This document summarizes information on four common infections that can cause complications if acquired during pregnancy: cytomegalovirus (CMV), parvovirus B19, varicella zoster virus (VZV), and toxoplasmosis. It discusses the prevalence, transmission, clinical presentations, risks of perinatal transmission, and maternal, fetal, and infant effects of each infection. CMV is the most common congenital infection, occurring in 0.2-2.2% of neonates. Parvovirus B19 can cause hydrops fetalis in up to 10-18% of cases. VZV exposure in the first or second trimester poses risks of congenital varicella syndrome.
Certain viruses can be transmitted from mother to fetus during pregnancy and cause fetal or neonatal damage. These include cytomegalovirus, rubella virus, varicella zoster virus, herpes simplex virus, and parvovirus B19. Cytomegalovirus is the most common cause, with an estimated 1% of newborns infected worldwide. Severe damage from cytomegalovirus, such as cytomegalic inclusion disease, occurs in about 1 in 5,000 to 1 in 20,000 births. Transmission is more likely when a mother has a primary infection compared to a recurrent infection. Clinical manifestations in the newborn are also more common following primary maternal infection.
This document discusses congenital viral infections that can be acquired during pregnancy and cause fetal or neonatal damage. It provides tables listing various viruses that can be transmitted perinatally, including known teratogenic viruses like cytomegalovirus, rubella virus, and herpes simplex virus. The tables show the frequency of these viral infections in pregnant women and their children. The document also discusses the consequences of different viral infections during pregnancy and outlines clinical syndromes and recommended diagnostic tests.
This document provides an overview of several congenital, perinatal, and neonatal viral infections. It summarizes the characteristics, risks, outcomes, prevention, and diagnosis of rubella, cytomegalovirus, herpes simplex virus, parvovirus B19, and varicella-zoster virus infections during pregnancy and in newborns. For each virus, it discusses transmission routes, clinical features of infection, risks of transmission and outcomes for the fetus or newborn, methods of diagnosis, and approaches to prevention and management.
This document summarizes various perinatal infections, including their diagnosis and treatment. It discusses infections caused by viruses like cytomegalovirus (CMV), herpes simplex virus (HSV), rubella, toxoplasmosis, HIV, and syphilis. For CMV, the document notes that infection is common in newborns and often asymptomatic, but can cause neurological and vision issues. Treatment of symptomatic congenital CMV with ganciclovir is discussed but toxicity is a concern. Diagnosis and management of other infections like congenital toxoplasmosis, syphilis and rubella are also covered.
Viral pathogenesis is the process by which a viral infection leads to disease. It depends on factors from both the virus and host. Key viral factors include the virus's ability to enter cells, spread systemically, and cause cell damage or death. The host immune response is also crucial, as it typically clears the virus but sometimes causes immunopathology. Outcomes range from acute recovery to chronic infection or disease. Examples provided demonstrate how specific viruses like rubella, herpes, dengue, hepatitis B, and HIV interact with hosts to produce different clinical manifestations.
This document discusses various infections that can occur during pregnancy and affect the fetus. It covers viral infections like rubella, measles, cytomegalovirus and herpes which can cause birth defects or complications if the mother is infected during pregnancy. It also discusses bacterial infections like group B streptococcus, gonorrhea and chlamydia which can lead to preterm birth or infection of the newborn. The document provides details on potential issues, screening and treatment recommendations for each infection.
This document summarizes common viral infections including measles, varicella, mumps, and viral hepatitis. Measles is caused by a paramyxovirus and causes a rash and respiratory symptoms. Varicella (chickenpox) is caused by varicella zoster virus and presents with a pruritic vesicular rash that spreads. Mumps is caused by a paramyxovirus and presents with painful swelling of the salivary glands. Hepatitis A and B viruses are described as common causes of viral hepatitis transmitted through fecal-oral and blood-borne routes respectively.
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
Certain viruses can be transmitted from mother to fetus during pregnancy and cause fetal or neonatal damage. These include cytomegalovirus, rubella virus, varicella zoster virus, herpes simplex virus, and parvovirus B19. Cytomegalovirus is the most common cause, with an estimated 1% of newborns infected worldwide. Severe damage from cytomegalovirus, such as cytomegalic inclusion disease, occurs in about 1 in 5,000 to 1 in 20,000 births. Transmission is more likely when a mother has a primary infection compared to a recurrent infection. Clinical manifestations in the newborn are also more common following primary maternal infection.
This document discusses congenital viral infections that can be acquired during pregnancy and cause fetal or neonatal damage. It provides tables listing various viruses that can be transmitted perinatally, including known teratogenic viruses like cytomegalovirus, rubella virus, and herpes simplex virus. The tables show the frequency of these viral infections in pregnant women and their children. The document also discusses the consequences of different viral infections during pregnancy and outlines clinical syndromes and recommended diagnostic tests.
This document provides an overview of several congenital, perinatal, and neonatal viral infections. It summarizes the characteristics, risks, outcomes, prevention, and diagnosis of rubella, cytomegalovirus, herpes simplex virus, parvovirus B19, and varicella-zoster virus infections during pregnancy and in newborns. For each virus, it discusses transmission routes, clinical features of infection, risks of transmission and outcomes for the fetus or newborn, methods of diagnosis, and approaches to prevention and management.
This document summarizes various perinatal infections, including their diagnosis and treatment. It discusses infections caused by viruses like cytomegalovirus (CMV), herpes simplex virus (HSV), rubella, toxoplasmosis, HIV, and syphilis. For CMV, the document notes that infection is common in newborns and often asymptomatic, but can cause neurological and vision issues. Treatment of symptomatic congenital CMV with ganciclovir is discussed but toxicity is a concern. Diagnosis and management of other infections like congenital toxoplasmosis, syphilis and rubella are also covered.
Viral pathogenesis is the process by which a viral infection leads to disease. It depends on factors from both the virus and host. Key viral factors include the virus's ability to enter cells, spread systemically, and cause cell damage or death. The host immune response is also crucial, as it typically clears the virus but sometimes causes immunopathology. Outcomes range from acute recovery to chronic infection or disease. Examples provided demonstrate how specific viruses like rubella, herpes, dengue, hepatitis B, and HIV interact with hosts to produce different clinical manifestations.
This document discusses various infections that can occur during pregnancy and affect the fetus. It covers viral infections like rubella, measles, cytomegalovirus and herpes which can cause birth defects or complications if the mother is infected during pregnancy. It also discusses bacterial infections like group B streptococcus, gonorrhea and chlamydia which can lead to preterm birth or infection of the newborn. The document provides details on potential issues, screening and treatment recommendations for each infection.
This document summarizes common viral infections including measles, varicella, mumps, and viral hepatitis. Measles is caused by a paramyxovirus and causes a rash and respiratory symptoms. Varicella (chickenpox) is caused by varicella zoster virus and presents with a pruritic vesicular rash that spreads. Mumps is caused by a paramyxovirus and presents with painful swelling of the salivary glands. Hepatitis A and B viruses are described as common causes of viral hepatitis transmitted through fecal-oral and blood-borne routes respectively.
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
This document discusses TORCH infections that can affect pregnancy. It covers Toxoplasmosis, Rubella, CMV, and Herpes infections. For each infection, it describes transmission, clinical manifestations, effects on pregnancy like risk of transmission and fetal anomalies, diagnosis, and treatment approaches. For toxoplasmosis, it highlights risks increase with gestational age and treatments include pyrimethamine and spiramycin. For rubella, congenital rubella syndrome can cause fetal defects if acquired early in pregnancy. CMV and herpes infections also pose risks of fetal transmission and growth restriction. Diagnosis involves serology and PCR testing of amniotic fluid. Treatment may include antivirals and monitoring for complications.
This document provides an overview of TORCH infections, which include toxoplasmosis, other (syphilis), rubella, cytomegalovirus, and herpes simplex virus. It discusses the introduction, screening, clinical features, diagnosis and management of each infection. Key points include that TORCH infections can cause congenital infections in infants if mothers are infected during pregnancy. Symptoms in infants range from asymptomatic to vision and brain abnormalities. Screening and treatment are important for improving infant outcomes.
A sincere effort
A compilation of all the diagnostic methods for diagnosis of ToRCH gp of infections in Pregnant women..
Presentation is done in two parts-
part-1 includes Toxoplasmosis and Rubella virus infection
Part-2- Cytomegalovirus, HSV-1, HSV-2 are covered
microbiological, lab diagnosis of Torch complex, Laboratory diagnosis of TORCH complex, Cytomegalovirus, Herpes simplex type1, HSV-1, Herpes simplex type2, HSV-2,
Shell vial technique,
The TORCH complex is a set of perinatal infections that can be transmitted from mother to fetus, including toxoplasmosis, rubella, CMV, and herpes. These infections pose risks for severe fetal anomalies and can cause fetal death. Toxoplasmosis is caused by the parasite Toxoplasma gondii and can be acquired through contaminated food, water, or soil. Rubella virus causes congenital rubella syndrome and poses greater risks the earlier in pregnancy the maternal infection occurs. CMV is the most common congenital viral infection and can cause hearing loss, seizures, or developmental delays in infants. Herpes infection during pregnancy risks transmission to the newborn, potentially causing skin lesions, eye damage
If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading
this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may
have had the genital type of Herpes (HSV2).
This document discusses infections in pregnancy, including TORCH infections (toxoplasmosis, other [syphilis], rubella, cytomegalovirus, and herpes simplex virus), as well as HIV in pregnancy. It describes how pregnancy predisposes women to certain infections due to immunocompromise. It provides details on screening, diagnosis, treatment and management of various infections that can affect the mother and fetus, including toxoplasmosis, rubella, cytomegalovirus, syphilis, herpes, and HIV. It also discusses pre-pregnancy, antenatal, intrapartum and postpartum care recommendations for HIV-positive women.
