Group A streptococcus: is there a genital carrier state in women following infection?

Group A streptococcus (GAS) is a rare but serious cause of postpartum and gynecological infections. There are no follow-up or prophylaxis guidelines for women with previous GAS genital infection. We aimed to evaluate the incidence of long-term gynecological carrier state in patients with a history of genital GAS infection. This is a prospective study of women who had a genital GAS infection and were followed for 1 year from the date of isolation. Cultures were obtained every 3-4 months. As a control group, women with no previously documented GAS infection were screened for GAS. Twenty-five women with a previous GAS infection participated in the study. Two of the 25 patients had positive vaginal GAS cultures during follow-up, giving a carrier rate of 8 %. Four hundred and thirty-six women participated in the control group; none was a carrier of GAS (p < 0.003). We found that common gynecological procedures were occasionally associated with invasive GAS infection. A significant rate of carriers was found among women with previous GAS genital infection. Common office procedures can be related to severe GAS infection. Consideration should be given to screening women with previous GAS infection prior to invasive as well as semi-invasive gynecological or obstetric procedures.

[Assisted reproduction technologies and the risk of fetal, chromosomal and genetic malformations].

BACKGROUND: Assisted reproduction techniques allowed thousands of otherwise infertile couples to attain pregnancy. As this technology moves into the mainstream of infertility treatment, it has become more critical to reassess its safety. OBJECTIVE: To review the birth outcome of patients undergoing conventional in-vitro fertilization and intracyto- plasmic sperm injection regarding fetal malformations, chromosomal and genetic abnormalities. METHODS: Selective review of the literature. RESULTS: Most of the published data is from observational studies and is not randomized or blinded. Unfortunately, most articles are inherently biased. Chromosomal and genetic abnormalities are increased probably only as a direct corollary to the underlying parental risk and not due to the technology itself. There is a slight increase in the congenital malformations rate, but inspection of these malformations reveal no clustering of any specific abnormality. CONCLUSIONS: Children born after assisted reproduction technologies have an increased risk of a major congenital malformation and chromosomal abnormalities compared with those born after natural conception. The risk is mainly due to paternal and maternal risk factors, which are more prevalent in couples who use assisted reproduction techniques for reproduction. Infertility-linked risk is highly probable for the observed findings. A technique-related risk, however, cannot be ruled out. Intracytoplasmic sperm injection appears to be a safe alternative for couples who otherwise would be unable to achieve pregnancy. The inherent risks associated with these genetically "at risk" couples mandate thorough evaluation and counseling before undertaking ICSI.

Prenatal ultrasonographic diagnosis of atypical Nonne-Milroy lymphedema.

Nonne-Milroy lymphedema is a relatively rare disorder characterized by firm edema of the lower extremities either on the whole leg or limited to the feet or toes. We report a case of atypical Nonne-Milroy syndrome that presented prenatally with bilateral leg edema, bilateral hydrothorax and lung hypoplasia at 22 weeks' gestation. The differential diagnoses are discussed.