, and skills, and places women at risk. The transmission from men to women is higher than the reverse. Every women should know their risks and modes of transmission. Women need to know that the risk of fetal infection from an HIV-positive mother is 20-40%, and that the risk is highest if HIV infection occurs or AIDS symptoms occur during pregnancy. Infant mortality from HIV may occur within the 1st several years. The following needs to be understood about reproduction and HIV: the risk of infection is very high when impregnated by an HIV male partner, and if children are desired, artificial insemination should be the preferred method. The reverse holds true, because penetrative sex without a condom allows transmission of the virus. The best option is for avoidance of childbearing if a partner has HIV. Abortion should be provided. Women need to develop the skills in language and confidence to negotiate safer sex, should be particular about choosing a loyal partner, and protect themselves by urging male condom use. The mode of transmission to babies is not from cuddling or handling. Breast feeding carries a meager risk of transmission, and should be continued if HIV infection occurs; the baby should be immunized. All health workers should receive training in order to provide support and care to mother and child in a private and confidential manner. Traditional healers have a role in providing advice on AIDS and condoms, spiritual support, and in changing behavior. Peer counseling is an important strategy for teenagers. There is a great need from society,husbands, and family to change the views of women and sex and to support women. Testing and screening of pregnant women in whom HIV infection is suspected is recommended.
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PMID:Role of women in prevention and control of AIDS. 185 51

Parvovirus B19 was identified in 1975. It causes infections megalerythemia in adults associated with skin eruptions and joint pain (about 50% of the adult population is immunized). The risk of contamination in case of an epidemia is high in school teachers and school personnel. In 1984, the parvovirus B19 was implicated as the cause of fetal anasarca. The risk of transplacental contamination is estimated at 33% in case of maternal infection. Pregnant women with parvovirus B19 infection and confirmed serology should have an echography every 15 days. Fetal anasarca can be complicated by in utero fetal death related to erythroid stem-cell anaemia. The diagnosis of fetal infection is based on PCR techniques on fetal blood. Symptomatic antenatal treatment with in utero transfusion was proposed as early as 1988. This method does not however appear to be necessary in all cases as the outcome in several reports of untreated fetuses was delivery of a normal child. There is the possibility of myocardial damage caused by parvovirus B19 which would make in utero transfusion difficult and limit its beneficial effect. Finally associated thrombopenia is often severe and increased fetal risk.
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PMID:[Parvovirus B19 infection and pregnancy]. 778 89

Fetal blood values were evaluated from 541 cordocenteses. Simple regressions were used to find a correlation between blood values and gestational age. We found a linear increase in hemoglobin concentration and hematocrit throughout gestation; a linear decrease of the mean corpuscular volume with the gestation was evidenced as a regular decrease in mean corpuscular hemoglobin. Lastly, the mean corpuscular hemoglobin concentration was constant during the gestation; a linear increase of the platelet count and the nucleated cells was also evidenced. We suggest that each fetal medicine unit should have its own reference ranges. It will permit to accurately diagnose fetal infection, fetal anemia, or any fetal disease where alterations of hematopoiesis have been described.
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PMID:Hematologic values of fetal blood obtained by means of cordocentesis. 826 65

Human cytomegalovirus (HCMV) is the most common cause of viral intrauterine infection and fetal damage largely due to maternal primary infection. Virological procedures which are able to detect HCMV fetal infection were evaluated. HCMV IgG antibodies were detected in 62.5% of the pregnant women and 1.47% had a primary infection. From March, 1992 to August, 1995, 29 seroconversions were observed, and in 64 other cases. HCMV IgM antibodies were detected in the first serological test. The mean IgG antibody avidity test (AI) was 31% for the 11 seroconversions tested and 74% in 32 cases where IgG and IgM HCMV antibodies were detected in the first serum. In the 29 HCMV seroconversions, 19 amniocentesis were carried out and 12 fetuses (41.4%) were infected in utero. In four amniotic fluids positive in culture and PCR, the fetus or newborns were infected and in one out of the two cordocentesis undertaken, hepatitis, anemia, and thrombocytopenia were noted. In four other cases, investigations seeking HCMV in amniotic fluid were negative whereas infants were infected at birth. Among the 64 cases with positive HCMV IgM and IgG antibodies detected in the first serological test, three fetuses were infected in utero, but no amniotic fluid was available in these cases. Amniotic fluids were studied in 39 cases, and HCMV detection by culture and PCR-hybridization was negative. HCMV DNA was detected in the maternal sera of five out of 21 pairs of seroconversions and in two cases on the first negative serum. The assay was also carried out on 50 of the 64 HCMV IgM positive sera. Two had detectable HCMV DNA.
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PMID:Evaluation of virological procedures to detect fetal human cytomegalovirus infection: avidity of IgG antibodies, virus detection in amniotic fluid and maternal serum. 889 34