This document provides information on nursing care for HIV/AIDS children. It discusses HIV transmission, clinical manifestations at different stages, opportunistic infections, antiretroviral therapy, nutrition management, immunizations, and nursing assessments and interventions. Key points include transmission from mother to child, asymptomatic onset but development of symptoms over time, opportunistic infections as immune system weakens, antiretroviral therapy to suppress virus, and holistic nursing care to support health and development.
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
TORCH syndrome is a group of symptoms caused by Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex, and other organisms including syphilis, Varicella zoster, and parvovirus.
This document discusses several congenital and perinatal viral infections including rubella, cytomegalovirus, herpes simplex virus, parvovirus B19, and varicella zoster virus. For each virus, it describes characteristics, risks of infection during pregnancy, methods of diagnosis, management considerations, and prevention strategies. The key information provided includes transmission routes, risks of fetal infection, potential sequelae of congenital infection, and approaches to screening, treatment and vaccination.
This document discusses the management of Cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD). It begins by presenting a case study of an 18-year-old man diagnosed with CMV-positive ulcerative colitis. It then provides background on CMV, including how it is transmitted, risk factors for reactivation, and definitions of CMV infection and disease. The document discusses diagnostic guidelines and techniques for detecting CMV in IBD patients. It explores the pathophysiology of CMV infection in IBD, prevalence and clinical findings of CMV colitis in Crohn's disease and ulcerative colitis, and influence of medical treatments on CMV reactivation. It concludes by
This document discusses Varicella-Zoster Virus, which causes chickenpox and shingles. It describes how chickenpox is highly contagious and mainly affects children, while shingles results from reactivation of the virus in nerve ganglia and mainly affects adults and immunocompromised individuals. Complications can be more severe in adults, newborns and immunocompromised patients. Treatment involves antiviral medications like acyclovir to reduce symptoms and duration. Vaccination and immune globulin can help prevent or lessen the disease in high-risk groups following exposure.
The document discusses TORCH testing, which screens for 5 infections - Toxoplasmosis, Other (Syphilis), Rubella, Cytomegalovirus, and Herpes Simplex Virus. These infections can be transmitted from mother to fetus and cause birth defects if acquired during pregnancy. TORCH testing measures IgG and IgM antibodies in blood to determine if a woman has had or has a current infection. Serial testing allows detection of a recent infection based on a rise in antibody levels. Positive IgM indicates a current/recent infection while only IgG indicates a past infection. TORCH screening helps identify women and infants at risk of congenital or neonatal infections.
This document provides information about human papillomavirus (HPV), including that there are over 200 types of HPV that can cause infections in humans. While most HPV infections cause no symptoms, some can cause warts or potentially lead to cancers like cervical cancer. HPV is transmitted through direct skin-to-skin contact, usually sexually. Vaccines can help prevent HPV infection and progression to disease for some high-risk HPV types.
Rubella, also known as German measles, is a contagious viral illness caused by the rubella virus. It is most common in children between 5-10 years of age. The virus is transmitted through respiratory droplets. Common symptoms include a rash and tender lymph nodes. If a woman is infected during pregnancy, especially in the first trimester, it can cause congenital rubella syndrome in the fetus, resulting in defects like deafness, heart problems, and intellectual disabilities. Diagnosis involves isolating the virus or detecting antibodies in blood tests. Vaccination is the best way to prevent rubella infection and its complications.
Rubella is a viral infection transmitted through respiratory droplets. It causes a rash and fever lasting less than a week. While usually mild, rubella infection during pregnancy can cause congenital rubella syndrome in the fetus, resulting in deafness, eye problems, and heart defects. Rubella virus is diagnosed through serologic tests detecting antibodies. Rubella vaccination helps prevent infection and congenital rubella syndrome.
Jim Datson has over 30 years of experience in senior management roles, including 15 years at the senior management level. He has expertise in people leadership, strategy leadership, financial leadership, and project leadership. His career includes roles as the National Fundraising Manager for St John, where he grew annual fundraising revenue from $25M to over $35M, and as the Regional Executive Officer for St John, where he helped recover a region that was technically bankrupt. He holds a BSc from the University of Otago and a Post-Graduate Diploma in Business Administration from the University of Canterbury.
Maternal sepsis is relatively common and usually results from infections originating from the genitourinary tract during labor and delivery or from other common infections exacerbated by pregnancy physiology. These infections have the potential to progress to severe sepsis and septic shock if not promptly recognized and properly managed. The most common causes of maternal sepsis discussed are pyelonephritis, chorioamnionitis, and septic abortion. Labor and delivery units should focus on developing procedures to quickly identify and treat pregnant women experiencing sepsis in order to prevent progression to severe sepsis or septic shock and minimize maternal morbidity and mortality.
This document discusses caffeine consumption and provides information about the amount of caffeine in various foods and drinks. It notes that the general consensus is to stay below 400mg of caffeine per day. However, it can be difficult to track total caffeine intake, as many foods and drinks contain caffeine but do not list the amounts. While caffeine has some potential health benefits, there are also risks from consuming too much, such as anxiety, sleep issues, and caffeine dependence or addiction. The document advises moderating caffeine intake and paying attention to individual tolerance levels.
This document discusses TORCH infections that can affect pregnancy. It covers Toxoplasmosis, Rubella, CMV, and Herpes infections. For each infection, it describes transmission, clinical manifestations, effects on pregnancy like risk of transmission and fetal anomalies, diagnosis, and treatment approaches. For toxoplasmosis, it highlights risks increase with gestational age and treatments include pyrimethamine and spiramycin. For rubella, congenital rubella syndrome can cause fetal defects if acquired early in pregnancy. CMV and herpes infections also pose risks of fetal transmission and growth restriction. Diagnosis involves serology and PCR testing of amniotic fluid. Treatment may include antivirals and monitoring for complications.
This document provides an overview of TORCH infections, which include toxoplasmosis, other (syphilis), rubella, cytomegalovirus, and herpes simplex virus. It discusses the introduction, screening, clinical features, diagnosis and management of each infection. Key points include that TORCH infections can cause congenital infections in infants if mothers are infected during pregnancy. Symptoms in infants range from asymptomatic to vision and brain abnormalities. Screening and treatment are important for improving infant outcomes.
A sincere effort
A compilation of all the diagnostic methods for diagnosis of ToRCH gp of infections in Pregnant women..
Presentation is done in two parts-
part-1 includes Toxoplasmosis and Rubella virus infection
Part-2- Cytomegalovirus, HSV-1, HSV-2 are covered
microbiological, lab diagnosis of Torch complex, Laboratory diagnosis of TORCH complex, Cytomegalovirus, Herpes simplex type1, HSV-1, Herpes simplex type2, HSV-2,
Shell vial technique,
The TORCH complex is a set of perinatal infections that can be transmitted from mother to fetus, including toxoplasmosis, rubella, CMV, and herpes. These infections pose risks for severe fetal anomalies and can cause fetal death. Toxoplasmosis is caused by the parasite Toxoplasma gondii and can be acquired through contaminated food, water, or soil. Rubella virus causes congenital rubella syndrome and poses greater risks the earlier in pregnancy the maternal infection occurs. CMV is the most common congenital viral infection and can cause hearing loss, seizures, or developmental delays in infants. Herpes infection during pregnancy risks transmission to the newborn, potentially causing skin lesions, eye damage
If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading
this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may
have had the genital type of Herpes (HSV2).
This document discusses infections in pregnancy, including TORCH infections (toxoplasmosis, other [syphilis], rubella, cytomegalovirus, and herpes simplex virus), as well as HIV in pregnancy. It describes how pregnancy predisposes women to certain infections due to immunocompromise. It provides details on screening, diagnosis, treatment and management of various infections that can affect the mother and fetus, including toxoplasmosis, rubella, cytomegalovirus, syphilis, herpes, and HIV. It also discusses pre-pregnancy, antenatal, intrapartum and postpartum care recommendations for HIV-positive women.
This document provides information on nursing care for HIV/AIDS children. It discusses HIV transmission, clinical manifestations at different stages, opportunistic infections, antiretroviral therapy, nutrition management, immunizations, and nursing assessments and interventions. Key points include transmission from mother to child, asymptomatic onset but development of symptoms over time, opportunistic infections as immune system weakens, antiretroviral therapy to suppress virus, and holistic nursing care to support health and development.
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
TORCH syndrome is a group of symptoms caused by Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex, and other organisms including syphilis, Varicella zoster, and parvovirus.
This document discusses several congenital and perinatal viral infections including rubella, cytomegalovirus, herpes simplex virus, parvovirus B19, and varicella zoster virus. For each virus, it describes characteristics, risks of infection during pregnancy, methods of diagnosis, management considerations, and prevention strategies. The key information provided includes transmission routes, risks of fetal infection, potential sequelae of congenital infection, and approaches to screening, treatment and vaccination.
This document discusses the management of Cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD). It begins by presenting a case study of an 18-year-old man diagnosed with CMV-positive ulcerative colitis. It then provides background on CMV, including how it is transmitted, risk factors for reactivation, and definitions of CMV infection and disease. The document discusses diagnostic guidelines and techniques for detecting CMV in IBD patients. It explores the pathophysiology of CMV infection in IBD, prevalence and clinical findings of CMV colitis in Crohn's disease and ulcerative colitis, and influence of medical treatments on CMV reactivation. It concludes by
This document discusses Varicella-Zoster Virus, which causes chickenpox and shingles. It describes how chickenpox is highly contagious and mainly affects children, while shingles results from reactivation of the virus in nerve ganglia and mainly affects adults and immunocompromised individuals. Complications can be more severe in adults, newborns and immunocompromised patients. Treatment involves antiviral medications like acyclovir to reduce symptoms and duration. Vaccination and immune globulin can help prevent or lessen the disease in high-risk groups following exposure.
