新型冠状病毒感染孕妇是否存在宫内垂直传播

新型冠状病毒肺炎疫情期间,母婴垂直传播问题引起了社会及围产医学界的广泛关注及热议,但目前尚无足够证据证明新型冠状病毒存在宫内垂直传播。本文重申了宫内垂直传播的相关概念,明确了相关研究的意义,并对未来在这一方面可能的研究方向及注意事项进行了阐述。同时呼吁科研工作者,坚持更加严谨求实的作风,进行科学的临床及基础研究,为提高对新型冠状病毒的认识提供科学的证据和信息。     

美国母胎医学会“妊娠期乙型肝炎的筛查、治疗及垂直传播的预防指南”要点解读

正乙型肝炎是由乙型肝炎病毒(hepatitis B,HBV)引起的一种严重危害人类健康的疾病,全世界的感染人数超过了24 000万。在美国,妊娠妇女群体中的HBV感染率约为0.7%~0.9%~([1-2])。宫内和围产期垂直传播是全球HBV传播的重要组成部分。研究表明,35%~50%的HBV携带者是由于围产期接触受感染的血液及其污染物而受到感染~([1])。预防受感染孕妇的HBV垂直传播给胎儿,对减少     

妊娠合并梅毒孕期规范治疗后新生儿梅毒血清学的变化特点及转归

目的 了解妊娠合并梅毒孕母所生新生儿梅毒血清学变化特点,初步探讨影响婴儿梅毒血清学转归的因素.方法 选择我院2006年1月至2008年1月经孕期规范治疗后的146例单胎妊娠合并梅毒的孕妇,孕妇产前和新生儿生后3 d内行快速血浆反应素试验(rapid plasma reagin,RPR)及梅毒螺旋体明胶凝集试验(treponema pallidum particle agglutination assay,TPPA).随访了其中92例婴儿生后24个月内RPR及TPPA的情况.结果 (1)146例新生儿中,140例(95.9%)TPPA阳性,其中94例(90.4%)新生儿期RPR滴度低于或等同于母亲产前RPR滴度;104例(71.2%)RPR和TPPA均为阳性,36例(24.7%)新生儿为TPPA单阳性.RPR和TPPA双阳性母亲的新生儿RPR阳性比例明显高于TPPA单阳性母亲新生儿(81.4%和36.4%,χ2=25.3,P<0.01).(2)随访的92例婴儿中,出生时RPR及TPPA双阳性者57例,56例(98.2%)的RPR在生后6个月内转阴,8个月内100%转阴,转阴高峰为生后2个月(78.9%,45例);TPPA在生后24个月内100%转阴.转阴高峰为生后10～18个月(64.9%,37例).TPPA单阳性的35例婴儿中,18个月内TPPA 100%转阴,转阴高峰在生后6～12个月(57.1%,20例).(3)母亲产前RPR滴度为1:1～1:4时,其婴儿RPR转阴时间晚于母亲RPR阴性者(P<0.05),1;4组为(2.5±0.8)月,长于1:1组的(1.2±0.4)月(P<0.01);但母亲产前RPR滴度与婴儿生后TPPA转阴时间无关(P>0.05).新生儿期的RPR滴度为1:4时,婴儿RPR转阴所需时间晚于1:1的新生儿[(3.7±0.9)月和(2.3±0.6)月,P<0.01];RPR滴度为1:1～1:4的新生儿,婴儿期TPPA转阴所需时间均晚于RPR阴性组[(11.0±2.2)月、(12.2±2.9)月、(11.2±2.8)月和(6.9±2.1)月,P<0.01)].结论 妊娠合并梅毒孕妇孕期规范治疗后分娩的新生儿梅毒血清学检测大部分仍呈阳性,母亲产前或分娩时静脉血RPR滴度高的婴儿,其阳性持续时间可能较长,但均能在生后一定时间内转阴.建议对梅毒血清学阳性新生儿生后长期随访,诊断先天性梅毒应慎重.     

