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BMJ Open Jul 2023Maternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (luids, ntibiotics, ource...
OBJECTIVE
Maternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (luids, ntibiotics, ource identification and treatment, ransfer and onitoring) for early identification and management of maternal sepsis in low-resource settings. This study aimed to determine feasibility of FAST-M intervention in a low-resource setting in Pakistan. The FAST-M intervention consists of maternal sepsis screening tools, treatment bundle and implementation programme.
DESIGN AND SETTING
A feasibility study with before and after design was conducted in women with suspected maternal sepsis admitted at the Liaquat University of Medical and Health Sciences hospital Hyderabad. The study outcomes were compared between baseline and intervention phases. In the baseline phase (2 months), the existing sepsis care practices were recorded, followed by a training programme for healthcare providers on the application of FAST-M tools. These tools were implemented in the intervention phase (4 months) to assess any change in clinical practices compared with the baseline phase.
RESULTS
During the FAST-M implementation, 439 women were included in the study. 242/439 were suspected maternal infection cases, and 138/242 were women with suspected maternal sepsis. The FAST-M bundle was implemented in women with suspected maternal sepsis. Following the FAST-M intervention, significant changes were observed. Improvements were seen in the monitoring of oxygen saturation measurements (25.5% vs 100%; difference: 74%; 95% CI: 68.4% to 80.5%; p<0.01), fetal heart rate assessment (58% vs 100%; difference: 42.0%; 95% CI: 33.7% to 50.3%; p≤0.01) and measurement of urine output (76.5% vs 100%; difference: 23.5%; 95% CI: 17.6% to 29.4%; p<0.01). Women with suspected maternal sepsis received all components of the treatment bundle within 1 hour of sepsis recognition (0% vs 70.5%; difference: 70.5%; 95% CI: 60.4% to 80.6%; p<0.01).
CONCLUSION
Implementation of the FAST-M intervention was considered feasible and enhanced early identification and management of maternal sepsis at the study site.
TRIAL REGISTRATION NUMBER
ISRCTN17105658.
Topics: Female; Humans; Pregnancy; Anti-Bacterial Agents; Feasibility Studies; Pakistan; Pregnancy Complications, Infectious; Sepsis
PubMed: 37518083
DOI: 10.1136/bmjopen-2022-069135 -
Pediatric Research Jan 2024The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require... (Review)
Review
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Cesarean Section; Pregnancy Complications, Infectious; Pandemics; Placenta; COVID-19; Pregnancy Outcome; Infectious Disease Transmission, Vertical
PubMed: 38057579
DOI: 10.1038/s41390-023-02950-2 -
PloS One 2024The impact of COVID-19 on the placenta is poorly described, particularly among minority women.
INTRODUCTION
The impact of COVID-19 on the placenta is poorly described, particularly among minority women.
MATERIALS AND METHODS
This is a retrospective case-control study. Micro- and macroscopic placental pathologic findings were compared for 15 COVID-19 positive and 36 negative mothers. Cases and controls were frequency matched on gestational age, race, maternal comorbidities, and delivery type. Data from the electronic medical record were supplemented with independent review of microscopic slides.
RESULTS
Placentas from cases and controls were similar except the median distance from the site of the cord insertion to the nearest disk margin was statistically significantly shorter among placentas from COVID-19 positive cases (3.5 versus 6.0 cm, p = 0.006). Case status was not associated with an increased risk of placental pathologies.
CONCLUSION
There are few pathologic differences between placentas of COVID-19 positive and negative mothers. Additional studies are needed to investigate the role of timing of infection.
Topics: Humans; Female; COVID-19; Pregnancy; Placenta; Adult; Retrospective Studies; Case-Control Studies; Pregnancy Complications, Infectious; SARS-CoV-2
PubMed: 38781150
DOI: 10.1371/journal.pone.0302682 -
Obstetrical & Gynecological Survey Dec 2023Group B (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often... (Review)
Review
IMPORTANCE
Group B (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often associated with poor screening and management.
OBJECTIVE
The aim of this study was to review and compare the most recently published influential guidelines on the screening and management of this clinical entity during antenatal and intrapartum periods.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada on the prevention of early-onset neonatal group B streptococcal disease was carried out.