The document discusses TORCH testing, which screens for 5 infections - Toxoplasmosis, Other (Syphilis), Rubella, Cytomegalovirus, and Herpes Simplex Virus. These infections can be transmitted from mother to fetus and cause birth defects if acquired during pregnancy. TORCH testing measures IgG and IgM antibodies in blood to determine if a woman has had or has a current infection. Serial testing allows detection of a recent infection based on a rise in antibody levels. Positive IgM indicates a current/recent infection while only IgG indicates a past infection. TORCH screening helps identify women and infants at risk of congenital or neonatal infections.
This document provides information about human papillomavirus (HPV), including that there are over 200 types of HPV that can cause infections in humans. While most HPV infections cause no symptoms, some can cause warts or potentially lead to cancers like cervical cancer. HPV is transmitted through direct skin-to-skin contact, usually sexually. Vaccines can help prevent HPV infection and progression to disease for some high-risk HPV types.
Rubella, also known as German measles, is a contagious viral illness caused by the rubella virus. It is most common in children between 5-10 years of age. The virus is transmitted through respiratory droplets. Common symptoms include a rash and tender lymph nodes. If a woman is infected during pregnancy, especially in the first trimester, it can cause congenital rubella syndrome in the fetus, resulting in defects like deafness, heart problems, and intellectual disabilities. Diagnosis involves isolating the virus or detecting antibodies in blood tests. Vaccination is the best way to prevent rubella infection and its complications.
Rubella is a viral infection transmitted through respiratory droplets. It causes a rash and fever lasting less than a week. While usually mild, rubella infection during pregnancy can cause congenital rubella syndrome in the fetus, resulting in deafness, eye problems, and heart defects. Rubella virus is diagnosed through serologic tests detecting antibodies. Rubella vaccination helps prevent infection and congenital rubella syndrome.
Jim Datson has over 30 years of experience in senior management roles, including 15 years at the senior management level. He has expertise in people leadership, strategy leadership, financial leadership, and project leadership. His career includes roles as the National Fundraising Manager for St John, where he grew annual fundraising revenue from $25M to over $35M, and as the Regional Executive Officer for St John, where he helped recover a region that was technically bankrupt. He holds a BSc from the University of Otago and a Post-Graduate Diploma in Business Administration from the University of Canterbury.
Maternal sepsis is relatively common and usually results from infections originating from the genitourinary tract during labor and delivery or from other common infections exacerbated by pregnancy physiology. These infections have the potential to progress to severe sepsis and septic shock if not promptly recognized and properly managed. The most common causes of maternal sepsis discussed are pyelonephritis, chorioamnionitis, and septic abortion. Labor and delivery units should focus on developing procedures to quickly identify and treat pregnant women experiencing sepsis in order to prevent progression to severe sepsis or septic shock and minimize maternal morbidity and mortality.
This document discusses caffeine consumption and provides information about the amount of caffeine in various foods and drinks. It notes that the general consensus is to stay below 400mg of caffeine per day. However, it can be difficult to track total caffeine intake, as many foods and drinks contain caffeine but do not list the amounts. While caffeine has some potential health benefits, there are also risks from consuming too much, such as anxiety, sleep issues, and caffeine dependence or addiction. The document advises moderating caffeine intake and paying attention to individual tolerance levels.
This document discusses the history and current state of fetal surgery. It begins with a brief history of fetal surgery from the first documented nonhuman fetal surgery in 1884 to the development of techniques in the 1940s-1960s. Key developments include the first reported human fetal surgery in 1965 and the advent of ultrasound technology in the late 1960s, which enabled less invasive fetal procedures. The document outlines the conditions currently treated with closed (non-hysterotomy) surgical therapies, including fetal transfusion and lower urinary tract obstruction. It emphasizes the importance of a multidisciplinary team approach and counseling for families considering fetal surgery.
- Preterm birth is defined as birth between 20-36 weeks of gestation. Preterm labor is diagnosed based on uterine contractions and cervical changes.
- Tests like fetal fibronectin and cervical length can help predict risk of preterm birth but have poor positive predictive value on their own.
- Antenatal corticosteroids between 24-34 weeks of gestation significantly reduce neonatal mortality and morbidity for preterm births within 7 days and should be considered routine.
- Magnesium sulfate before 32 weeks of gestation reduces the risk of cerebral palsy in surviving infants.
Parto pretermino tardio y a termino tempranorubenhuaraz
The document discusses guidelines for medically indicated late-preterm and early-term deliveries between 34 and 38 weeks gestation. It acknowledges neonatal risks are lower after 39 weeks but certain maternal or fetal complications may warrant earlier delivery. Timing of delivery should balance risks to the mother and baby, considering factors like gestational age accuracy and individual patient circumstances. Recommendations include delivering between 36-37 weeks for conditions like placenta previa or a prior C-section, and no earlier than 38 weeks for an otherwise uncomplicated small baby. All decisions require weighing risks and should be personalized.
Manejo de embarazo a termino tardio y posterminorubenhuaraz
This document provides guidelines for the clinical management of late-term and postterm pregnancies. Late-term refers to pregnancies between 41 0/7 and 41 6/7 weeks gestation, while postterm refers to pregnancies reaching or exceeding 42 0/7 weeks gestation. Risks to the fetus and neonate increase with advancing gestational age beyond 40 weeks, including complications like meconium aspiration and stillbirth. Accurate determination of gestational age through early ultrasound is important to properly identify and manage late-term and postterm pregnancies. The guidelines recommend antepartum fetal surveillance and induction of labor to decrease morbidity and mortality risks for prolonged pregnancies.
1) The spectrum and severity of heart disease in reproductive-aged women is changing, with congenital heart disease now accounting for over half of cardiac disease in pregnancy and ischemic heart disease on the rise.
2) A multidisciplinary approach is needed to determine risks and management strategies for pregnant women with heart disease. Pregnancy is generally not advised for those with severe disease like pulmonary hypertension or severe ventricular dysfunction.
3) Preconception counseling provides an opportunity to review risks specific to a woman's cardiac condition and help guide her decision about pregnancy. Assessment of functional status and imaging can help predict maternal and fetal risks.
Este documento presenta los resultados de un estudio sobre el efecto del herbicida 2,4-D en la germinación de semillas de maíz y frijol. Se realizaron tratamientos con diferentes concentraciones de 2,4-D y se midió el porcentaje de germinación. Los resultados mostraron que concentraciones más bajas de 2,4-D aumentaron la germinación, mientras que concentraciones más altas redujeron la germinación o funcionaron como herbicida. No hubo diferencias significativas en la germinación debido al tiempo.
This document provides guidelines for the evaluation and management of nonimmune hydrops fetalis (NIHF). It summarizes that NIHF is excessive fluid accumulation in fetal tissues without red blood cell alloimmunization as the cause. The most common causes are found to be cardiovascular abnormalities, chromosomal anomalies like Down syndrome, and hematologic conditions such as anemia. Evaluation of NIHF includes determining if it is nonimmune, detailed ultrasound exams, fetal testing for structural defects and genetic/chromosomal issues, and middle cerebral artery Doppler to check for anemia. Treatment depends on the underlying cause and gestational age. Outcomes are related to the specific etiology and gestational age at detection and delivery, with aneuploid
Baby-Bello-Bella is a boutique that designs and hand-makes dresses for baby girls, including flower girl dresses, little bridesmaid dresses, birthday dresses, formal dresses, and holiday dresses. The boutique offers many colors and styles to match baby girls and more formal options like red, blue, or black. Baby-Bello-Bella wants customers to find a unique and special dress for their little girl's special day.
This document presents a case study and methods to re-establish a condemned boiler. It includes an introduction, contents listing, acknowledgements, abstract on the Hindustan Storage & Distribution Company where the boiler is located, specifications and diagrams of the boiler, scope of dismantling and repair work, results of dismantling, scope of work after renovation including flue gas analysis and boiler tuning.
Antoine Marquis Seabrook is a US Army veteran with 10 years of experience in power generation, schematics, and wire diagrams. He is trained in repairing small gas turbine engines and holds current certifications in hazmat handling, army maintenance systems, and fuel handling. Seabrook seeks to apply his skills in equipment inspection, testing, and repair.
Beyond High or Low: Multi-fidelity Rapid Prototyping - University of Illinoi...Hannah Deering
University of Illinois WebCon 2016
Rapid prototyping allows you to quickly test out ideas, discover the duds and build up the winners, efficiently steering towards the best solutions. However, creating prototypes rapidly is often easier said than done. This talk will advance the discussion beyond simply high-fidelity or low-fidelity to a more nuanced understanding of prototype complexity. We'll explore how fine tuning each of the six dimensions of fidelity can significantly reduce the amount of effort needed to accomplish your prototypes goals. I will share real world examples of how this approach has helped to hone building prototypes on a fast-paced agile development team.
In this presentation you'll learn:
How prototyping can fit into your design process
How to identify and focus your prototyping goals
How to select the right level of fidelity to achieve those goals
Rapid Prototyping - Experiencing UX Meetup - Des Moines - August 24, 2015Hannah Deering
Strategies on creating prototypes more quickly and cheaply in order to better explore, validate & communicate designs. Presentation given at the August Des Moines UX Meetup.
http://www.meetup.com/Experiencing-UX-DSM/events/224078491/
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
The TORCH complex is a set of perinatal infections that can be transmitted from mother to fetus, including toxoplasmosis, rubella, CMV, and herpes. These infections pose risks for severe fetal anomalies and can cause fetal death. Toxoplasmosis is caused by a parasite and transmitted through undercooked meat, soil, or water. Rubella virus causes congenital defects especially if the mother is infected in the first trimester. CMV and herpes viruses are also transplacentally transmitted and can cause issues like hearing loss, jaundice, or brain damage in the fetus or newborn. Diagnosis involves tests on maternal, amniotic, and neonatal samples. Treatment focuses on supportive
Viral infections / 4th stage students / Dr. Alaa AwnALAA AWN
Viruses are infectious agents that contain genetic material enclosed in a protein coat. They cannot replicate without infecting a host cell. There are two main classifications of viral infections - by the type of genetic material (DNA or RNA viruses) and by the organ or host infected. Common viral infections in humans include those caused by herpes viruses like HSV-1 and VZV, influenza viruses, adenoviruses, enteroviruses and hepatitis viruses.