乙型肝炎垂直传播及预防

对乙型肝炎垂直传播(Vertical transmission)的含义目前尚有不同的看法。一般认为,所谓乙型肝炎垂直传播,即妊娠期患急性或慢性乙型肝炎或慢性无症状乙型肝炎表面抗原(HBsAg)携带者母亲将乙型肝炎病毒(HBV)传播给其婴儿并引起婴儿感染的过程。Stokes等于1951年首先证明病毒性肝炎垂直传播的存在。随着乙型肝炎血清学指标的发现,乙型肝炎的这种传播方式逐渐受到人们的重视。在世界上某些地区乙型肝炎垂直传播率是很高的,它是造成乙型肝炎家庭聚集性的重要原因,是人群中存在的大量HBsAg携带者的重要来源,亦可能与某些地区原发性肝细胞癌的发生有关。因此研究乙型肝炎垂直传播的发生规律并寻找有效的预防办法是十分必要的。本文仅就     

妊娠期人巨细胞病毒感染对母儿的影响及诊治

人巨细胞病毒是引起胎儿、婴儿先天性病毒感染的最常见原因之一。宫内明确诊断胎儿受损存在困难,IgG抗体亲和力测定、羊水的病毒检测结合超声检查对诊断有帮助。应用人巨细胞病毒特异性高效免疫球蛋白进行宫内的预防治疗有一定作用。对于人巨细胞病毒血清学阳性孕妇分娩早产儿或低出生体重儿,母乳喂养可能对新生儿有不利影响。     

乙肝疫苗联合乙肝免疫球蛋白预防HBeAg阴性的HBV感染母亲母婴传播的效果评估

目的:评价乙型肝炎(简称乙肝)疫苗联合乙肝免疫球蛋白(HBIG)常规免疫预防措施在阻断HBeAg阴性的乙肝病毒(HBV)感染母亲母婴传播的临床效果,观察分娩方式和喂养方式对HBV母婴传播的影响。方法:对2004年1月至2012年3月在本院分娩的231例HBsAg阳性但HBeAg阴性母亲及其252例儿童随访,记录母亲孕期HBIG使用情况、分娩方式、子女出生后免疫预防措施和喂养方式,并采血检测相关指标;199例儿童曾检测脐血HBV标志物。结果:16.08%儿童脐血HBsAg阳性,但所有252例儿童随访时(3.3±2.3岁)HBsAg和抗-HBc均阴性,抗-HBs阳性率74.21%。孕期使用HBIG和未使用HBIG母亲的子女抗-HBs阳性率分别为65.22%和73.33%(χ2=1.797,P>0.05)。剖宫产组和自然分娩组母亲的儿童抗-HBs阳性率分别为76.85%和72.22%(χ2=0.69,P>0.05)。111例儿童为母乳喂养,65例人工喂养,76例混合喂养,抗-HBs阳性率分别68.47%、78.46%和78.95%(χ2=3.417,P>0.05)。结论:HBsAg阳性但HBeAg阴性孕妇的子女经正规免疫预防后,几乎无HBV感染;脐血HBsAg阳性不能确定母婴感染;孕妇孕晚期使用HBIG、分娩和喂养方式对HBV母婴传播和新生儿对乙肝疫苗的抗体应答无影响。     

孕妇乙肝免疫球蛋白被动免疫阻断HBV母婴垂直传播作用机理的研究

目的 :研究HBV阳性孕妇孕期应用乙肝免疫球蛋白 (HBIG)预防HBV宫内感染的作用机理。方法 :将 78例乙肝表面抗原 (HBsAg)阳性孕妇分为两组 :预防组 30例 ,于孕 2 8、32、36周肌肉注射HBIG 3次 ,每次 2 0 0IU ;对照组 4 8例 ,只随访查体不用药。检测母儿血清乙肝标志物 (HBVM)和细胞因子IFN γ ,IL 12 ,IL 6水平用双抗夹心酶联免疫吸附法 (DAS ELISA) ,测定HBVDNA含量用荧光定量PCR(FQ PCR)技术。结果 :78例HB sAg阳性孕妇分娩的新生儿宫内感染 10例 ,宫内感染率为 12 .82 % .HBIG预防组孕妇的胎儿HBV感染率显著低于对照组 (P <0 .0 5 ) ;预防组新生儿脐血清抗 HBs检出率显著高于对照组 (P <0 .0 0 1) ;预防组孕妇血清中IFN γ ,IL 12水平显著高于对照组 (P <0 .0 5 ) ,IL 6水平、HBVDNA含量则显著低于对照组 (P <0 .0 5 )。结论 :孕妇HBIG被动免疫可有效阻断HBV母婴垂直传播。     

新型冠状病毒肺炎确诊及疑似孕妇阴道分娩经验总结

正2019年12月湖北省武汉市发现新型冠状病毒肺炎,初期此疫情蔓延迅速,经医务人员的不懈努力,国内疫情已得到逐步控制。武汉大学中南医院作为此次抗击疫情的新型冠状病毒肺炎确诊及疑似孕产妇救治定点医院,为保障孕产妇这一特殊人群的围产期安全,避免发生新型冠状病毒肺炎院内传播,结合国家对新型冠状病毒肺炎诊疗方案指导及本院相关临床病例的处理流程,对此次疫情下确诊及疑似新型冠状病毒肺炎孕妇经阴道分娩过程进行经验总结,并提出以下建议,以供参考。     

