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PubMed1986

Infective endocarditis in obstetric and gynecologic practice.

Infective endocarditis is an important but uncommon complication in obstetric or gynecologic practice; we found only 124 cases reported in English and selected European papers during the last 40 years. The majority of cases (74%) were caused by streptococci; viridans streptococci predominated, while enterococci and group B streptococci were uncommon except after abortion. The overall mortality rate was 29%, while the mortality rate for the fetus when the mother developed infective endocarditis was 23%. The incidence of endocarditis in this setting is low and seems to be decreasing. Therefore, the risk-benefit ratio may not favor routine use of prophylaxis for endocarditis. We conclude that antibiotics need not be given for prevention of endocarditis before most common obstetric and gynecologic procedures. These include uncomplicated vaginal deliveries, uncomplicated spontaneous or induced abortions, dilatation and curettage, insertion or removal of intrauterine contraceptive devices (in the absence of pelvic infection), and biopsies of the cervix. For patients in whom both the underlying heart lesion and the obstetric or gynecologic procedure seem to pose significant risk for endocarditis, prophylaxis should be given. Two parenteral regimens for patients at highest risk are recommended: ampicillin plus gentamicin or vancomycin plus gentamicin. For lower-risk situations, one oral regimen is suggested: amoxicillin.

Abortion, Spontaneous↗
PubMed1989

Relationship between virulence of Chlamydia psittaci strains and establishment of persistent infection of McCoy cells.

The pathogenicity of chlamydial strains for their natural hosts and their ability to induce persistent infections in McCoy cells were compared. Both virulent and avirulent strains persistently infected McCoy cells, but the appearance of the cell culture varied between strains. Avirulent strains induced completely inapparent persistent infection (infection Type 1), while with invasive strains the culture alternated between periods of cell multiplication and periods of extensive cytopathic change (infection Type 2). The virulence of virulent strains was not attenuated, even after 6 months of culture, but after 2 or 3 months some avirulent strains produced infection Type 2 and became invasive for mice and abortive for ewes. This variation of virulence was accompanied by a modification of protein patterns.

Abortion, Veterinary↗
PubMed2004

Efficacy of live Chlamydophila abortus vaccine 1B in protecting mice placentas and foetuses against strains of Chlamydophila pecorum isolated from cases of abortion.

The efficacy of Chlamydophila abortus vaccine strain 1B in protecting against two selected Chlamydophila pecorum strains, isolated from an aborted goat (M14) in Morocco and a ewe (AB10) in France, was investigated in a mouse model, by comparing the reduction in number of bacteria in the placentas of vaccinated mice challenged intraperitoneally at 11 days of pregnancy with the reference C. abortus (AB7) and C. pecorum (M14, or AB10) strains, to those of unvaccinated mice. Vaccine 1B was shown to provide effective protection against the field strains of C. pecorum, since it significantly reduced the placental Chlamydophila colonisation. The two C. pecorum strains were not sufficiently abortifacient in mice to use reduction in abortion as a criterion of protection.

Abortion, Veterinary↗
PubMed2006

Artificial insemination of cows with semen in vitro contaminated with Neospora caninum tachyzoites failed to induce neosporosis.

Neosporosis is a major cause of abortion in cattle all over the world. Congenital transmission as well as horizontal transmission by ingestion of oocysts has been described. The detection of Neospora caninum DNA in bull semen warrants the investigation of possible transmission through the use of contaminated semen. In this experiment four cows were artificially inseminated with frozen-thawed semen contaminated in vitro with viable N. caninum tachyzoites (group A) and four control cows were inseminated with tachyzoites-free frozen-thawed semen, from the same bull (group B). Serum samples were collected 15 days before the artificial insemination (AI) and at days 10, 14, 21, 28, 45, 60 and 75 post-insemination. All sera samples were tested for neosporosis by direct agglutination test (DAT). Three of the cows from group A had negative DAT titers (< or =1:20) in all of the samples, while the fourth cow from this group had a low titer of antibodies (1:80) at day 10, and became negative at day 45, suggesting a stimulation of the immune system by the tachyzoites placed in uterus, rather than the induction of an infection. All of the cows from group B had negative DAT titers (< or =1:20) in all of the samples. These results suggest that transmission of neosporosis by artificial insemination with frozen-thawed semen is an unlikely event.

Abortion, Veterinary↗
PubMed1997

Transmission of varicella-vaccine virus from a healthy 12-month-old child to his pregnant mother.

A 12-month-old healthy boy had approximately 30 vesicular skin lesions 24 days after receiving varicella vaccine. Sixteen days later his pregnant mother had 100 lesions. Varicella-vaccine virus was identified by polymerase chain reaction in the vesicular lesions of the mother. After an elective abortion, no virus was detected in the fetal tissue. This case documents transmission of varicella-vaccine virus from a healthy 12-month-old infant to his pregnant mother.

Abortion, Induced↗
PubMed1998

Intrauterine viral infection at the time of second trimester genetic amniocentesis.