Torch infections in pregnancy presentationAashissh Shah
The document provides an overview of TORCH infections, which are a group of perinatal infections that can be passed from a pregnant woman to her fetus. The TORCH acronym stands for Toxoplasmosis, Other (syphilis, varicella, parvovirus B19, listeriosis, coxsackie virus), Rubella, Cytomegalovirus, and Herpes simplex virus. Each infection is described in terms of transmission, clinical features, diagnosis, and treatment. Congenital infections can cause severe fetal anomalies or loss. Screening and treatment are important for preventing adverse effects in pregnancy.
Evaluation of Infection In Pregnancy
- Some infections can be transmitted from mother to fetus and cause serious issues. Rarely, serious maternal illness can impact the fetus as well.
- Intra-amniotic infections from bacteria in the vaginal flora can cause infections like sepsis and meningitis in newborns.
- Common organisms that cause neonatal sepsis include Streptococcus agalactiae (group B strep), E. coli, coagulase-negative staphylococci, and Staphylococcus aureus. Screening and treatment is recommended for some high risk infections.
This document provides background information on maternal infections in pregnancy. It discusses various viral, bacterial, fungal, and parasitic infections that can affect both mother and baby during pregnancy. Some key points:
- Infections are a major cause of morbidity and mortality for both mothers and babies in developing countries. Common infections in Ghana include malaria, Group B Streptococcus, and other bacterial infections.
- Pregnancy increases susceptibility to certain infections due to immune system changes that help tolerate the fetus. The placenta can also serve as a site of infection for some pathogens.
- Major viral infections discussed include chickenpox, influenza, rubella, cytomegalovirus, and HIV. Bacterial infections
Primary maternal syphilis infection can infect the fetus in utero. Without treatment, fetal infection risks include stillbirth, premature birth, low birthweight, and neonatal death. Fetal infection may also cause deformities of the nose, long bones, and teeth. Diagnosis involves maternal and fetal serology, with treatment of pregnant women and neonates with penicillin to prevent transmission and morbidity.
Infectious diseases can cause complications during pregnancy such as congenital abnormalities, increased risk of pregnancy loss, and preterm birth. Some key infectious diseases discussed in the document include rubella, toxoplasmosis, cytomegalovirus, chickenpox, parvovirus, and listeria. These diseases are commonly transmitted through respiratory droplets, contaminated food or water, or direct contact. Complications for the fetus can include deafness, blindness, neurological impairments, and even termination of the pregnancy may be recommended in some cases if infection occurs early. Screening, vaccination, treatment with antibiotics or immunoglobulins are some management strategies discussed.
Cytomegalovirus (CMV) is a type of herpes virus that infects humans. It is very common, with 60-90% of people worldwide being infected, usually with no symptoms. However, it can cause serious disease in people with weakened immune systems. The virus remains in the body for life after infection and can reactivate to cause illness. It is transmitted through body fluids and can be passed from mother to child during pregnancy or delivery, sometimes causing birth defects. While there is no vaccine, treatment focuses on antiviral drugs for those at high risk of complications from CMV.
Neonatal infections are common and can cause illness or death in newborns. Newborns are susceptible to infections due to exposure to microorganisms in the uterus, during delivery, and in the hospital environment, as well as an immature immune system. Common infections discussed in the document include toxoplasmosis, rubella, cytomegalovirus, herpes simplex, varicella zoster, hepatitis B, HIV/AIDS, and syphilis. Signs and symptoms, diagnosis, and treatment approaches are described for each infection.
Cytomegalovirus is a herpesvirus that commonly infects humans. It can cause enlarged cells (cytomegalic inclusion disease) and poses a risk for severe infections in infants during pregnancy or birth as well as immunosuppressed individuals. The virus replicates slowly in human fibroblasts and establishes lifelong latent infections. Primary infection is usually asymptomatic but can resemble mononucleosis. Congenital infection may cause death, growth problems, or long-term neurological and vision issues in infants. Polymerase chain reaction testing and antigen detection are now used to diagnose active cytomegalovirus infections.
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...Lifecare Centre
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New development from France for Indian Gynaecologists & public to know :Dr Sharda Jain
CMV is a common herpesvirus that can infect people of all ages, including pregnant women.
CMV is not the same as HSV (herpes simplex virus), although they belong to the same viral family.
Sexually transmitted disease in pregnancyDR MUKESH SAH
An STI during pregnancy can pose serious health risks for you and your baby. As a result, screening for STIs , such as human immunodeficiency virus (HIV), hepatitis B, chlamydia and syphilis, generally takes place at the first prenatal visit for all pregnant women.
This document discusses perinatal infections, providing details on several pathogens that can cause congenital infections including Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus, and Treponema pallidum (syphilis). It describes the transmission, signs/symptoms, diagnosis, and treatment of infections caused by each pathogen. Key points include that primary maternal infection with toxoplasmosis, rubella virus, or herpes is highest risk for fetal transmission and infection earlier in pregnancy leads to worse outcomes. Diagnosis involves pathogen detection and serologic testing, while treatment focuses on antimicrobials and supportive care of the newborn.
The TORCH complex refers to a group of perinatal infections - Toxoplasmosis, Other (syphilis, varicella, parvo virus), Rubella, Cytomegalovirus, and Herpes simplex virus type 2. These infections can cross the placenta and infect the fetus, potentially causing severe anomalies or death. Toxoplasmosis is caused by the protozoan Toxoplasma gondii which can infect fetuses during acute maternal infection via the placenta. Rubella virus infection during pregnancy increases risks of fetal anomalies, especially in the first trimester. Cytomegalovirus is a herpes virus that commonly infects fetuses, with 30
This document provides information about poliomyelitis (polio) including its history, virus characteristics, transmission, clinical presentation, diagnosis, epidemiology, vaccines (IPV and OPV), and vaccination recommendations. It describes poliovirus as an enterovirus that infects motor neurons and can cause paralysis. It was once a major cause of disability but vaccination programs have significantly reduced cases globally.
This document discusses several common viral infections in pregnancy including herpes varicella zoster virus (chickenpox), herpes simplex virus, parvovirus, cytomegalovirus, rubella virus, and HIV. It provides details on the transmission, incubation period, maternal and fetal risks, diagnosis, and management of each infection. For herpes varicella zoster virus, it describes the risks of primary infection, reactivation (shingles), and prevention with vaccination. It emphasizes the need for VZIG treatment if a non-immune pregnant woman is exposed. For herpes simplex virus, it highlights the risks of neonatal herpes acquired at delivery and recommendations for cesarean section in some
Approach to congenital cmv infection in newbornJigar Patel
This document provides an overview of congenital cytomegalovirus (CMV) infection. CMV is a herpesvirus that can be transmitted from mother to fetus. Approximately 40,000 infants are born with congenital CMV annually in the US, with 10-15% experiencing hearing loss. Symptomatic infants may experience jaundice, hepatosplenomegaly, or hearing loss at birth. Treatment involves antiviral therapy with ganciclovir or valganciclovir for symptomatic infants or those with hearing loss or central nervous system involvement to improve outcomes. Adverse effects require monitoring bloodwork during the recommended 6 month course of treatment.
The document summarizes recommendations for human papillomavirus (HPV) vaccination from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. It recommends routine HPV vaccination for females and males aged 11-12 to help reduce cancers and genital warts caused by HPV. Two HPV vaccines are approved and have shown to be highly effective and safe when administered before the onset of sexual activity according to clinical trials. Obstetrician-gynecologists should educate patients about HPV vaccination.
This document summarizes guidelines for the management of premature rupture of membranes (PROM). It defines PROM and discusses the risks and outcomes associated with term and preterm PROM. For term PROM at 37 weeks or later, the document recommends inducing labor over expectant management to reduce infection risks and speed delivery. For preterm PROM, it recommends considering delivery versus expectant management based on gestational age and fetal status. While the optimal timing remains unclear, data suggest delivery between 34-37 weeks may reduce infection risks without increasing neonatal risks.
This document provides guidelines for antepartum fetal surveillance techniques based on the latest scientific evidence. It discusses various techniques used for antepartum fetal surveillance including maternal fetal movement assessment, contraction stress test, nonstress test, biophysical profile, and modified biophysical profile. The goal of using these techniques is to prevent fetal death by identifying fetuses that may be undergoing uterine placental compromise. A normal result from these antepartum fetal surveillance tests is highly reassuring, with false negative rates generally below 1%, however, acute catastrophic changes may still result in fetal death.
Prediccion y prevencion del parto preterminorubenhuaraz
This document discusses screening and prevention of preterm birth, which is the leading cause of neonatal mortality in the US. It describes various risk factors for preterm birth such as a prior preterm birth, short cervical length on ultrasound, vaginal bleeding, infections, and behavioral factors like smoking. Transvaginal ultrasound is an effective way to screen for short cervical length, which is a strong predictor of preterm birth risk. The document reviews evidence for different proposed screening and treatment methods, noting that while some risk factors are associated with preterm birth, treatments have not been shown to consistently and definitively reduce that risk.
This document provides guidance on evaluating and managing intrapartum fetal heart rate tracings based on a three-tiered categorization system. Category I tracings are normal and require routine surveillance. Category II tracings require more frequent evaluation and potential corrective measures, with the presence of accelerations or variability helping to determine risk of acidemia. Category III tracings indicate the highest risk and preparations for delivery. Specific patterns like variable decelerations are managed initially with positioning and potentially amnioinfusion, while recurrent late decelerations require measures to improve uteroplacental perfusion. Intrapartum tachycardia requires evaluating for underlying causes.
This study analyzed data from 4,618 women who had spontaneous vaginal deliveries at term to develop norms for fetal descent in labor. The results show:
1) Multiparous women and those who labored spontaneously without augmentation had faster fetal descent at all stations compared to nulliparous women and those whose labor was induced or augmented.