RESULTS
There is a consensus among the reviewed guidelines regarding the optimal screening specimen type, indications for intrapartum antibiotic administration such as bacteriuria during pregnancy, clinical signs of chorioamnionitis or maternal pyrexia, and history of GBS-related neonatal disease. There is also agreement on several conditions where no intervention is recommended, that is, antepartum treatment of GBS and GBS-positive women with planned cesarean delivery and intact membranes. Controversy exists regarding the optimal screening time, with the Royal College of Obstetricians and Gynecologists stating against routine screening and on management strategies related to preterm labor and preterm prelabor rupture of membranes.
CONCLUSIONS
The development of consistent international practice protocols for the timely screening of GBS and effective management of this clinical entity both during pregnancy and the intrapartum period seems of paramount importance to safely guide clinical practice and subsequently improve neonatal outcomes.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Complications, Infectious; Antibiotic Prophylaxis; Streptococcal Infections; Infectious Disease Transmission, Vertical; Australia; Streptococcus agalactiae
PubMed: 38134342
DOI: 10.1097/OGX.0000000000001223 -
NeoReviews May 2024Varicella is a highly contagious disease caused by the varicella-zoster virus and has a wide range of clinical presentations. Varicella can cause mild disease in infants... (Review)
Review
Varicella is a highly contagious disease caused by the varicella-zoster virus and has a wide range of clinical presentations. Varicella can cause mild disease in infants born to infected persons who are immunized as a result of previous vaccination or previous clinical or subclinical infection. However, varicella can also lead to severe life-threatening disease in infants, particularly for those born to nonimmunized persons. In this review, we will summarize the natural history of varicella-zoster infection in pregnant persons, infants with congenital varicella syndrome, and infants with postnatal varicella infection. We will also provide guidance about isolation recommendations and chemoprophylaxis for exposed hospitalized infants. Finally, we will describe risk factors for developing disseminated disease and review the approach to treatment of infected infants.
Topics: Humans; Chickenpox; Pregnancy; Female; Pregnancy Complications, Infectious; Infant; Infant, Newborn; Chickenpox Vaccine; Antiviral Agents; Risk Factors
PubMed: 38688890
DOI: 10.1542/neo.25-5-e274 -
Frontiers in Public Health 2023Tuberculosis (TB) in young infants (<3 months of age), often referred to as perinatal TB, is underdiagnosed, leading to severe morbidity and high mortality. Perinatal TB... (Review)
Review
Tuberculosis (TB) in young infants (<3 months of age), often referred to as perinatal TB, is underdiagnosed, leading to severe morbidity and high mortality. Perinatal TB includes both congenital and postnatal transmission of . We aimed to increase an awareness of TB in neonates and young infants and to provide guidance on the assessment and management when in contact with mothers with TB during or soon after pregnancy. Approximately 217,000 pregnant women develop TB annually; if they are not diagnosed and treated during pregnancy, their infants are at high risk of adverse birth outcomes and TB disease. Although safe and effective antituberculosis treatment regimens are available during pregnancy, the diagnosis of TB is challenging. Infants born to mothers newly diagnosed with TB, not receiving any effective treatment or with cultures not yet negative, should be assessed for TB disease or infection. TB preventive therapy should be instituted if the infant is clinically well but exposed to TB, while prompt initiation of TB treatment is essential if TB disease is presumed. HIV status of mother and infant should be considered as this will affect the management. Further research is needed for the diagnosis and prevention of TB during pregnancy, an early diagnosis of TB in infants, and antituberculosis drug pharmacokinetics in young infants.
Topics: Infant, Newborn; Infant; Pregnancy; Female; Humans; Pregnancy Complications, Infectious; Tuberculosis; Antitubercular Agents; Mycobacterium tuberculosis; Mothers
PubMed: 38026389
DOI: 10.3389/fpubh.2023.1239734 -
Neuroscience and Biobehavioral Reviews Oct 2023Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health... (Review)
Review
Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.