乙型肝炎疫苗和乙肝免疫球蛋白阻断乙肝病毒母婴传播的效果

目的:调查实际应用中免疫预防阻断乙型肝炎病毒(HBV)母婴传播的效果,观察孕期注射乙肝免疫球蛋白(HBIG)能否减少HBV母婴感染。方法:对2006年1月至2010年12月在镇江市妇幼保健院分娩的224例乙肝表面抗原(HBsAg)阳性母亲以及250例儿童,结合住院病历,进行回顾性调查,记录母亲孕期HBIG使用情况、子女出生后HBIG和乙型肝炎疫苗接种资料,并采血检测HBV血清标志物及谷丙转氨酶(ALT)。其中69例儿童出生后免疫预防前采外周血检测HBV血清标志物。结果:250例HBsAg阳性孕妇的子女随访时年龄(3.3±1.6)岁,出生时检测HBV标志物的69例中,4例HB-sAg阳性,其中2例随访时HBsAg仍阳性,乙型肝炎e抗原(HBeAg)也阳性,说明慢性感染,另外2例HBsAg转阴;1例出生时HBsAg阴性,但随访时转为阳性。另1例出生时未检测,随访时HBsAg阳性。因此共4例(1.6%)慢性感染HBV,其母亲均为HBeAg阳性。4例感染儿童中,2例出生时未注射HBIG,且未正规接种疫苗。随访的224例母亲中,215例明确孕期使用HBIG的情况;76例子女的母亲孕期注射了HBIG,1例(1.3%)HBsAg阳性,142例子女的139例母亲孕期未使用HBIG,3例(2.1%)HBsAg阳性(P>0.05)。结论:HBsAg阳性孕妇的子女经正规免疫预防后,HBV母婴阻断效果良好,部分预防失败是由于未实施正规预防。新生儿出生时HBV血清标志物不能作为诊断是否感染HBV的指标。孕晚期使用HBIG对阻断母婴感染无效。     

新型冠状病毒肺炎防控期间通过医院公众号平台加强孕妇产检的管理

为了做好孕产妇新型冠状病毒肺炎的预防和产检管理,本文阐述如何通过医院公众号平台有效指导孕妇合理产检、科学防疫、降低传播风险,同时密切关注孕妇心理健康问题。做好国家一级响应期间孕产妇新型冠状病毒肺炎(Novel Coronavirus Pneumonia,NCP)的预防和产检管理。本文重点通过医院公众号平台有效指导孕妇合理产检、科学防疫、降低传播风险,同时密切关注孕妇心理健康问题,为抗击新型冠状病毒感染及孕妇更好的预后提供参考。     

Hepatitis C and pregnancy

Hepatitis C is the most common chronic bloodborne infection in the United States. The diagnosis of vertical transmission is reliably established by a positive serum hepatitis C virus (HCV) RNA on 2 occasions 3 to 4 months apart after the infant is at least 2 months old and/or by the detection of anti-HCV antibodies after the infant is 18 months old. Vertical transmission in HCV RNA-negative pregnant women is approximately 1% to 3% versus approximately 4% to 6% in HCV RNA-positive women. From the standpoint of vertical transmission, no critical HCV RNA titer has been established. Coinfection with HIV has been shown to increase the risk of vertical transmission of HCV, but highly active antiretroviral therapy may decrease the risk significantly. In HIV-negative women, route of delivery does not influence vertical transmission. In HCV/HIV-coinfected women, decisions regarding mode of delivery should be based on HIV status. There is no association between vertical transmission of HCV and gestational age at delivery or the presence of chorioamnionitis. The use of a scalp electrode has been associated with vertical transmission and this practice is discouraged. Data are conflicting regarding duration of ruptured membranes and the risk of vertical transmission of hepatitis C. When the duration of membrane rupture exceeds 6 hours, the risk may be increased. There is no evidence demonstrating an increased risk of HCV transmission in HIV-negative women who breast feed. In HCV/HIV-coinfected women, breast feeding is discouraged in women who have consistent access to safe infant formula. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that vertical transmission of hepatitis C (HCV) does occur, state that coinfection with HIV increases the transmission rate, and summarize that there is no association between gestational age or presence of chorioamnionitis and no evidence that a cesarean delivery prevents transmission.     