2) The median time to descend between station levels was less than 2 hours, though there was wide variation, with some women spending over 12 hours at the same high station.
3) By 6 cm dilation, the median station was 0 for nulliparous women and -1 for multiparous women. 95% of all women were at station 0
The document discusses the definition of term pregnancy. Previously, term was considered 37-42 weeks of gestation, but research shows neonatal outcomes vary within this range. To address this, a work group in 2012 recommended replacing "term" with more specific designations: early term (37-38 weeks), full term (39-40 weeks), late term (41 weeks) and post-term (42+ weeks). They encourage clinicians and researchers to uniformly use these new designations to facilitate data reporting, quality care and research.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Torch y gestacion
1. 1510 VOL. 125, NO. 6, JUNE 2015 OBSTETRICS & GYNECOLOGY
Background
Cytomegalovirus
Cytomegalovirus is a ubiquitous double-stranded DNA
herpesvirus that is transmitted by sexual contact or direct
contact with infected blood, urine, or saliva. After an
incubation period of 28–60 days (mean, 40 days), CMV
infection induces immunoglobulin M (IgM) antibody
production followed by an immunoglobulin G (IgG) anti-
body response. Viremia can be detected for 2–3 weeks
after primary infection (infection in a previously sero-
negative individual). Although adults with primary CMV
infection are usually asymptomatic, individuals may
experience a mononucleosis-like syndrome, with fever,
chills, myalgias, malaise, leukocytosis, lymphocytosis,
abnormal liver function, and lymphadenopathy (3).
After the primary infection, CMV remains latent in host
cells and recurrent, or secondary, infection can occur.
Secondary infection (intermittent viral excretion in the
presence of host immunity) can occur after reactivation
of the latent endogenous CMV strain or by reinfection
with a different exogenous viral strain (4).
Prevalence of CMV immunity, in primary or second-
ary infection, varies significantly by geographic region,
socioeconomic status, and ethnicity (5–7). The incidence
of primary CMV infection among previously seronega-
tive pregnant women in the United States ranges from
0.7% to 4%, with estimates of secondary infection ranging
up to 13.5% (7–11). Vertical transmission of CMV may
occur as a result of transplacental infection after primary
Cytomegalovirus, Parvovirus B19,
Varicella Zoster, and Toxoplasmosis
in Pregnancy
Among the many physiologic changes that occur during pregnancy, the maternal immune system is altered to dampen
the maternal inflammatory response and allow for fetal antigen tolerance (1, 2). Although such immunologic changes
diminish the chance of fetal rejection, they potentially increase maternal and fetal vulnerability to certain infectious
diseases. Common infections that cause mild-to-moderate disease in healthy adults and children can cause serious
maternal and fetal complications if acquired during pregnancy. A unique concern with maternal infection is the
potential for mother-to-child transmission or congenital infection. Cytomegalovirus (CMV), parvovirus B19, varicella
zoster virus (VZV), and toxoplasmosis are common infections associated with moderate-to-severe fetal and infant com-
plications when acquired congenitally. The purpose of this document is to update the current understanding of these
infections, including their clinical presentations; their modes and risks of perinatal transmission; and their maternal,
fetal, and infant effects, and to offer guidelines for preventing and managing these infections during pregnancy.
Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the Committee on Practice Bulletins—Obstetrics with the assis-
tance of Geeta K. Swamy, MD. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These
guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs
of the individual patient, resources, and limitations unique to the institution or type of practice.
PRACTICE BULLETIN
Number 151, June 2015 (Replaces Practice Bulletin Number 20, September 2000)
clinical management guidelines for obstetrician–gynecologists
The American College of
Obstetricians and Gynecologists
WOMEN’S HEALTH CARE PHYSICIANS
Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
2. VOL. 125, NO. 6, JUNE 2015 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster 1511
B19 infection is transient aplastic crisis, which is more
common in those with an underlying hemoglobinopathy.
Most infections are mild; most individuals recover com-
pletely from parvovirus B19 infection and require only
supportive care during the acute phase.
Transmission of parvovirus B19 most commonly
occurs through respiratory secretions and hand-to-
mouth contact. The infected person generally is infectious
5–10 days after exposure, before the onset of the rash or
other symptoms, and is no longer infectious by the time
of onset of the rash (31). In response to infection, IgM
and IgG antibodies are produced. The IgM response,
which persists for 1 month to several months, is indica-
tive of a recent infection. IgG antibodies persist indefi-
nitely and, in the absence of IgM, indicate prior infection
and lifelong immunity. Prevalence of seropositivity
to parvovirus B19 increases with age, and 50–65% of
reproductive-aged women are seropositive (32–34). The
risk of maternal parvovirus B19 infection varies with
level of exposure to the infected individual. Exposure
to a household member infected with parvovirus B19 is
associated with a 50% risk of seroconversion (32, 34,
35). The risk of transmission in a child care setting or
classroom is lower, approximately 20–50% (34, 36, 37).
After acute parvovirus B19 infection during preg-
nancy, rates of maternal-to-fetal transmission range from
17% to 33% (32, 38). Although most cases of fetal infec-
tion resolve spontaneously with no adverse outcomes,
fetal parvovirus B19 has been associated with sponta-
neous abortion, hydrops fetalis, and stillbirth (30, 31).
The rate of fetal loss among women with serologically
proven parvovirus B19 infection ranges from 8–17%
before 20 weeks of gestation to 2–6% after 20 weeks
of gestation (39–43). In utero, parvovirus B19 infection
can lead to nonimmune hydrops fetalis. An estimated
8–10% (potentially up to 18–27%) of cases of nonim-
mune hydrops fetalis are associated with parvovirus B19
infection (30, 31). Because the virus is cytotoxic to ery-
throid precursors, hydrops fetalis most often results from
aplastic anemia, although hydrops also can be related to
myocarditis or chronic fetal hepatitis (44). Severe effects
are seen most frequently among fetuses when maternal
parvovirus B19 infection occurs before 20 weeks of
gestation (40).
The fetus is particularly vulnerable to disease trans-
mission and severe complications in the second trimester
because of the mechanisms of viral placental transport
and rapid changes in fetal hematopoiesis that occur dur-
ing this period (44). Stillbirth that results from maternal
infection has occurred from 1 week up to 11 weeks after
maternal infection. However, hydrops is unlikely to
develop if it has not occurred by 8 weeks after maternal
infection (45).
or secondary infection, exposure to contaminated genital
tract secretions at delivery, or breastfeeding (12). Most
infants with congenital CMV are asymptomatic at birth.
Clinical findings of symptomatic congenital CMV infec-
tion include jaundice, petechiae, thrombocytopenia,
hepatosplenomegaly, growth restriction, myocarditis,
and nonimmune hydrops (10, 13, 14).
Cytomegalovirus is the most common congenital
infection, occurring in 0.2–2.2% of all neonates (9, 15,
16). The annual cost of treating the permanent disabili-
ties and complications caused by CMV infections in the
United States is estimated to be more than $1.86 billion
(17). Transplacental CMV transmission represents the
most significant risk of developing clinical sequelae.
Cytomegalovirus infection resulting from exposure to
infected cervical secretions or breast milk is typically
asymptomatic and is not associated with severe neo-
natal sequelae (18, 19). With primary maternal CMV
infection, the overall risk of transmission to the fetus
is approximately 30–40% (20–23). Although vertical
transmission may occur at any stage of pregnancy, the
risk of transmission is greatest in the third trimester (24,
25). Transmission rates for primary infection are 30%
in the first trimester, 34–38% in the second trimester,
and 40–72% in the third trimester. However, more
serious fetal sequelae occur after maternal CMV infec-
tion during the first trimester. Of those fetuses infected
in utero after a primary infection, 12–18% will have
signs and symptoms of CMV infection at birth and up
to 25% will develop sequelae (15, 26). Approximately
30% of severely infected infants die, and 65–80% of
survivors have severe neurologic morbidity (8, 27, 28).
The incidence of severe fetal infection is much lower
after recurrent maternal infection than after primary
infection. Vertical transmission after a recurrent infec-
tion is 0.15–2% (8, 26). Infants infected after maternal
CMV reactivation generally are asymptomatic at birth.
Congenital hearing loss is typically the most severe
sequela of secondary infection, and congenital infection
after recurrent infection is unlikely to produce multiple
sequelae (26, 29).
Parvovirus B19
Parvovirus B19 is a single-stranded DNA virus that
causes the childhood exanthema erythema infectiosum,
also known as fifth disease. Children typically demon-
strate a facial rash, sometimes similar in appearance to a
slapped cheek, in addition to possible fever, body rash,
and joint pain. In immunocompetent adults, the most
common symptoms of parvovirus B19 infection are a
reticular rash on the trunk and peripheral arthropathy,
although approximately 20% of infected individuals are
asymptomatic (30). Another manifestation of parvovirus
Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
3. 1512 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster OBSTETRICS & GYNECOLOGY
In pregnancy, varicella may be transmitted across
the placenta, which results in congenital or neonatal
chickenpox. The risk of congenital varicella syndrome
is low (0.4–2%); limited to exposure during early preg-
nancy (first trimester 0.4%, second trimester 2%, third
trimester 0%); and characterized by skin scarring, limb
hypoplasia, chorioretinitis, and microcephaly (53–57).
Neonatal VZV infection is associated with a high neo-
natal death rate when maternal disease develops from
5 days before delivery to 48 hours postpartum as a result
of the relative immaturity of the neonatal immune sys-
tem and the lack of protective maternal antibodies (58,
59). Susceptible (seronegative) pregnant women theo-
retically can acquire varicella infection from exposure
to individuals with herpes zoster infection (shingles).
However, transmission is extremely rare because contact
with an open cutaneous lesion is required and viral shed-
ding is lower with recurrent varicella infection compared
with primary chickenpox (51, 54, 60).
