RESUMEN
Objectives Congenital infection with Toxoplasma gondii is known to result in neurological and brain disorders including ophthalmic disorders later in life. Research in Ghana revealed high sero-prevalence among pregnant women and eye patients. This study determines the risk of congenital transmission of T. gondii infection in Accra, Ghana. Methods One hundred consented pregnant women aged 18-45 years (mean 29.85 ± 5.76) participated. Venous blood and tissue samples were taken from the maternal side of each placenta after delivery. Cord blood samples were also taken after they were separated from the infants. Finger-prick blood was taken from infants of participating women at 2 or 6 weeks post-natal. ELISA was used to detect T. gondii antibodies in all blood samples while Nested-PCR was used to detect T. gondii DNA from placental tissues. Data was analysed using SPSS v. 16. Results Overall, 37.6 % of maternal blood, 39.5 % of umbilical cord blood, and 57.5 % of post-natal infant blood were positive for anti-T. gondii IgG. No anti-T. gondii IgM was detected in any of those samples. Toxoplasma gondii DNA was detected in 39.8 % of placental tissue samples. Strong association was observed in the occurrence of placental T. gondii DNA and anti-T. gondii IgG positive women (ø = 0.810, p < 0.00001) as well as high Relative risk shown in the likelihood of foetal exposure to infection in latently-infected women (RR 10.39; CI 4.47-24.17; p < 0.00001). Conclusions for Practice The presence of anti-T. gondii IgG antibodies only, and T. gondii DNA in placental tissues indicate the women might have been infected early during the pregnancy, placing about 39.8 % of the babies at risk. These results can strongly influence policy to screen and treat pregnant women for T. gondii infection.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/epidemiología , Toxoplasma/aislamiento & purificación , Toxoplasmosis/diagnóstico , Adolescente , Adulto , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Ghana/epidemiología , Humanos , Inmunoglobulina G , Recién Nacido , Persona de Mediana Edad , Madres , Reacción en Cadena de la Polimerasa , Embarazo , Prevalencia , Factores de Riesgo , Toxoplasma/genética , Toxoplasmosis/sangre , Toxoplasmosis/epidemiología , Toxoplasmosis/parasitologíaRESUMEN
OBJECTIVE: To evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg). PATIENTS AND METHODS: Forty patients were included in a retrospective study from 1998 to 2008. RESULTS: Fifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23+6 wg and reached 80% after 24 wg (P=0.006). Perinatal mortality affected more frequently primigravida women (OR=5.16; IC9 5% [0.99-36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1±13.8 vs. 40.3±2.3j; P=0.01). Chorioamnionitis complicated all pregnancies terminated before 26 wg versus 50% of pregnancies terminated after 26 wg (P=0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P=0.02; OR=4.3; IC95% [0,99-22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid. DISCUSSION AND CONCLUSION: The gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality.
Asunto(s)
Rotura Prematura de Membranas Fetales/terapia , Edad Gestacional , Resultado del Embarazo/epidemiología , Adulto , Proteína C-Reactiva/análisis , Corioamnionitis/epidemiología , Corioamnionitis/microbiología , Femenino , Muerte Fetal , Rotura Prematura de Membranas Fetales/mortalidad , Mortalidad Fetal , Humanos , Embarazo , Estudios Retrospectivos , Fumar/efectos adversos , Fumar/epidemiología , Tasa de SupervivenciaRESUMEN
OBJECTIVES: To define the optimal delay before inducing labor in the management of premature rupture of the membranes (PRM) at term with unfavourable cervix in order to reduce the risk of caesarean section as well as the risk of maternal and foetal infection. MATERIALS AND METHODS: Retrospective study of three homogeneous groups carried out over on a period of 4years in two centres. All the patients were included after premature rupture of membranes at term with unfavourable cervix (Bishop score<6). We defined three expected delays after PRM at term: less than 7h (group 1), between 7 and 12h (group 2) and more than 12h (group 3). We have assessed the obstetrical, maternal and foetal consequences for each group. RESULTS: Sixty patients were allocated in group 1, 49 in group 2 and 46 in group 3. There was no significant difference in the rate of caesarean between the three groups but it was lower in group 2: 6.1% versus 18.3% in group 1 and 21.7% in group 3. No statistical difference was observed concerning maternal or foetal infections. CONCLUSION: In PRM at term, neither our study nor literature data allow us to conclude about the optimal delay before inducing labor.