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1.
Medicine (Baltimore) ; 98(44): e17744, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689826

RESUMO

Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.


Assuntos
Sepse Neonatal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Sepse/diagnóstico , Sífilis Congênita/diagnóstico , Sífilis/diagnóstico , Estudos de Casos e Controles , China , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/microbiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Sepse Neonatal/microbiologia , Sepse Neonatal/mortalidade , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/mortalidade , Estudos Retrospectivos , Sepse/microbiologia , Sepse/mortalidade , Sífilis/microbiologia , Sífilis/mortalidade , Sorodiagnóstico da Sífilis , Sífilis Congênita/mortalidade
2.
Medicine (Baltimore) ; 98(44): e17751, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689830

RESUMO

Maternal bacterial sepsis during pregnancy and the postpartum period is a common cause of maternal mortality and fetal morbidity and mortality. This study was performed to analyze perinatal prognosis and related factors of maternal bacterial sepsis in west China.We conducted a cross-sectional study of pregnant women with bacterial sepsis who were admitted into a tertiary care center in western China between 2011and 2015. Data from these cases were collected and analyzed.Eighty six women were identified with bacterial sepsis in our hospital, and the incidence of maternal bacterial sepsis was 1.7 per 1000 maternities, the incidence of septic shock was 1.8 per 10,000 maternities, and 1 maternal death occurred. Among the 86 pregnant women with bacterial sepsis, genital tract infection was the most common source of infection (41/86, 47.7%). The most common bacteria in the Gram-positive bacteria group was Listeria monocytogenes and in the Gram-negative bacteria group was Escherichia coli. The premature delivery rate (65.7%) was substantially higher in the Gram-negative bacteria group (P = .011), and the miscarriage rate (31.3%) was higher in the Gram-positive bacteria group (P = .042). The fetal/neonatal mortality rate was 20% (21/105) and higher in the Gram-positive bacteria group (P = .008), and the infant mortality rate in 1 year was 7.1% (6/84).Bacterial sepsis remains an alarming cause of both maternal and fetal morbidity and mortality, and infant mortality. Key treatment involves a multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women with sepsis and early initiation of appropriate antibiotics according to the type of bacterial infection. The effect of maternal sepsis on long-term fetal outcome should be investigated.


Assuntos
Bactérias Gram-Negativas , Bactérias Gram-Positivas , Complicações Infecciosas na Gravidez/mortalidade , Infecções do Sistema Genital/mortalidade , Sepse/mortalidade , Aborto Espontâneo/microbiologia , Aborto Espontâneo/mortalidade , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Infecções do Sistema Genital/microbiologia , Sepse/microbiologia
3.
Lakartidningen ; 1162019 Sep 27.
Artigo em Sueco | MEDLINE | ID: mdl-31573669

RESUMO

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Assuntos
Mortalidade Materna , Adolescente , Adulto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Morte Materna , Transtornos Mentais/mortalidade , Transtornos Mentais/prevenção & controle , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde , Sociedades Médicas , Suicídio/prevenção & controle , Suécia/epidemiologia , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
5.
BMC Infect Dis ; 19(1): 683, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375073

RESUMO

BACKGROUND: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. METHODS: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02-7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48-0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75-1.34). CONCLUSIONS: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.


Assuntos
Influenza Humana/mortalidade , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/virologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Gestantes , Fatores de Risco
6.
Emerg Infect Dis ; 25(8): 1469-1476, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310223

RESUMO

Syphilis is a sexually transmitted infection that has direct adverse effects on maternal and infant health through vertical Treponema pallidum transmission during early pregnancy. We evaluated congenital syphilis as a predictor of the quality of basic maternal and child healthcare in Brazil during 2010-2015. We investigated case rates and correlations with epidemiologic and socioeconomic indicators. We observed rising congenital syphilis incidence rates and increasing syphilis-associated perinatal and infant mortality rates in all regions. Case rates were highest in the Northeast, Southeast, and South, and congenital syphilis infant mortality rates were highest in the Northeast and Southeast. We observed correlations between congenital syphilis rates and infant death, spontaneous abortion (miscarriage), and stillbirth rates. We also noted correlations between rates of stillbirth caused by syphilis and inadequate prenatal care. Our study suggests gaps in basic healthcare for pregnant women and indicates the urgent need for measures to increase early diagnosis and appropriate treatment.