Toxoplasmosis
Toxoplasmosis is caused by the intracellular parasite
Toxoplasma gondii. T gondii exists in several forms: a
trophozoite, which is the invasive form, and a cyst or an
oocyst, which are latent forms (61). Human infection
is acquired by consumption of cysts in undercooked
meat from infected animals, consumption of insect-
contaminated food, contact with oocysts from the feces
of infected cats (the only definitive hosts), or contact
with infected materials or insects in soil (62). Infection
with T gondii usually is asymptomatic, although after
an incubation period of 5–18 days, some nonspecific
symptoms may occur. In the immunocompetent adult,
the clinical course is benign and self-limited. Most often,
toxoplasmosis presents as asymptomatic cervical lymph-
adenopathy, with symptoms occurring in only 10–20%
of infected adults. Other symptoms include fever, mal-
aise, night sweats, myalgias, and hepatosplenomegaly.
Parasitemia can occur after infection, which in pregnant
women can seed the placenta and cause subsequent fetal
infection. Congenital transmission of T gondii from an
infected woman results in an overall risk of congenital
toxoplasmosis ranging from 20% to 50% without treat-
ment (63–65). The later in gestation that the infection
occurs, the more likely transmission is to occur. The rate
of vertical transmission increases from 10% to 15% in
the first trimester, to 25% in the second trimester, and
to more than 60% in the third trimester (65–67). The
severity of fetal infection depends on gestational age at
the time of transmission. The earlier the fetus is infected,
the more severe the disease (65, 67). Most infected
infants do not have clinical signs of infection at birth,
but as many as 90% will develop sequelae, including
Long-term neurodevelopmental outcomes are uncer-
tain in fetuses with congenital parvovirus B19 infection
that do not succumb to the disease. Earlier studies
suggested no long-term adverse effects in fetuses with
hydrops that have been transfused after maternal infec-
tion, whereas a more recent study suggested an increase
in neurodevelopmental impairment among fetuses with
hydrops that underwent transfusion (42, 43, 46).
Varicella Zoster Virus
Varicella zoster virus is a highly contagious DNA herpes-
virus that is transmitted by respiratory droplets or close
contact. The infection rate among susceptible (seronega-
tive) contacts is 60–90% after exposure (47). The incu-
bation period after infection is 10–20 days, with a mean
of 14 days (47). The period of infectivity begins 48 hours
before the rash appears and lasts until the vesicles crust
over. The primary infection causes chickenpox, which
is characterized by fever, malaise, and a maculopapular
pruritic rash that becomes vesicular. After the primary
infection, VZV remains dormant in sensory ganglia and
can be reactivated to cause a vesicular erythematous skin
rash known as herpes zoster, or shingles. The antibody
to VZV develops within a few days after the onset of
infection, and prior infection with VZV confers lifelong
immunity to primary infection.
Before 1995, when a varicella vaccine became
available in the United States, VZV infection was com-
mon, with about 4 million people becoming infected
each year. Of those individuals who were infected, up to
13,000 required hospitalization and up to 150 died. After
childhood varicella vaccination became routine, disease
incidence decreased 82% from 2000 to 2010 and annual
varicella-related deaths dropped from approximately
150 each year to 14 in 2007 (48, 49). Of the 14 deaths,
11 were adults 50 years or older, two were adults aged
20–49 years, and one was a young child (48).
Even before routine vaccination, varicella infec-
tion was uncommon in women during pregnancy (esti-
mated to occur in 0.4–0.7 per 1,000 pregnant women)
because of the high prevalence of natural immunity (50).
Maternal varicella infection is likely to be even lower
now, with the introduction of routine vaccination and the
overall reduction in disease. Pregnancy complicated by
maternal varicella infection is associated with maternal,
fetal, and neonatal effects. The disease is usually benign
and self-limited in children, with adults suffering more
serious morbidity, such as encephalitis and pneumo-
nia. Approximately 10–20% of pregnant women with
varicella infection will develop pneumonia, which is a
significant risk factor for maternal mortality, estimated
to be as high as 40% (51, 52).
Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
4. VOL. 125, NO. 6, JUNE 2015 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster 1513
the absence of infection (7, 8). The reported sensitivity
of CMV IgM serologic assays is 50–90% (8, 75).
Which methods are used to diagnose fetal
cytomegalovirus infection and what are the
diagnostic criteria?
Congenital CMV may be suspected prenatally after a
documented maternal primary infection or, more com-
monly because universal screening is not recommended,
after ultrasound findings suggestive of infection. These
findings include abdominal and liver calcifications, hep-
atosplenomegaly, echogenic bowel or kidneys, ascites,
cerebral ventriculomegaly, intracranial calcifications,
microcephaly, hydrops fetalis, and growth restriction
(78–81). Nevertheless, such findings are more likely to
be associated with other abnormalities, such as aneu-
ploidy, and the positive predictive value of each of these
markers for CMV infection is quite weak (82). The pres-
ence of echogenic bowel, for instance, is only predictive
of CMV infection approximately 3% of the time (79).
After detection of maternal infection or suspected
fetal infection based on ultrasound findings, congenital
CMV can be detected in the amniotic fluid of infected
fetuses by either culture or PCR. Fetal blood sampling,
which is less sensitive than amniotic fluid testing and
carries additional risks for the fetus, is not warranted
(75, 83). The sensitivity of CMV amniotic fluid culture
ranges from 70% to 80% compared with a sensitivity
of 78% to 98% for PCR (specificity of 92% to 98%)
(84–91). The sensitivity of amniotic fluid testing for
prenatal diagnosis of congenital CMV infection is mark-
edly lower if performed before approximately 21 weeks
of gestation (91, 92). Although a positive culture or PCR
is highly predictive of congenital infection, the detection
of CMV in amniotic fluid does not predict the severity
of congenital CMV infection.
How should maternal and fetal cytomegalo-
virus infections be managed?
Currently, no therapies are available for the treatment
of maternal or fetal CMV infection. Antiviral medica-
tions such as ganciclovir, valganciclovir, and foscarnet
are approved by the U.S. Food and Drug Administration
(FDA) only for treatment of patients with acquired
immunodeficiency syndrome (AIDS) or organ trans-
plants. Although ganciclovir has been shown to cross
the placenta by simple diffusion and reportedly has
been used for treatment of congenital CMV, its use
is not recommended outside of a research protocol
because of risks that have been documented in animal
studies (93). In one recent study of the prevention of
congenital CMV infection, valganciclovir appeared to
chorioretinitis and subsequent severe visual impairment,
hearing loss, or severe neurodevelopmental delay (63,
68, 69). Other clinical manifestations of congenital toxo-
plasmosis include rash, hepatosplenomegaly, ascites,
fever, periventricular calcifications, ventriculomegaly,
and seizures (70–72).
Immunoglobulin M antibodies appear soon after
acute infection and reach maximum levels in 1 month
(63, 73). Immunoglobulin G antibodies appear after IgM
antibodies, are detectable within a few weeks after infec-
tion, and confer immunity. High titers of IgG and IgM
may persist for years.
Clinical Considerations
and Recommendations
Cytomegalovirus
Which methods are used to diagnose mater-
nal cytomegalovirus infection and what are
the diagnostic criteria?
Most adult CMV infections are asymptomatic, which
makes recognition of primary infection difficult. Cyto-
megalovirus may be detected by viral culture or poly-
merase chain reaction (PCR) of infected blood, urine,
saliva, cervical secretions, or breast milk, although diag-
nosis of CMV infection in adults usually is established
by serologic testing. Serum samples collected 3–4 weeks
apart, tested in parallel for anti-CMV IgG, are essential
for the diagnosis of primary infection. Seroconversion
from negative to positive or a significant increase
(greater than fourfold [eg, from 1:4 to 1:16]) in anti-
CMV IgG titers is evidence of infection. In addition, the
use of IgG avidity assays, which measure the maturity
of the IgG antibody, combined with IgM titers allows for
improved identification of primary infection (sensitivity
of 92%) when compared with standard serial serologic
assays (74). For the first 2–4 months after initial CMV
infection, immature, or low-avidity, IgG antibodies are
produced, followed by high-avidity IgG production. The
ability to ascertain the timing of CMV infection varies
by assay, but the presence of IgM and low-avidity IgG
is consistent with primary infection occurring within the
past 2–4 months (75, 76). The presence of CMV-specific
IgM is a useful but not completely reliable indication
of a primary infection because only 10–30% of women
with detectable CMV-specific IgM will have a primary
infection (75, 77). Further, CMV-specific IgM titers may
not be positive during an acute infection, may persist for
many months after the primary infection, may be present
during reactivation or reinfection, or may be present in
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5. 1514 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster OBSTETRICS & GYNECOLOGY
50% efficacy in preventing CMV infection at 1 year
(100). However, efficacy was not sustained in the long
term and the number of women with CMV infection
was not sufficient to determine whether the vaccine pre-
vented congenital infection. Phase III studies are needed
to demonstrate efficacy and safety (101).
Should women be screened for cytomegalo-
virus before or during pregnancy?
Routine serologic screening of pregnant women for
CMV is not recommended (102, 103). The limitations of
maternal IgM antibody screening in differentiating pri-
mary from recurrent infection makes the results difficult
to use in counseling patients about fetal risk. In addition,
maternal immunity does not eliminate the possibility of
fetal infection given that up to 75% of congenital CMV
infections worldwide may be due to reactivation of
latent virus or reinfection with a new viral strain (104).
The lack of a proven treatment to prevent congenital
transmission further diminishes the potential benefit of
universal screening (23).
Parvovirus B19
Which methods are used to diagnose maternal
parvovirus B19 infection and what are the
diagnostic criteria?
Pregnant women exposed to parvovirus B19 should have
serologic screening performed as soon as possible after
exposure to determine if they should be monitored for
seroconversion (105).
Women who are IgM negative and IgG positive
have evidence of previous exposure and immunity
and, thus, are not at risk of transplacental transmis-
sion. Women who are IgM positive, regardless of IgG
status, should be monitored for potential fetal infection.