Topics: Female; Humans; Pregnancy; Cytomegalovirus; Inflammation; Mental Disorders; Pregnancy Complications, Infectious; Toxoplasma; Infant, Newborn
PubMed: 37708918
DOI: 10.1016/j.neubiorev.2023.105390 -
The Lancet. Infectious Diseases Jan 2024Congenital syphilis is a major global cause of fetal loss, stillbirth, neonatal death, and congenital infection. In 2020, the global rate of congenital syphilis was 425... (Review)
Review
Congenital syphilis is a major global cause of fetal loss, stillbirth, neonatal death, and congenital infection. In 2020, the global rate of congenital syphilis was 425 cases per 100 000 livebirths-substantially higher than WHO's elimination target of 50 cases per 100 000 livebirths. Case rates are rising in many high-income countries, but remain low compared with those in low-income and middle-income settings. This Review aims to summarise the current epidemiology and knowledge on transmission and treatment of syphilis in pregnancy, and proposes measures to reduce the rising incidence seen worldwide. We also describe emerging diagnostic and treatment tools to prevent vertical transmission and improve management of congenital syphilis. Finally, we outline a programme of public health priorities, which include research, clinical, and preventive strategies.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Syphilis, Congenital; Pregnancy Complications, Infectious; Syphilis; Stillbirth; Prenatal Care; Infectious Disease Transmission, Vertical
PubMed: 37604180
DOI: 10.1016/S1473-3099(23)00314-6 -
Scientific Reports Mar 2024Sepsis is responsible for 50% of intrahospital maternal deaths worldwide. Incidence is increasing in both low and middle-, and high-income countries. There is little...
Sepsis is responsible for 50% of intrahospital maternal deaths worldwide. Incidence is increasing in both low and middle-, and high-income countries. There is little data on incidence and clinical outcomes of obstetric infections including maternal sepsis in the Nordic countries. The aims of this study are to give estimates of the occurrence of obstetric infections and maternal sepsis in a Norwegian hospital cohort, assess the quality of management of maternal sepsis cases, and evaluate the usefulness of diagnostic codes to identify maternal sepsis retrospectively. We conducted a retrospective cohort study of pregnant, labouring, post-abortion, and postpartum women. We assessed the accuracy of the diagnostic code most frequently applied for maternal sepsis, O85. We found 7.8% (95% confidence interval 7.1-8.5) infection amongst pregnant, labouring, and postpartum women. The incidence of maternal sepsis was 0.3% (95% confidence interval 0.2-0.5), and the majority of sepsis cases were recorded in the postpartum period. Two thirds of women were given broad-spectrum antibiotics at the time sepsis was diagnosed, but only 15.4% of women with puerperal sepsis were given antimicrobials in accordance with national guidelines. When used retrospectively, obstetric infection codes are insufficient in identifying both maternal and puerperal sepsis, with only 20.3% positive predictive value for both conditions. In conclusion, obstetric infections contribute significantly to maternal morbidity in Norway's second largest maternity hospital. This study provides incidences of maternal infections for hospitalised patients in temporal relation to pregnancy, labour, abortion and the postpartum period, knowledge which is valuable for planning of health care services and allocation of resources. In addition, the study highlights areas where improvement is needed in clinical handling of maternal sepsis. There is need for studies on the management quality and use of correct diagnostic codes in this patient category.
Topics: Pregnancy; Humans; Female; Retrospective Studies; Pregnancy Complications, Infectious; Postpartum Period; Sepsis; Pre-Eclampsia; Hospitals
PubMed: 38480912
DOI: 10.1038/s41598-024-56486-4 -
Birth (Berkeley, Calif.) Sep 2023The World Health Organization recommends skin-to-skin contact (SSC) in newborns of mothers with COVID-19, applying infection prevention and control measures, and after a... (Review)
Review
BACKGROUND
The World Health Organization recommends skin-to-skin contact (SSC) in newborns of mothers with COVID-19, applying infection prevention and control measures, and after a process of antenatal counseling on the possible risks and benefits. In this study, the reasons given for and against postnatal SSC in mothers with COVID-19 were reviewed.
METHOD
Between November and December 2020, we conducted a scoping review. Twenty-six relevant studies were identified. The results were extracted and presented narratively.
RESULTS
The reasons described for avoiding SSC have include contradictory recommendations, risk of virus transmission, impossibility of universal antepartum maternal screening for COVID-19, work overload, and ethical considerations. The reasons given for the maintenance of SSC include maternal and infant benefits of SSC, previous experiences in viral outbreaks, protection of newborns against infections, decreased contact with professionals, caregivers and surfaces, and preservation of natural processes.
CONCLUSIONS
The recommendation to allow SSC is based primarily on the acceptance that horizontal perinatal transmission is unlikely if correct hygiene precautions are taken and that the benefits of SSC outweigh the potential risks of neonatal COVID-19 infection. Knowing the reasons that have motivated the current recommendations on SSC is essential to be able to carry out an effective prenatal parental education that allows a shared decision to be made.
Topics: Infant; Infant, Newborn; Female; Humans; Pregnancy; Mothers; COVID-19; Infectious Disease Transmission, Vertical; Pregnancy Complications, Infectious; Parturition
PubMed: 36774626
DOI: 10.1111/birt.12715