Assuntos
Saúde da Criança , Assistência à Saúde , Transmissão Vertical de Doença Infecciosa , Complicações Infecciosas na Gravidez/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Sífilis Congênita/epidemiologia , Saúde da Mulher , Brasil/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Mortalidade , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/mortalidade , Vigilância em Saúde Pública , Fatores Socioeconômicos , Natimorto , Sífilis Congênita/microbiologia , Sífilis Congênita/mortalidade
7.
Int J Gynaecol Obstet ; 146(1): 39-42, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037723

RESUMO

Despite major advances in the last century, particularly in high resource settings, maternal sepsis remains a common and potentially preventable cause of direct maternal death globally. A barrier to further progress has been the lack of consensus on the definition of maternal sepsis. Publications from two recent multidisciplinary consensus conferences, one on sepsis in the non-pregnant adult and the other on sepsis in the pregnant woman, concluded that the criteria for diagnosing sepsis should be clinically-based, applicable at the bedside, and should not be laboratory-based. Informed by reviews of the evidence, in 2017 WHO published a new definition of maternal sepsis based on the presence of suspected or confirmed infection. It also announced a Global Maternal and Neonatal Sepsis Initiative to identify the diagnostic criteria for the early identification, epidemiology, and disease classification of maternal sepsis. Standardizing the criteria for maternal sepsis optimizes clinical audit and research. It may facilitate the evaluation of the role of different clinical parameters and biomarkers in the diagnosis, earlier recognition and management of maternal infection and sepsis. Further work is required to develop an international consensus on the criteria for diagnosing maternal sepsis and any associated organ dysfunction.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Sepse/diagnóstico , Adulto , Conferências de Consenso como Assunto , Diagnóstico Precoce , Feminino , Humanos , Morte Materna/prevenção & controle , Mortalidade Materna , Escores de Disfunção Orgânica , Gravidez , Complicações Infecciosas na Gravidez/classificação , Complicações Infecciosas na Gravidez/mortalidade , Medição de Risco , Sepse/classificação , Sepse/mortalidade
8.
BJOG ; 126 Suppl 3: 41-48, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30897278

RESUMO

OBJECTIVE: To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary health facilities. POPULATION: Women admitted with complications during pregnancy, childbirth or puerperium. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria. MAIN OUTCOME MEASURES: Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). RESULTS: Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non-obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO. CONCLUSION: Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications. FUNDING: The original research that generated the data for this secondary analysis and the publication of this secondary analysis were funded by the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). TWEETABLE ABSTRACT: Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals.


Assuntos
Morte Materna/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações Infecciosas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/mortalidade , Complicações na Gravidez/mortalidade , Adulto , Anemia/mortalidade , Estudos Transversais , Feminino , Infecções por HIV/mortalidade , Inquéritos Epidemiológicos , Humanos , Incidência , Hepatopatias/mortalidade , Morte Materna/etiologia , Mortalidade Materna , Nigéria/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Centros de Atenção Terciária
9.
PLoS One ; 14(3): e0214050, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921353

RESUMO

BACKGROUND: Linking routinely-collected data provides an opportunity to measure the effects of exposures that occur before birth on maternal, fetal and infant outcomes. High quality linkage is a prerequisite for producing reliable results, and there are specific challenges in mother-baby linkage. Using population-based administrative databases from Brazil, this study aimed to estimate the accuracy of linkage between maternal deaths and birth outcomes and dengue notifications, and to identify potential sources of bias when assessing the risk of maternal death due to dengue in pregnancy. METHODS: We identified women with dengue during pregnancy in a previously linked dataset of dengue notifications in women who had experienced a live birth or stillbirth during 2007-2012. We then linked this dataset with maternal death records probabilistically using maternal name, age and municipality. We estimated the accuracy of the linkage, and examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS: Of the 10,259 maternal deaths recorded in 2007-2012, 6717 were linked: 5444 to a live birth record, 1306 to a stillbirth record, and 33 to both a live and stillbirth record. After identifying 2620 missed-matches and 124 false-matches, our estimated sensitivity was 72%, specificity was 88%, and positive predictive value was 98%. Linkage errors were associated with maternal education and self-identified race; women with more than 7 years of education or who self-declared as Caucasian were more likely to link. Dengue status was not associated with linkage error. CONCLUSION: Despite not having unique identifiers to link mothers and birth outcomes, we demonstrated a high standard of linkage, with sensitivity and specificity values comparable to previous literature. Although there were no differences in the characteristics of dengue cases missed or included in our linked dataset, linkage error occurred disproportionally by some social-demographic characteristics, which should be taken into account in future analyses.