Women who are IgM and IgG negative are susceptible
to parvovirus B19 infection and serologic testing should
be repeated in 4 weeks. If repeat testing demonstrates
positive IgM or IgG, these women should be monitored
for potential fetal infection.
Which methods are used to diagnose fetal
parvovirus B19 infection and what are the
diagnostic criteria?
Fetal infection can be diagnosed using PCR to detect par-
vovirus B19 DNA in amniotic fluid (106–108). Although
tests that measure quantitative serum and tissue DNA
viral load exist, they are not widely available, and quali-
tative PCR (with a sensitivity that has been reported to
be as high as 100%) is used to diagnose fetal infection
during pregnancy (44). Testing for fetal parvovirus B19
improve hearing and neurodevelopmental measures at
age 6 months among congenitally infected neonates
(94). However, the effectiveness of valganciclovir treat-
ment in the reduction of long-term neurologic sequelae
remains unknown, and its use in routine clinical care is
not recommended.
Passive immunization with CMV-specific hyperim-
mune globulin also is under investigation as a potential
means of preventing congenital CMV infection among
women with known primary infection. A prospective
cohort study conducted in Italy suggested that the use
of CMV-specific hyperimmune globulin was associated
with a lower chance of congenital infection (22). A sub-
sequent randomized, placebo-controlled, double-blind
trial, also conducted in Italy, failed to confirm these
findings (23). Based on the cumulative findings thus
far, CMV-specific hyperimmune globulin is not recom-
mended for the prevention of congenital CMV infection
outside of a research protocol.
In cases of known maternal CMV infection, refer-
ral to a maternal–fetal medicine or infectious disease
specialist with expertise in pregnancy management may
be warranted. Typically, serial ultrasonographic surveil-
lance that includes assessment of fetal anatomy (eg, the
cerebral ventricles) and growth is performed.
How should women be counseled about
prevention of cytomegalovirus?
Some groups of women are at higher risk of CMV
infection. In one study, 11% of seronegative child care
workers demonstrated seroconversion within 10 months
of hire (95). Other studies have shown that 53% of fami-
lies with young children have one or more seronegative
family members who seroconvert within a year (96, 97).
In two studies, increasing parity was associated with
increasing CMV seroprevalence (98, 99). This demon-
strates the possibility of child-to-mother transmission
(98). Some have suggested that pregnant women should
be instructed on the importance of personal hygiene and
safe-handling techniques (eg, the use of latex or nonla-
tex gloves and rigorous hand washing after exposure to
potentially infected articles, such as diapers, or respira-
tory secretions), as well as avoidance of sharing utensils
with or kissing young children if saliva is present. Such
guidelines may be difficult to implement because they
often are considered impractical or burdensome. At
present, such patient instruction remains unproven as a
method to reduce the risk of congenital CMV infection.
Although a vaccine is not yet available, develop-
ment of a CMV vaccine for primary prevention has been
the focus of several studies. A recombinant glycoprotein,
adjuvant vaccine was tested in a phase II trial of sero-
negative women of reproductive age and demonstrated
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6. VOL. 125, NO. 6, JUNE 2015 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster 1515
sequelae, targeted screening for parvovirus B19 during
pregnancy currently is not recommended either (120).
Testing should be performed for patients with symp-
toms consistent with parvovirus B19 infection or for
those with exposure to suspected or confirmed acute
infections.
Varicella Zoster Virus
Which methods are used to diagnose maternal
varicella zoster virus infection and what are
the diagnostic criteria?
Varicella, or chickenpox, usually is diagnosed based on
the clinical findings of a classic pruritic, vesicular rash,
so laboratory testing is not needed. If laboratory diag-
nosis is required, a sample taken from an unroofed skin
lesion or vesicular fluid can be tested using a qualitative
varicella PCR assay. Pregnant women should have vari-
cella immunity status documented in early pregnancy by
a history of previous infection or varicella vaccination.
If a pregnant woman denies a history of either varicella
vaccination or prior infection, documentation can be
accomplished with the use of varicella IgG serology.
Which methods are used to diagnose fetal
varicella zoster virus infection and what are
the diagnostic criteria?
Although two small studies estimated the rate of con-
genital varicella syndrome after maternal infection with
VZV to be 1–2%, these studies were subject to bias, and
these rates may be overestimated (54, 56). Fetal varicella
can be indicated by the presence of ultrasonographic
abnormalities after documented acute maternal infection.
Ultrasound findings suggestive of congenital varicella
include hydrops, hyperechogenic foci in the liver and
bowel, cardiac malformations, limb deformities, micro-
cephaly, and fetal growth restriction (121). In one series,
five fetuses with congenital VZV demonstrated ultra-
sound findings consistent with fetal infection, and all the
infants died by 4 months of age (122). However, not all
fetuses with congenital VZV and ultrasound abnormali-
ties fare poorly (123). Furthermore, a recent evaluation
of congenitally infected children demonstrated that those
who did not have anatomic abnormalities due to VZV
infection had normal neurodevelopment (124).
How should maternal and fetal infections
with varicella zoster virus be managed?
Oral acyclovir, if started within 24 hours of developing
the rash, has been shown to reduce the duration of new
lesion formation and the total number of new lesions
infection should be considered when ultrasonography
reveals hydrops fetalis.
How should maternal and fetal parvovirus
B19 infections be managed?
Pregnant women with acute parvovirus B19 infection
based on serologies should be monitored for the devel-
opment of fetal anemia using serial ultrasonography.
Standard monitoring should include assessment for asci-
tes, placentomegaly, cardiomegaly, hydrops fetalis, and
impaired fetal growth. In addition, Doppler assessment
of the peak systolic velocity of the fetal middle cerebral
artery should be performed because this measure has
been identified as an accurate predictor of fetal anemia
(109–113). However, fetal death can occur without
evidence of hydrops fetalis (107, 114). Serial ultraso-
nographies should be performed every 1–2 weeks for
8–12 weeks after exposure. In the absence of ultrasound
evidence of fetal sequelae by 8–12 weeks after exposure,
adverse outcomes related to parvovirus B19 infection are
highly unlikely (105, 115).
If hydrops fetalis is present or severe fetal anemia
is suspected in the setting of parvovirus B19, fetal blood
sampling should be performed to determine the fetal
hematocrit in preparation for fetal transfusion. Although
there is procedure-related risk, intrauterine transfusion
should be considered if severe fetal anemia is present
(116–119).
How should women be counseled about
prevention of parvovirus B19?
When outbreaks of parvovirus B19 infection occur
in situations in which prolonged, close-contact expo-
sure occurs, such as in schools, homes, or child care
centers, options for prevention of transmission are
limited. Exposure cannot be eliminated by identifying
and excluding individuals with acute parvovirus B19
infection; up to 20% are asymptomatic, and those with
infection are infectious before they develop symptoms.
Exclusion of pregnant women from the workplace dur-
ing endemic periods is not recommended. If pregnant
women are exposed to individuals who are suspected or
known to be infected with parvovirus B19, they should
report this exposure to their obstetrician–gynecologists
or other obstetric providers.
Should all women be screened for parvovirus
B19 before or during pregnancy?
Routine serologic screening of pregnant women for par-
vovirus B19 is not recommended. Given the low inci-
dence of seroconversion during pregnancy combined with
the variable risk of fetal transmission and subsequent
Copyright ª by The American College of Obstetricians
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Unauthorized reproduction of this article is prohibited.
7. 1516 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster OBSTETRICS & GYNECOLOGY
Pregnant women who have no history of chickenpox
or who lack immunity documented by serology should
avoid VZV-infected individuals until their rash lesions
have crusted over and they are no longer infectious
(133). Pregnant women who are not immune to VZV
and are exposed to someone with active primary infec-
tion with chickenpox should receive VZIG as soon as
possible, ideally within 96 hours of exposure, to prevent
or attenuate the disease manifestations of VZV infection
(135). According to the Centers for Disease Control
and Prevention, in circumstances when VZIG cannot be
given within the ideal window, it still may be given up
to 10 days after exposure (136). Although prevention of
maternal VZV infection through VZIG administration
should eliminate the possibility of congenital transmis-
sion, evidence to support this theory is insufficient. At
present, VZIG can only be obtained directly from the
manufacturer because of regulations related to sole-
source production and FDA approval under the orphan
drug program (136).
Should women be screened for varicella
zoster virus before or during pregnancy?
A history of chickenpox infection is 97–99% predictive
of the presence of serology consistent with past infection
and life-long immunity (133). Women of reproductive
age should be asked before conception about their VZV
immune status (evidence of immunity conferred either
by prior infection or two-dose vaccination) and vacci-
nated before pregnancy if indicated. Proof of immunity,
when not suggested by history, is obtained by testing
for the varicella IgG antibody. If nonimmunity is ascer-
tained after a woman becomes pregnant, postpartum
vaccination is recommended (133).
Toxoplasmosis
Which methods are used to diagnose maternal
toxoplasmosis infection and what are the
diagnostic criteria?
Although isolation of T gondii from blood or body
fluids establishes the presence of acute infection, sero-
logic testing for the detection of the specific antibody to
T gondii is the primary method of diagnosis in the
clinical setting. Serologic assays for toxoplasmosis are
not well standardized and have high rates of false-
positive and false-negative test results (73, 137).
Immunoglobulin M titers may persist for many months
or years after acute infection (63, 73). Immunoglobu-
lin G and IgM testing should be used for the initial
evaluation of a pregnant woman suspected to have
and to improve constitutional symptoms (125–127). Oral
acyclovir appears to be safe and, given the potential for
severe maternal illness from VZV infection, should be
considered for use in pregnant women if lesions develop
(128). Although the efficacy of intravenous acyclovir
has not been established in randomized controlled trials,
it may reduce maternal morbidity and mortality associ-
ated with varicella pneumonia (52, 129).
Maternal treatment with acyclovir has not been
shown to ameliorate or prevent the fetal effects of
congenital varicella syndrome (130). Varicella-zoster
immune globulin (VZIG) should be given to infants born
to women who develop varicella between 5 days before
and 2 days after delivery, although this treatment does
not universally prevent neonatal varicella (131). Infants
who develop varicella within the first 2 weeks of life
should be treated with intravenous acyclovir (128, 132).