HIV-1 Infection in Pregnancy: Prevention of Mother-to-child Transmission

There are over 22 million people worldwide infected by the HIV virus. Most HIV infections are sexually acquired, and women, mainly in the reproductive age, account for a large proportion of cases. The HIV-1 virus can be vertically transmitted during pregnancy, delivery or through breast feeding. Perinatal transmission is the main cause of paediatric HIV infections. The aim of the present review is to discuss the prevention of vertical transmission of the HIV virus from the mother to her child.The strength of evidence supports the administration of antenatal, intrapartum and neonatal zidovudine or other antiretroviral drugs. High maternal HIV load during pregnancy was found to be associated with an increased risk of vertical transmission. Zidovudine was shown to reduce the risk of vertical HIV transmission by 68 percent in a double-blind placebo-controlled randomized trial (P < 0.001). Caesareon section increases the risk of maternal complications, with a possible, albeit unproved benefit of reducing vertical transmission, and should be discussed with the mother. Other alternative methods (condom use, smoking cessation, vaginal cleansing at delivery) are more readily available worldwide. They have a positive influence on maternal health, but their role in decreasing the risk of vertical transmission awaits confirmation. Education, the use of antiretroviral therapies and safe infant bottle feeding should be made accessible to HIV-infected women whenever possible.     

HIV infection and pregnancy: diagnostic and follow-up program for the pregnant woman and newborn child

The authors take as their starting point the cases of 8 pregnancies in HIV serologically positive women, admitted for their observation from July 1986 to March 1988. They emphasize the importance of clinical, anamnestic and serological screening in order to identify those subjects at risk, and thereby prevent the vertical transmission of the virus. To this end, they propose a protocol to be used for all women at risk, both pregnant and not, both seropositive and seronegative. They also advise repeated clinical and immunological checks of the children of asymptomatic carrier mothers.     

Therapeutic and other interventions to reduce the risk of mother-to-child transmission of HIV-1 in Europe

Objectives To document policies regarding the use of interventions to reduce risk of vertical transmission of human immunodeficiency virus (HIV) and assess the extent of changes since 1994.
Design A postal questionnaire survey and data from the European Collaborative Study (ECS), a prospective multi-centre cohort study.
Setting Fifty-four obstetric centres in 16 European countries.
Sample A questionnaire response from 54 obstetricians; 669 deliveries to HIV-infected women enrolled in the ECS from 1994 to 1997.
Main outcome measures Use of zidovudine during pregnancy, at delivery and to the neonate; caesarean section delivery rates; vaginal lavage; avoidance of breastfeeding; vertical transmission rate.
Results Zidovudine therapy to reduce vertical transmission is now widespread in Europe and routine in all but one centre surveyed, although regimens vary. In 11 (26%) centres elective caesarean section is offered to all HIV-infected women and a further nine (21%) have a policy of routine vaginal lavage. In all centres HIV-infected women are advised to avoid breastfeeding. In the ECS there has been a significant temporal decline in the vertical transmission rate with an increase in zidovudine use. More than 90% of women in the ECS who were delivered in 1997 received one or more components of zidovudine therapy; the rate of vertical transmission is 9% where zidovudine has been used, compared with 15% without use of zidovudine.
Conclusions Although the use of zidovudine to reduce vertical transmission is increasing in Europe and, with the avoidance of breastfeeding, is associated with a decline in vertical transmission, the success of these interventions will be limited by the uptake of antenatal screening.     

Guidelines for the Care of Pregnant Women Living With HIV and Interventions to Reduce Perinatal Transmission: Executive Summary

ObjectiveThis guideline reviews the evidence relating to the care of pregnant women living with HIV and the prevention of perinatal HIV transmission. Prenatal care of pregnancies complicated by HIV infection should include monitoring by a multidisciplinary team with experts in this area.OutcomesOutcomes evaluated include the impact of HIV on pregnancy outcome and the efficacy and safety of antiretroviral therapy and other measures to decrease the risk of vertical transmission.EvidencePublished literature was retrieved through searches of PubMed and The Cochrane Library in 2012 and 2013 using appropriate controlled vocabulary (HIV, anti-retroviral agents, pregnancy, delivery) and key words (HIV, pregnancy, antiretroviral agents, vertical transmission, perinatal transmission). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English or French. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to June 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.ValuesThe quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).     