Assuntos
Declaração de Nascimento , Bases de Dados Factuais , Atestado de Óbito , Registro Médico Coordenado , Adulto , Brasil/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Dengue/complicações , Dengue/epidemiologia , Dengue/mortalidade , Feminino , Humanos , Recém-Nascido , Nascimento Vivo/epidemiologia , Masculino , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/mortalidade , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Sistema de Registros , Natimorto/epidemiologia
10.
Top Magn Reson Imaging ; 28(1): 29-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30817678

RESUMO

In the present case series, the cause of death of infants diagnosed with congenital Zika syndrome (CZS) was lung disease (pneumonia and sepsis with massive pulmonary aspiration), probably secondary to dysphagia and reflux. The main findings in infants with a confirmed diagnosis of CZS who died were as follows: (1) calcification and hypoplasia of the lentiform nuclei, hypoplasia of the caudate nuclei, and calcification at the cortical-subcortical junction was noted in all cases (100%) and calcification of the caudate nuclei was noted in 66.7% of cases; (2) calcification in the brainstem and along the lateral wall of the lateral ventricles was noted in only the case with arthrogryposis (33.3%); and (3) lesions in the posterior fossa (hypoplasia of the brainstem and cerebellum) were noted in two cases (66.7%), including the case with arthrogryposis. The findings concerning calcifications and brain malformations obtained from non-contrast computed tomography (CT) demonstrated good agreement with findings obtained from the postmortem pathological analysis; however, CT failed to detect discontinuity of the pia mater with heterotopia, invasion of the cerebral tissue into the subarachnoid space, and discontinuity of the ependyma in the lateral ventricles with gliosis; this last feature was only imaged in the most severe case of extreme microcephaly with a simplified gyral pattern. Only histopathology showed grouped calcifications associated with scattered calcifications suggestive of the neuron morphology.


Assuntos
Encéfalo/diagnóstico por imagem , Complicações Infecciosas na Gravidez/mortalidade , Tomografia Computadorizada por Raios X/métodos , Infecção por Zika virus/congênito , Infecção por Zika virus/mortalidade , Autopsia , Encéfalo/ultraestrutura , Encéfalo/virologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/mortalidade , Causas de Morte , Feminino , Humanos , Lactente , Pneumopatias/etiologia , Pneumopatias/mortalidade , Microcefalia/etiologia , Microcefalia/mortalidade , Microcefalia/virologia , Gravidez , Sepse/etiologia , Sepse/mortalidade , Síndrome , Zika virus , Infecção por Zika virus/diagnóstico por imagem
11.
Am J Obstet Gynecol ; 220(4): 391.e1-391.e16, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30786257

RESUMO

BACKGROUND: Sepsis is a leading cause of pregnancy-related mortality. Previous studies have reported an increased prevalence of sepsis during pregnancy. Despite national campaigns to increase sepsis awareness, there is a lack of pregnancy-specific guidelines. OBJECTIVE: We aimed to provide updated national estimates of the prevalence and trends of sepsis, sepsis-related in-hospital mortality, and factors associated with in-hospital mortality among women with sepsis at delivery. STUDY DESIGN: We conducted a serial, cross-sectional analysis using data from the 2002-2015 National Inpatient Sample, the largest publicly available all-payer inpatient database in the United States. We used International Classification of Diseases, ninth edition, Clinical Modification diagnosis and procedure codes to identify the study sample of delivery-associated hospitalizations and to capture diagnoses of sepsis (defined as infection with associated end-organ dysfunction). The primary outcome was in-hospital mortality. Obstetric comorbidities and pregnancy-related outcomes were also analyzed. Logistic regression was used to explore factors associated with sepsis during pregnancy and, among those with sepsis, to identify predictors of in-hospital mortality. Joinpoint regression was used to estimate the temporal trends in both sepsis and in-hospital mortality. RESULTS: Of the more than 55 million delivery-associated hospitalizations, 13,129 women met criteria for sepsis, corresponding to a rate of 2.4 per 10,000 deliveries. This rate increased from 1.2 to 3.7 per 10,000 over the study period, representing an annual increase of 6.6% (95% confidence interval, 4.2-9.1). The highest crude rates of sepsis (per 10,000) were among deliveries paid for by Medicare (14.8), deliveries to women aged 40 years or older (8.0), and deliveries to non-Hispanic black women (4.6). Compared with women without sepsis, women with sepsis had a greater than 10-fold increased prevalence of most selected obstetric comorbidities. One in 11 women with sepsis died prior to discharge, compared with 1 death in every 15,411 deliveries without sepsis. The sepsis-related mortality rate decreased 21.8% each year from 2010 through 2015. Maternal age greater than 40 years and nonprivate insurance demonstrated the highest odds of sepsis-related in-hospital mortality. CONCLUSION: While rates of delivery-associated sepsis have increased, case fatality has decreased.