How should women be counseled about
prevention of varicella zoster virus?
Nonpregnant women of reproductive age should be
questioned about previous infection with varicella
before conception and offered vaccination if no his-
tory of chickenpox or prior vaccination is elicited and
if nonimmune serologies have been documented (133).
Vaccination should be emphasized for those who have
close contact with individuals at high risk of severe
disease (eg, health care personnel, family contacts of
individuals with immunocompromising conditions) or
are at high risk of exposure or transmission (eg, teach-
ers; child care employees; residents and staff members in
institutional settings, including correctional institutions;
college students; military personnel; adolescents and
adults living in households with children; nonpregnant
women of childbearing age; international travelers)
(133). Pregnant women who do not have a history of
varicella infection or of immunization and show no sero-
logic evidence of immunity should receive the first dose
of varicella vaccine upon completion or termination of
the pregnancy. The second dose should be administered
4–8 weeks after the first dose (133).
The varicella vaccine is given to anyone 12 months
of age or older as a two-dose regimen. Conception
should be delayed for 3 months after the last dose
because there is a small chance of mild varicella infec-
tion after vaccination with the live, attenuated vaccine.
However, standard vaccine surveillance systems have
not detected any cases of congenital varicella after inad-
vertent administration of the varicella vaccine during
early pregnancy (134). Thus, varicella vaccine exposure
during early pregnancy does not warrant pregnancy
termination (133).
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8. VOL. 125, NO. 6, JUNE 2015 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster 1517
expert in maternal–fetal medicine or infectious disease
should be obtained. Pregnant women who are acutely
infected with toxoplasmosis should be treated with spi-
ramycin to reduce transplacental parasitic transfer (149).
Spiramycin is a macrolide antibiotic that concentrates in,
but does not readily cross, the placenta (149). Use of spi-
ramycin after confirmatory testing in a reference labora-
tory generally requires assistance from the FDA because
the drug is not commercially available in the United
States (145, 150). Fetal infection with toxoplasmosis
should be treated with a combination of pyrimethamine,
sulfadiazine, and folinic acid because this regimen more
effectively eradicates parasites in the placenta and fetus
than spiramycin alone and can lessen the severity of
disease in the affected fetus (151, 152). Treatment of
infants with symptomatic congenital toxoplasmosis con-
sists of pyrimethamine, sulfadiazine, and folinic acid for
1 year (72, 153).
How should women be counseled about
prevention of toxoplasmosis?
Factors associated with acquisition of T gondii include
handling materials contaminated by cat feces; consum-
ing contaminated undercooked meat, dairy, produce,
or water; and working in soil without gloves. Pregnant
women should be counseled on proper hand washing
techniques, pet care measures, and dietary recommenda-
tions to prevent toxoplasmosis, as well as many other
infectious illnesses. Much attention has been given to
educational programs to reduce maternal T gondii infec-
tion and, thus, congenital toxoplasmosis. Despite the
successes demonstrated in some observational studies,
several reviews (including a Cochrane review) suggest
that weaknesses in study design prevent the conclusion
that such strategies effectively reduce congenital toxo-
plasmosis (154–156).
Should women be screened for toxoplasmosis
before or during pregnancy?
Routine serologic screening of pregnant women for
toxoplasmosis is not recommended. There are many
challenges involved in routine screening, including a
relatively low seroprevalence (approximately 38% of
pregnant women have evidence of prior toxoplasmosis
infection), which means that most women are suscep-
tible to infection; relatively low incidence of acute infec-
tion; lack of standardized serologic assays outside of
reference laboratories; and cost (147, 157). In the United
States, prenatal screening for toxoplasmosis should be
limited to women who are immunosuppressed or human
immunodeficiency virus (HIV) positive.
toxoplasmosis. A negative IgM test result and a posi-
tive IgG test result are indicative of remote infection
and pose no concern for fetal transmission in an immu-
nocompetent woman (73, 137). Negative IgM and IgG
test results indicate either the absence of infection or
a recent acute infection without enough time for sero-
conversion. If IgM and IgG test results are positive,
the patient has had either a recent infection or a false-
positive result. If acute infection is a possibility, sero-
logic testing should be repeated in 2–3 weeks to look
for an increase in IgG antibodies consistent with recent
infection (73, 137). Consideration should be given to
performing initial and repeat serologies in an expe-
rienced toxoplasmosis reference laboratory in which
specific confirmatory tests, such as the Sabin–Feldman
dye test or indirect fluorescent antibody test, are
performed (63, 73, 137).
If maternal toxoplasmosis infection has been sero-
logically confirmed, reference laboratories can perform
IgG avidity testing to determine when the infection
may have occurred. Low avidity is indicative of pri-
mary infection within the past 5 months, which may be
helpful information in prenatal diagnosis and counseling
(137, 138).
Which methods are used to diagnose fetal
toxoplasmosis infection and what are the
diagnostic criteria?
Ultrasonography can demonstrate severe congenital
toxoplasmosis; suggestive findings include ventricu-
lomegaly, intracranial calcifications, microcephaly,
ascites, hepatosplenomegaly, and intrauterine growth
restriction. Amniocentesis should be offered to preg-
nant women when fetal toxoplasmosis is suspected.
Polymerase chain reaction of amniotic fluid is the pre-
ferred diagnostic test, given its relatively high sensitivity
and specificity and its lower risk to the fetus than cordo-
centesis (66, 67, 137, 139–143). Amniocentesis should
be performed after 18 weeks of gestation to lessen the
chance of a false-negative test result (142).
How are maternal and fetal infections with
toxoplasmosis managed?
Suspected maternal infection should be confirmed in a
reference laboratory, given the poor test performance
of toxoplasmosis serologies in many commercial labo-
ratories (144, 145). A Cochrane review of more than
3,000 publications suggests that maternal treatment does
not reduce or prevent fetal infection but may reduce
congenital disease severity (146–148). In the pres-
ence of acute maternal infection, consultation with an
Copyright ª by The American College of Obstetricians
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9. 1518 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster OBSTETRICS & GYNECOLOGY
If hydrops fetalis is present or severe fetal anemia is
suspected in the setting of parvovirus B19, fetal blood
sampling should be performed to determine the fetal
hematocrit in preparation for fetal transfusion.
Although there is procedure-related risk, intrauterine
transfusion should be considered if severe fetal ane-
mia is present.
Routine serologic screening of pregnant women for
parvovirus B19 is not recommended.
Routine serologic screening of pregnant women for
toxoplasmosis is not recommended.
The following recommendation is based primar-
ily on consensus and expert opinion (Level C):
Pregnant women should have varicella immunity
status documented in early pregnancy by a history of
previous infection or varicella vaccination. If a preg-
nant woman denies a history of either varicella vac-
cination or prior infection, documentation can be
accomplished with the use of varicella IgG serology.
Proposed Performance
Measure
Documentation of screening for varicella risk status
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Summary of
Recommendations and
Conclusions
The following recommendations and conclusions
are based on good and consistent scientific
evidence (Level A):
Pregnant women with acute parvovirus B19 infec-
tion based on serologies should be monitored for the
development of fetal anemia using serial ultraso-
nography. In addition, Doppler assessment of the
peak systolic velocity of the fetal middle cerebral
artery should be performed, because this measure
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Oral acyclovir appears to be safe and, given the
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infection, should be considered for use in pregnant
women if lesions develop. Although the efficacy of
intravenous acyclovir has not been established in
randomized controlled trials, it may reduce maternal
morbidity and mortality associated with varicella
pneumonia.
Pregnant women who are not immune to VZV and
are exposed to someone with active primary infec-
tion with chickenpox should receive VZIG as soon
as possible, ideally within 96 hours of exposure, to
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VZV infection.
Pregnant women who are acutely infected with
toxoplasmosis should be treated with spiramycin to
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Routine serologic screening of pregnant women for
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Pregnant women exposed to parvovirus B19 should
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monitored for seroconversion.
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16. VOL. 125, NO. 6, JUNE 2015 Practice Bulletin Cytomegalovirus, Parvovirus B19, Varicella Zoster 1525
The MEDLINE database, the Cochrane Library, and the
American College of Obstetricians and Gynecologists’
own internal resources and documents were used to con
duct a literature search to locate relevant articles published
between January 1990–March 2015. The search was
restricted to articles published in the English language.
Priority was given to articles reporting results of original
research, although review articles and commentaries also
were consulted. Abstracts of research presented at sympo
sia and scientific conferences were not considered adequate
for inclusion in this document. Guidelines published by
organizations or institutions such as the National Institutes
of Health and the American College of Obstetricians and
Gynecologists were reviewed, and additional studies were
located by reviewing bibliographies of identified articles.
When reliable research was not available, expert opinions
from obstetrician–gynecologists were used.
Studies were reviewed and evaluated for quality according
to the method outlined by the U.S. Preventive Services
Task Force:
I Evidence obtained from at least one properly
designed randomized controlled trial.
II-1 Evidence obtained from well-designed controlled
trials without randomization.
II-2 Evidence obtained from well-designed cohort or
case–control analytic studies, preferably from more
than one center or research group.
II-3 Evidence obtained from multiple time series with or
without the intervention. Dramatic results in uncon
trolled experiments also could be regarded as this
type of evidence.
III Opinions of respected authorities, based on clinical
experience, descriptive studies, or reports of expert
committees.
Based on the highest level of evidence found in the data,
recommendations are provided and graded according to the
following categories:
Level A—Recommendations are based on good and con
sistent scientific evidence.
Level B—Recommendations are based on limited or incon
sistent scientific evidence.
Level C—Recommendations are based primarily on con
sensus and expert opinion.
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Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmo-
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Obstetricians and Gynecologists. Obstet Gynecol 2015;125:1510–25.
Copyright ª by The American College of Obstetricians
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