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4 results

  • Chapter 22 - Infectious Diseases in Pregnancy

  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Grace Lim, University of Pittsburgh
  • Book:
    Obstetric Anesthesia and Uncommon Disorders
    Published online:
    26 January 2024
    Print publication:
    01 February 2024, pp 367-388

  • Summary

    Infections cause direct maternal morbidity and remain a leading cause of maternal morbidity in the United States and globally. In this chapter, we will discuss the physiologic considerations of infectious diseases in pregnancy, alterations in pregnancy response to infections, changes in immune cell populations, and fetal immune response. Pregnancy is a state of relative immunosuppression order for the maternal “host” to not reject fetus and this immunosuppression has consequences in the setting of infectious illness. The pathophysiology, epidemiology, obstetric management, antibiotic therapy, and anesthetic management of the most frequent bacterial and viral infections in the obstetric patient including chorioamnionitis, sepsis, human immunodeficiency virus (HIV), group A streptococcus, and TORCH infections. Additionally, we will present the obstetric and anesthetic management of uncommon bacterial, viral, and parasitic infections. This chapter provides nuanced understanding of peripartum immunologic physiology, an overview of common obstetrical infections, and a quick resource for uncommon as well as tropical infections, such as tuberculosis and malaria as they relate to pregnancy for obstetrics anesthesia providers. Management pearls included in this chapter can improve maternal and fetal outcomes for pregnant patients with infections illnesses.

  • Chapter 15 - Labor at Term

  • from Section 2 - Labor and Delivery
  • Edited by Amira El-Messidi, McGill University, Montréal, Alan D. Cameron, University of Glasgow
  • Book:
    OSCEs in Obstetrics and Maternal-Fetal Medicine
    Published online:
    23 February 2023
    Print publication:
    16 February 2023, pp 199-227

  • Summary

    During your call duty, a healthy 30-year-old primigravida at 40+4 weeks’ gestation, confirmed by first-trimester sonography, presents to the obstetric emergency assessment unit of your hospital center with possible spontaneous rupture of the chorioamniotic membranes after a two-day history of increased aching in the low back and coccyx. You recall meeting the patient at a routine prenatal visit at 32 weeks’ gestation while briefly covering your colleague’s practice; you ascertained all aspects of maternal-fetal care had been normal. Electronic health records indicate she has since remained compliant with obstetric care, which has been uncomplicated up to the latest prenatal visit three days ago.

  • Causal role of group B Streptococcus-induced acute chorioamnionitis in intrauterine growth retardation and cerebral palsy-like impairments

  • M.-J. Allard, M.-E. Brochu, J. D. Bergeron, M. Segura, G. Sébire
  • Journal:
    Journal of Developmental Origins of Health and Disease / Volume 10 / Issue 5 / October 2019
    Published online by Cambridge University Press:
    10 January 2019, pp. 595-602

  • Chorioamnionitis and intrauterine growth retardation (IUGR) are risk factors for cerebral palsy (CP). Common bacteria isolated in chorioamnionitis include group B Streptococcus (GBS) serotypes Ia and III. Little is known about the impact of placental inflammation induced by different bacteria, including different GBS strains. We aimed to test the impact of chorioamnionitis induced by two common GBS serotypes (GBSIa and GBSIII) on growth and neuromotor outcomes in the progeny. Dams were exposed at the end of gestation to either saline, inactivated GBSIa or GBSIII. Inactivated GBS bacteria invaded placentas and triggered a chorioamnionitis featured by massive polymorphonuclear cell infiltrations. Offspring exposed to GBSIII – but not to GBSIa – developed IUGR, persisting beyond adolescent age. Male rats in utero exposed to GBSIII traveled a lower distance in the Open Field test, which was correlating with their level of IUGR. GBSIII-exposed rats presented decreased startle responses to acoustic stimuli beyond adolescent age. GBS-exposed rats displayed a dysmyelinated white matter in the corpus callosum adjacent to thinner primary motor cortices. A decreased density of microglial cells was detected in the mature corpus callosum of GBSIII-exposed males – but not females – which was correlating positively with the primary motor cortex thickness. Altogether, our results demonstrate a causal link between pathogen-induced acute chorioamnionitis and (1) IUGR, (2) serotype- and sex-specific neuromotor impairments and (3) abnormal development of primary motor cortices, dysmyelinated white matter and decreased density of microglial cells.

  • 11 - Infection

    • By Paul Dias, Specialist Registrar in Anaesthetics and Intensive Care, Royal Wolverhampton Hospitals, NHS Trust, Wolverhampton, UK
  • Alexander Heazell, University of Manchester, John Clift
  • Book:
    Obstetrics for Anaesthetists
    Published online:
    21 August 2009
    Print publication:
    06 March 2008, pp 130-135

  • Summary

    Infection occurring in pregnancy can result in significant morbidity and mortality for both mother and child. This chapter talks about prophylaxis, screening, chorioamnionitis, Group B streptococcal infection, human immunodeficiency virus (HIV), and genital herpes. It explains the implications of these infections on pregnancy and their postpartum management. Depending on the type of infection, there is an increased incidence of preterm delivery, intrauterine growth restriction, intrauterine and infant death and mother-to-child transmission of infection. Women undergoing repair of a third or fourth degree tear require intra-operative and post-operative antibiotic therapy to prevent infection which increases wound breakdown and the incidence of fistula formation. Group B streptococcal infection is the most frequent cause of severe sepsis in the first week of life. Treatment of women with high viral load of HIV usually consists of highly active antiretroviral therapy (HAART) to stabilize symptoms and reduce viraemia.