Assisted reproduction in hepatitis carrier couples

Chronic Hepatitis B virus (HBV) infection is endemic worldwide, and the prevalence is especially high in the Asia-Pacific regions. Despite its high prevalence, the literature regarding the impact of HBV infection on subfertility and fertility treatment remains limited and conflicting. Latest studies do not suggest any detrimental effect of HBV infection on the outcome of IVF/ICSI treatment in women having chronic HBV infection. There is evidence that HBV exists in ovarian tissue including oocyte and follicular fluid, and therefore has the potential risk of transmission to the embryo, which can explain the finding of vertical transmission despite immunoprophylaxis. Most recently, we have observed the evidence of HBV viral replication in female HBV carriers undergoing IVF/ICSI treatment. This raises the question of whether antiviral medication should be administered during ovarian stimulation in IVF/ICSI treatment cycles for women with chronic HBV infection to help reduce the chance of vertical transmission.     

Vertical transmission of HIV from mother to child in sub-Saharan Africa: modes of transmission and methods for prevention

The impact of the human immunodeficiency virus (HIV) epidemic in sub-Saharan Africa on future mortality rates of infants, children, and mothers, life expectancy, and economic growth is profound. Vertical transmission of HIV, transmission from mother to child, is a major factor in the increasing rates of HIV infection in sub-Saharan Africa. Vertical transmission of HIV occurs in utero, intrapartum during labor and delivery, and postpartum during breast-feeding. Because of the large numbers of HIV-infected mothers in developing countries, the majority trials regarding prevention of vertical transmission of HIV have been conducted in sub-Saharan Africa. Thus, sub-Saharan Africa has become a human laboratory, which demonstrates both the successes and failures of preventative methods to reduce vertical transmission of HIV. This review summarizes the body of research dedicated to understanding the pathophysiology of vertical transmission of HIV and pharmacology of inhibition of vertical transmission of HIV. While many debate the ethics of conducting trials in developing countries where effective prevention modalities have been slow to be implemented for economic, social and political reasons, studies continue and researchers continue to discover therapies and preventative methods, which may reduce the future devastation of HIV both in sub-Saharan Africa and throughout the world.     

Diagnostic difficulties of Toxoplasma gondii infection in pregnant women. Is it possible to explain doubts by polymerase chain reaction?

OBJECTIVES: Toxoplasma gondii infection during pregnancy is still a difficult problem in the contemporary perinatology. Difficulties met during interpretation of serological tests carried out in pregnant patients to detect Toxoplasmosis implies more and more frequent use of the Polymerase Chain Reaction (PCR). DESIGN: To evaluate the dependence between serological tests and quantity of the Toxoplasma gondii genomes in mothers' blood and amniotic fluid or neonatal blood, the quantitative PCR (q-PCR) method was applied. MATERIALS AND METHODS: The analysis was performed in 81 pregnant women. Maternal blood, amniotic fluid and newborns' umbilical blood samples were evaluated for the presence of Toxoplasma gondii DNA. IgG and IgM Toxoplasma gondii antibodies were evaluated by the ELISA method. RESULTS: High seroprevalence (51.9%) of the Toxoplasma gondii was confirmed. Toxoplasma gondii genetic material in blood and/or amniotic fluid was found in 33 patients. It was stated that quantity of the protozoa and anti-IgM presence in mothers' blood are the factors influencing significantly the Toxoplasma gondii manifestation in amniotic fluid. CONCLUSION: High suitability of PCR in diagnosis of Toxoplasmosis during pregnancy and vertical transmission was confirmed.     

Prenatal diagnosis of congenital toxoplasmosis

Ninety-three pregnant women with Toxoplasma gondii seroconversion during pregnancy underwent prenatal diagnosis of fetal toxoplasmosis. The following tests were used: (1). amniocentesis for mouse inoculation (93 subjects), (2). amplification of T. gondii DNA by polymerase chain reaction (PCR) (79 subjects), and (3). cordocentesis for the detection of T. gondii-specific IgM antibodies (13 subjects). All patients had serial ultrasonographic scans to detect those fetuses with abnormalities that could be associated with congenital toxoplasmosis. Eighteen pregnancies (19.4%) had evidence of vertical transmission. A total of 11/18 (61.1%) had positive amniotic mouse inoculation test, while 10/12 (83.3%) had positive PCR results. The combination of both tests allowed the prenatal diagnosis in 17/18 infected fetuses (94.4%). All patients who underwent cordocentesis for the detection of T. gondii-specific IgM antibodies had negative results. However, in two of the above cases fetal toxoplasmosis was detected by amniotic fluid studies. In five of the infected fetuses there were abnormal ultrasonographic findings. All pregnancies with evidence of vertical transmission were terminated, whereas the remaining pregnancies proceeded normally to term. The present data showed that amniotic fluid studies, preferably PCR amplification of T. gondii DNA, are the best diagnostic tools for the detection of vertical transmission in pregnancies with seroconversion during pregnancy.