Assuntos
Parto Obstétrico , Mortalidade Hospitalar/tendências , Seguro Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Sepse/epidemiologia , Adulto , Afro-Americanos , Fatores Etários , Americanos Asiáticos , Comorbidade , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Modelos Logísticos , Idade Materna , Medicaid , Medicare , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Prevalência , Sepse/mortalidade , Estados Unidos , Adulto Jovem
12.
Obstet Gynecol Surv ; 74(2): 93-98, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30756123

RESUMO

Importance: Herpes simplex virus (HSV) hepatitis is a rare condition with a high mortality rate. Immunocompromised individuals, including pregnant women, are the most susceptible. When primary infection occurs during pregnancy, risk for disseminated HSV is greatly increased. Disseminated HSV can manifest in the form of HSV hepatitis. Objective: We aim to review the literature and summarize what is known about HSV hepatitis in pregnancy to aid in the diagnosis and treatment of this condition. Evidence Acquisition: A literature search of PubMed and Web of Science was performed. A total of 237 citations were found. All citations were independently reviewed. Thirty-eight full-text articles were identified and included in this review. Additional data from 1 unpublished case from our institution was included. Results: Fifty-six cases were included with average gestational age at diagnosis of 30 weeks. Patients presented with a wide variety of gastrointestinal, respiratory, neurologic, and urogenital symptoms. The most common examination findings were fever and abdominal tenderness. Only 18.2% of patients had a vesicular rash. All patients had a transaminitis, and 85% had positive viral cultures. A multitude of treatments were used with the majority of favorable outcomes occurring after treatment with acyclovir. Conclusions and Relevance: Although HSV hepatitis is rare, it carries a mortality rate of up to 39% for mothers and neonates. Therefore, it is crucial that HSV hepatitis be included on the differential diagnosis when a patient presents with fever and transaminitis. When HSV hepatitis is suspected, empiric therapy with acyclovir can be initiated with no additional risk to the fetus.


Assuntos
Herpes Simples/virologia , Complicações Infecciosas na Gravidez/virologia , Simplexvirus , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Feminino , Herpes Simples/tratamento farmacológico , Herpes Simples/mortalidade , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/mortalidade , Resultado da Gravidez
13.
J Infect Chemother ; 25(1): 41-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30377069

RESUMO

The present retrospective study provides an in-depth analysis of the maternal sepsis-related deaths reported in Japan, and aims to guide future care regarding maternal sepsis. This is a nationwide, retrospective, descriptive cohort study. Data were retrospectively analyzed on all maternal death cases related to sepsis reported in Japan from 2010 through 2016. A total of 7,347,727 births and 317 maternal deaths were reported during the study period. The cause of maternal death was sepsis in 24 women (7.5%). Causative bacteria were Streptococcus pyogenes (54.2%), Chlamydia psittaci (8.3%), Mycobacterium tuberculosis (8.3%), Escherichia coli (4.2%), Neisseria meningitidis (4.2%), Epstein-Barr virus (4.2%), and unknown (16.6%). In maternal death due to S. pyogenes (13 women), onset periods ware antepartum in 10 women (76.9%) and postpartum in 3 (23.1%); death within 24 h after hospital admission occurred in 7 women (53.8%); and the median time from hospital admission to death was 12 h (6-744 h). The most common causative bacteria in to maternal sepsis-related death were GAS. When encountering severe sepsis during the peripartum period, we recommend considering severe GAS infection and early intervention.