We report a case of spontaneous reversal in utero of hydrops fetalis caused by parvovirus B19 maternal-fetal infection. The route leading to fetal hydrops is not fully understood. Severe anemia with hypoxemia and viral fetal myocarditis have been incriminated. Then the main issue is fetal death or spontaneous abortion. Cases of spontaneous reversal of hydrops fetalis are unusual. Fetal regenerative anemia is a good prognostic factor and emphasizes the place of conservative management.
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PMID:Nonimmune hydrops fetalis caused by intrauterine human parvovirus B19 infection: a case of spontaneous reversal in utero. 921 42

Parvovirus B19 is usually associated with an acute, self-limited disease in children. In patients with a congenital hemolytic anemia, infection with this virus can cause an aplastic crisis. We describe such a crisis in an adult with asymptomatic hereditary spherocytosis. The association between acute red blood cell aplasia and infection with parvovirus B19 is well described in patients with hereditary hemolytic anemia, particularly sickle cell anemia. This association has also been described, although less frequently, in patients with other inherited hemolytic diseases, such as hereditary spherocytosis. In children, human parvovirus B19 causes an acute self-limited illness known as erythema infectiosum (fifth disease). In immunocompromised individuals, chronic infections can occur and cause a severe, persistent anemia. In pregnant women, infection can, but usually does not, lead to fetal infection. An infected fetus can have severe anemia, congestive heart failure, generalized edema (fetal hydrops) and even death. Most cases of aplastic crises associated with parvovirus B19 in patients with hereditary spherocytosis have been reported in children and adolescents. In this paper we describe an aplastic crisis in a 28 year old man with asymptomatic hereditary spherocytosis.
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PMID:Aplastic crisis associated with parvovirus B19 in an adult with hereditary spherocytosis. 930 16

The protozoan parasite Toxoplasma gondii is a serious cause of fetal mortality in sheep and goats. Oocysts, the parasite stage responsible for initiating infection, are produced following a primary infection in cats. A primary infection in pregnant sheep and goats can establish a placental and fetal infection which may result in fetal death and resorption, abortion or stillbirth. Diagnosis is aided by the clinical picture, the presence of characteristic small white necrotic foci in placental cotyledons, the possible presence of a mummified fetus and on fetal serology and histopathology. Development of the polymerase chain reaction (PCR) specific for T. gondii may also provide a valuable diagnostic tool. Measures to control abortion include improved management of farm cats, fodder and water. Vaccination of sheep with the live vaccine is an effective preventive measure and the use of decoquinate in feed may be useful in some situations. Neospora caninum is related to T. gondii and while its asexual life cycle is similar to that of the latter it is currently not known whether it has a similar sexual life cycle in a definitive host. Neospora is an important cause of fetal loss in cattle and parallels that of T. gondii infection in sheep and goats. While it does not appear to cause frequent losses in these latter animals, experimental infection is readily induced in them and if initiated during pregnancy provides a very good model of the bovine infection. Furthermore clinical signs and pathological lesions in sheep and goats are similar to those induced in them by T. gondii, although there are subtle histopathological differences. These changes will aid possible diagnosis as will specific serological tests such as the indirect immunofluorescent antibody test and the enzyme linked immunosorbent assay and the PCR. Sarcocystis, which exists as numerous species, undergoes a coccidian-like life cycle with each having a distinctive definitive (usually carnivore) host which excretes sporocysts into the environment. Clinical sarcocystiosis is much less commonly diagnosed than toxoplasmosis and neither is it normally associated with fetal infection or abortion in either sheep or goats. However, infection is extremely common throughout the world and follows ingestion of food or water contaminated with sporocysts. Clinical signs, when seen, include fever, anaemia, inappetance and weight loss or reduced weight gain. Central nervous signs (hind limb weakness, ataxia, paresis), acute myopathy and death may occur. Diagnosis is difficult as infection is so common and clinical signs absent, mild or non-specific. Serology may be useful in some situations and histopathology/immunohistochemistry is valuable for confirming the cause of death. Control relies on preventing contamination of pasture and water with faeces of dogs, foxes and cats or by controlling access of young susceptible stock to contaminated land. Relatively little is known of the immunity induced by infection with Sarcocystis spp. but research indicates that protective immunity does develop and that cell-mediated mechanisms are probably important. It is likely that sarcocystiosis is underdiagnosed as a problem and that better diagnostic methods are needed to show the true extent of the losses caused. Neosporosis on the other hand would appear not to be so common in sheep and goats. The value of experimental infections in these animals may be to provide a comparative model of the infection in cattle in the same way that our understanding of toxoplasmosis in sheep provides a superior model of human toxoplasmosis.
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PMID:Protozoan infections (Toxoplasma gondii, Neospora caninum and Sarcocystis spp.) in sheep and goats: recent advances. 968 43