OBJECTIVE: To determine whether preexisting intrauterine viral infection is associated with postamniocentesis pregnancy loss. METHODS: We accessed our bank of second-trimester amniotic fluid (AF) samples obtained aseptically and stored at -20C from all 11,971 women who underwent genetic amniocentesis between 1988 and 1995. Samples were retrieved from every case of spontaneous pregnancy loss within 30 days of the amniocentesis (excluding aneuploidy and anomalies, n = 66). Sixty-six control samples were randomly chosen from subjects who delivered at term and were matched for year of test, gestational age, maternal age, and indication for amniocentesis. Investigators were blinded to the status of the samples, which were studied by polymerase chain reaction (PCR) for the presence of adenovirus, parvovirus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, enterovirus, influenza A virus, and beta-actin DNA. Results were compared with interleukin-6 (IL-6) levels previously measured by enzyme-linked immunosorbent assay in the same samples. RESULTS: Sixty-two study cases and 60 controls were sufficient for all PCR studies. Fourteen AF samples contained a single virus: five (8%) of 62 study cases and nine (15%) of 60 controls (P = .27). Adenovirus accounted for nine (64%) of 14 viruses identified: four of 62 cases and five of 60 controls (P = .74). Cytomegalovirus was not identified in any study cases but was found in three controls. The mean IL-6 levels in samples with and without virus were not significantly different (4.8+/-15.9 ng/mL with virus compared with 2.0+/-8.8 ng/mL without virus; P = .53). CONCLUSION: Presence of virus in second-trimester AF is not significantly associated with elevated IL-6 levels or with early postamniocentesis pregnancy loss.

Abortion, Spontaneous↗
PubMed1976

Parity of women contracting rubella in pregnancy. Implications with respect to rubella vaccination.

Data from the National Congenital Rubella Surveillance Programme showed that 44% of children with congenital rubella reported to the programme were born to primiparae. This high proportion is thought to be due to the fact that there was a two-fold increase in the rate of abortion for rubella in pregnancy for women with two or more children. This higher incidence of congenital rubella in firstborns emphasises the need for rubella vaccination prior to a woman's first pregnancy.

Abortion, Therapeutic↗
PubMed2002

[Abortion in humans caused by Chlamydophila abortus (Chlamydia psittaci serovar 1)].

On a farm housing cattle and goats an abortion storm occurred affecting 50% of the goats during the lambing season 2000/2001. In one of three investigated caprine abortions Chlamydophila abortus could be identified as etiology. During this time a pregnant woman (pregnancy week 19/20) had contact with aborting goats. She developed a severe generalized infection and aborted. The placenta contained Chlamydophila abortus shown by immunohistochemistry and PCR. Aim of the present case report is to alert veterinarians about the potential zoonotic risk of ovine/caprine abortions.

Abortion, Spontaneous↗
PubMed1982

[Amniotic infection syndrome after amniocentesis--a case report].

A severe amniotic infection syndrome with a septic shock and a consumption coagulopathy is reported after an amniocentesis in second trimester. In literature, the risk of an amnionitis after amniocentesis amounts to 0.1%-0.4% and the risk of a severe maternal infection reaches 0.03%-0.19%. The available data show, that the clinical symptoms (rise in temperature, signs of septic shock) start 24-36 hours after the punction. The earlier treatment (evacuation of the uterus or - if necessary - hysterectomy) is accomplished, the more favourable will be the course of the disease with respect to septic shock and DIC. Determination of germs in each amniotic fluid seems to be of prognostic value; thus treatment can be started before infection becomes detrimental for the mother.

Abortion, Therapeutic↗
PubMed2003

Second-trimester pregnancy loss at an urban hospital.

OBJECTIVES: Second-trimester spontaneous pregnancy losses are less common than first-trimester losses, and are often associated with ascending infection and/or acute chorioamnionitis. A Medline search revealed only two large studies published in the recent literature, reporting incidences of chorioamnionitis of 39.3% and 58.2%, respectively. These studies did not address the use of histopathology for the identification of organisms. Since ascending infection is likely to be a significant cause of second-trimester loss in the inner-city population at the University Hospital in Newark, New Jersey, we sought to evaluate the usefulness of stains for microorganisms, which are rarely utilized on these specimens. METHODS: Retrospective review of the medical records and pathologic material for cases of spontaneous abortions seen at the University Hospital in Newark between January 1999 and March 2001 was undertaken. Stains for microorganisms were performed on archival placental tissue for cases with histologic acute chorioamnionitis. RESULTS: A total of 67 cases were available for review, of which 38 cases (56.7%) showed histologic acute chorioamnionitis, similar to the rates in one previous study, but significantly higher than those in the other (p = 0.01). Of 25 cases with histological chorioamnionitis for which appropriate fetal material was available, 13 cases (52%) showed polymorphonuclear leukocytes (PMNs) in the fetal lungs, one case (4%) showed PMNs in the fetal stomach, and seven cases (28%) showed PMNs in both the lung and the stomach. Of the 38 cases with chorioamnionitis, Gram stains showed Gram-positive cocci in six cases, two of which were culture positive for group B streptococcus. Warthin-Starry stains showed filamentous organisms consistent with Fusobacterium sp. in the placenta in three cases. CONCLUSIONS: Acute chorioamnionitis is associated with second-trimester pregnancy loss at this inner-city hospital, and may be related to the high incidence of risk factors in this population. A small proportion of cases can be further characterized by the inclusion of Gram and Warthin-Starry stains in the evaluation. Selection of cases with histologic acute chorioamnionitis for further study with special stains may provide additional information on the causative organism.

Aborted Fetus↗