Assuntos
Mortalidade Materna , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/mortalidade , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/mortalidade , Streptococcus pyogenes/isolamento & purificação , Adulto , Chlamydophila psittaci/genética , Chlamydophila psittaci/isolamento & purificação , Estudos de Coortes , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Feminino , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/isolamento & purificação , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/sangue , Estudos Retrospectivos , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/genética , Inquéritos e Questionários , Adulto Jovem
14.
Rev Chilena Infectol ; 35(4): 424-430, 2018 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-30534930

RESUMO

BACKGROUND: Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies. AIMS: To describe the incidence, clinical features and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies. METHODS: Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database. RESULTS: Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants. CONCLUSION: The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.


Assuntos
Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/mortalidade , Sepse/mortalidade , Sepse/prevenção & controle , Infecções Estreptocócicas/mortalidade , Infecções Estreptocócicas/prevenção & controle , Adolescente , Adulto , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Adulto Jovem
15.
Cardiovasc J Afr ; 29(5): 289-295, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30059130

RESUMO

OBJECTIVE: To document maternal and foetal morbidity and mortality in anticoagulated, pregnant patients with mechanical heart valves until 42 days postpartum. METHODS: In a tertiary single-centre, prospective cohort, 178 consecutive patients at the cardiac-obstetric clinic were screened for warfarin use between 1 July 2010 and 31 December 2015. Of 33 pregnancies identified, 29 were included. Patients received intravenous unfractionated heparin from six to 12 weeks' gestation and peripartum, and warfarin from 12 to 36 weeks. Maternal outcomes including death, major haemorrhage and thrombosis, and foetal outcomes were documented. RESULTS: There were two maternal deaths, five returns to theatre post-delivery, eight patients transfused, six major haemorrhages, one case of infective endocarditis and three ischaemic strokes. Ten pregnancies had poor foetal outcomes (six miscarriages, three terminations, one early neonatal death). Twenty patients required more than 30 days' hospitalisation, and 15 required three or more admissions. HIV positivity was associated with surgical delivery (p = 0.0017). CONCLUSION: Complication rates were high despite centralised care.


Assuntos
Anticoagulantes/efeitos adversos , Implante de Prótese de Valva Cardíaca , Heparina/efeitos adversos , Hemorragia Pós-Parto/induzido quimicamente , Complicações Cardiovasculares na Gravidez/induzido quimicamente , Varfarina/efeitos adversos , Aborto Espontâneo/induzido quimicamente , Adulto , Anticoagulantes/administração & dosagem , Feminino , Mortalidade Fetal , Idade Gestacional , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Heparina/administração & dosagem , Humanos , Nascimento Vivo , Mortalidade Materna , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/terapia , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Cardiovasculares na Gravidez/terapia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/mortalidade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , África do Sul , Fatores de Tempo , Varfarina/administração & dosagem , Adulto Jovem
16.
Sci Rep ; 8(1): 9938, 2018 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-29967399

RESUMO

Dengue is a mosquito-borne disease with major public health importance due to its growing incidence and geographical spread. There is a lack of knowledge on its contribution to maternal death. We conducted a population-based cohort study to investigate the association between symptomatic dengue during pregnancy and deaths in Brazil from 2007 to 2012. We did this by linking routine records of confirmed dengue cases to records of deaths of women who had a live birth. Using the Firth method, we estimated odds ratios for maternal deaths associated with dengue during pregnancy. Dengue increased the risk of maternal death by 3 times (95%CI,1.5-5.8) and dengue haemorrhagic fever increased the risk of maternal death by 450 times (95%CI,186.9-1088.4) when compared to mortality of pregnant women without dengue. The increase in risk occurred mostly during acute dengue 71.5 (95%CI,32.8-155.8), compared with no dengue cases. This study showed an increased risk of adverse outcomes in pregnant women with dengue. Therefore in areas where dengue is circulating, the health of pregnant women should be not only a public health priority, but health professionals attending pregnant women with dengue should more closely observe these patients to be able to intervene in a timely way and avoid deaths.