An enlarged fetal spleen can be associated with fetal infection, anemia and different syndromes but its prenatal diagnosis is rare. We report on a diagnosis of splenomegaly at 32 weeks' gestation in a fetus which was found to be affected by cytomegalovirus infection. An enlarged spleen was suspected when the stomach was found to be displaced anteriorly and medially and the diagnosis was supported on visualization of the splenic vessels by color and three-dimensional power Doppler ultrasound. The patient had been referred because of fetal growth restriction and intracerebral anomalies and the additional finding of splenomegaly was highly suspicious for cytomegalovirus infection. This was confirmed by positive maternal serology and by neonatal virus excretion in urine. Retrospectively, examination of stored blood samples from 9 and 23 weeks' gestation revealed an early cytomegalovirus infection. Antenatal and neonatal magnetic resonance imaging examinations showed microcephaly, lissencephaly and the presence of microcalcifications. At the age of 9 months, the child suffers from severe neurological impairment and blindness due to severe optical atrophy. This case emphasizes that color Doppler and three-dimensional power Doppler ultrasound can facilitate the antenatal diagnosis of splenomegaly and can help to delineate the spleen from the similar-looking neighboring liver.
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PMID:Marked splenomegaly in fetal cytomegalovirus infection: detection supported by three-dimensional power Doppler ultrasound. 1223 Apr 58

The factors contributing toward the high incidence of low weight births in developing countries were described and suggestions for reducing the number of low weight births were made. Low birth weight infants were defined as those babies who weighed 2500 g or less at birth. Socioeconomic, cultural, biological, maternal, obstetric, and fetal factors, identified in previous studies as contributory factors, were summarized. In regard to social, economic, and cultural factors, low birth weight is positively correlated with 1) low socioeconomic status; 2) poor maternal diet; 3) short birth intervals; 4) illegitimacy; 5) the performance of strenuous work during the last 6 weeks of pregnancy; 6) low maternal education; and 7) smoking. Biological factors positively associated with low birth weight include 1) early and late maternal age; 2) 1st births; 3) low maternal weight and short maternal stature; 4) the birth of females; 5) slow maternal growth patterns; and 6) high altitude pregnancies. Maternal factors positively associated with low birth weight include 1) the presence of maternal tuberculosis, heart disease, renal failure, and hypertension; 2) low maternal caloric and protein intake; 3) maternal anemia; 4) obstetric complications; 5) a history of previous low weight births, abortions, stillbirths, or premature births; 6) various uterine and placental factors; 7) multiple pregnancies; and 8) inadequate prenatal care. Fetal factors associated with low weight births include fetal infection and congenital abnormalities. The cause of low weight births varies in different populations and the 1st step in any preventive program is to determine the major causes of low weight births in the target population. Preventive measures include 1) improving secioeconomic and public health conditions; 2) upgrading maternal diets and maternal and prenatal health care; 3) expanding health education programs; and 4) preventing premature births.
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PMID:Epidemiology and prevention of low birth weight babies in a developing country. 1231 Jan 5


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