Assuntos
Dengue/mortalidade , Complicações Infecciosas na Gravidez/mortalidade , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Mortalidade Materna , Gravidez , Adulto Jovem
17.
Indian J Med Microbiol ; 36(1): 121-123, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29735841

RESUMO

Hepatitis E infection (HEV) in pregnant females, especially in the third trimester is associated with poor foetomaternal outcomes. However, the mechanisms of severe liver injury remain obscure. In a recent HEV outbreak in North India, six pregnant females were detected to be positive for HEV infection with concomitant hepatitis A infection in three pregnant females. None of the pregnant females were positive for hepatitis B or hepatitis C infection. The mortality was 50% in pregnant females. In an outbreak, besides, testing for hepatitis markers and understanding the pathogenesis of HEV infection in pregnancy, improving basic hygienic standards is of utmost importance.


Assuntos
Vírus da Hepatite A/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite E/isolamento & purificação , Hepatite E/mortalidade , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/virologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Surtos de Doenças , Feminino , Hepatite A/complicações , Hepatite A/mortalidade , Hepatite B/complicações , Hepatite B/mortalidade , Hepatite E/complicações , Humanos , Índia , Fígado/lesões , Fígado/virologia , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Adulto Jovem
18.
Pediatr Infect Dis J ; 37(12): 1271-1278, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29750766

RESUMO

BACKGROUND: HIV-exposed uninfected (HEU) infants are a growing population with potentially poor health outcomes. We evaluated morbidity and mortality in HEU formula-fed infants enrolled in the NICHD HPTN 040/PACTG 1043 trial. METHODS: Infectious morbidity, mortality and undernutrition were evaluated within a cohort of 1000 HEU infants enrolled between April 2004 and April 2010 in Brazil (n = 766) and South Africa (n = 234) as part of the NICHD/HPTN 040 trial of 3 different antiretroviral regimens to decrease intrapartum HIV vertical transmission. RESULTS: Twenty-three percent of infants had at least 1 infectious serious adverse effect. Infants born to mothers with <12 years of education [adjusted odds ratio (AOR), 2.6; 95% confidence interval [CI], 1.2-5.9), with maternal viral load of >1,000,000 copies/mL at delivery (AOR, 9.9; 95% CI, 1.6-63.1) were more likely to have infectious serious adverse effects. At 6 months, the infant mortality rate per 1000 live births overall was 22 ± 2.6, 9.1 ± 1.8 in Brazil and 64.1 ± 3 in South Africa. Undernutrition and stunting peaked at 1 month of age with 18% having a weight-for-age Z score ≤-2, and 22% with height for Z score ≤-2. The likelihood of infant mortality was greater among infants born in South Africa compared with Brazil (AOR, 6.2; 95% CI, 2.5-15.8), high maternal viral load (AOR, 1.7; 95% CI, 1.01-2.9) and birth weight-for-age Z score ≤-2 (AOR, 5.2; 95% CI, 1.8-14.8). CONCLUSIONS: There were high rates of undernutrition, stunting and infectious serious adverse effect in this study's formula-fed HEU population. Suppressing maternal HIV viral load during the peripartum period may be a modifiable risk factor to decrease infant mortality.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/complicações , Mortalidade Infantil , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Brasil/epidemiologia , Causas de Morte , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Lactente , Fórmulas Infantis , Masculino , Desnutrição/epidemiologia , Desnutrição/etiologia , Estado Nutricional , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/mortalidade , Fatores de Risco , África do Sul/epidemiologia , Carga Viral
19.
Trop Med Int Health ; 23(7): 724-737, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29779260

RESUMO

OBJECTIVE: To evaluate mother and infant outcomes in the largest prevention of mother-to-child-transmission (PMTCT) programme in Haiti in order to identify gaps towards elimination of HIV and syphilis. METHODS: Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999 to 2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery as well as infant enrolment in PMTCT, HIV testing and HIV infection. Four PMTCT programme periods were compared: period 1 (1999-2004, mono ARV), period 2 (2005-2009, dual ARV), period 3 (2010-2012, Option B) and period 4 (Oct 2012-2014, Option B+). Kaplan-Meier methods were used to assess retention in PMTCT care. RESULTS: Among 4665 pregnancies, median age was 27 years and median CD4+ was 494 cells/µl (IQR 328-691). A total of 75% of women received antiretrovirals before delivery, and 73% were retained in care through delivery. Twenty-two percent of women were lost before delivery, <1% died and 6% had stillbirths or abortions. Ninety-four percent of infants who were born alive enrolled in PMTCT, of whom 92% had complete HIV testing. One hundred and sixty-one infants were HIV+, giving a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8% and 3.6% in periods 1-4). Retention among women through 12 months after PMTCT enrolment did not significantly differ across periods. However, among women who received antiretrovirals at the time of enrolment, retention 12 months later was lower in the Option B+ period (83%) than in periods 2 and 3 (94% and 93%) (P < 0.001). Syphilis infection among women decreased from 16% in period 1 to 8% in period 4, whereas syphilis testing of infants increased from 17% to 91%. CONCLUSION: Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Sífilis/prevenção & controle , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Infecções por HIV/transmissão , Haiti/epidemiologia , Humanos , Recém-Nascido , Serviços de Saúde Materno-Infantil/normas , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/mortalidade , Diagnóstico Pré-Natal , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Sífilis/epidemiologia , Sífilis/mortalidade , Sífilis/transmissão , Adulto Jovem
20.
Ultrasound Obstet Gynecol ; 52(5): 569-576, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29785793

RESUMO

OBJECTIVE: To explore the outcome of fetuses affected by congenital parvovirus B19 (PB19) infection, with or without signs of hydrops on ultrasound. METHODS: PubMed, EMBASE and CINAHL databases were searched for studies reporting on prenatal diagnosis and outcome of fetal PB19 infection. The outcomes explored were miscarriage, perinatal death (PND), intrauterine death, neonatal death, spontaneous resolution of hydrops or fetal anemia, need for intrauterine transfusion (IUT), resolution of hydrops or anemia after transfusion, fetal loss following transfusion, abnormal brain scan after birth and abnormal neurodevelopmental outcome. Outcomes were reported according to the presence or absence of signs of hydrops on ultrasound. A subgroup analysis was performed including hydropic and non-hydropic fetuses diagnosed at < 20 weeks and ≥ 20 weeks of gestation. Meta-analyses of proportions and meta-analyses using individual-data random-effects logistic regression were performed to analyze the data. RESULTS: Thirty-five observational studies were included, involving 611 fetuses affected by PB19 infection. The risks of miscarriage (odds ratio (OR), 11.5; 95% CI, 2.7-49.7) and PND (OR, 4.2; 95% CI, 1.6-11.0) were higher in fetuses with PB19 infection presenting, compared with those not presenting, signs of hydrops on ultrasound. In fetuses affected by hydrops, spontaneous resolution of the infection, defined as disappearance of hydrops without need for IUT, occurred in 5.2% (95% CI, 2.5-8.8%) of cases whereas, in the group of fetuses not affected by hydrops, infection resolved in 49.6% (95% CI, 20.7-78.6%) of cases. IUT was performed in 78.7% (95% CI, 66.4-88.8%) of hydropic and in 29.6% (95% CI, 6.0-61.6%) of non-hydropic fetuses affected by congenital PB19 infection and resolution of the infection after IUT occurred in 55.1% (95% CI, 34.0-75.3%) and in 100% (95% CI, 57.3-100%) of cases, respectively. The risk of fetal loss after IUT was higher in fetuses affected compared with those not affected by hydrops (OR, 9.8; 95% CI, 2.8-34.6). The prevalence of abnormal brain imaging was 9.8% (95% CI, 2.5-21.0%) in fetuses affected and 0.0% (95% CI, 0.0-7.0%) in those not affected by hydrops, whilst the corresponding figures for abnormal neurodevelopmental outcome were 9.5% (95% CI, 2.6-20.2) and 0.0% (95% CI, 0.0-7.5), respectively; however, statistical power to assess these outcomes was inadequate due to the small number of included cases. CONCLUSIONS: Hydrops is the main determinant of mortality and adverse perinatal outcome in fetuses with PB19 infection. Perinatal outcome in non-hydropic fetuses is generally favorable. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Eritema Infeccioso/mortalidade , Hidropisia Fetal/mortalidade , Complicações Infecciosas na Gravidez/mortalidade , Eritema Infeccioso/complicações , Eritema Infeccioso/virologia , Feminino , Morte Fetal , Idade Gestacional , Humanos , Hidropisia Fetal/virologia , Parvovirus B19 Humano/patogenicidade , Gravidez , Complicações Infecciosas na Gravidez/virologia , Diagnóstico Pré-Natal
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