Perinatal transmission of human papillomavirus from gravidas with latent infections.
P Tenti, R Zappatore, P Milgliora et al) (Univ of Pavia, Italy;)
Obstet Gynecol 93: 475-479,1999.
Mother to child transmission in the perinatal period may be a route of human papillomavirus (HPV) infections.
711 pairs of mothers of newborn were studied. Nasopharyngeal aspirates were HPV negative in all 11 infants in whom membrane rupture occurred less than 2 hours before delivery.
The risk of HPV transmission to the oropharyngeal mucosa of the infants of women with latent HPV infection is low. Time between amnion rupture and delivery appears to be critical in predicting transmission. Infants who are HPV positive should be considered contaminated instead of infected since virus is cleared within several months after birth.
Impact of a Risk Based Prevention Policy on Neonatal group B Streptococcal disease.
Factor SH, Levine OS, Nassar A, et al (Univ.of Miami-Jackson Mem Med Ctr)
Am J Obstet Gynecol 179:1568-1571, 1998
Background : Intrapartum antibiotic prophylaxis can prevent neonatal group B streptococcal infections. The outcomes of a program, begun in 1992 at 1 center, in which women with obstetric risk factors received intrapartum antibiotic prophylaxis are reported.
The use of intrapartum antibiotic prophylaxis based on risk factors was correlated with a reduction in group B streptococcal disease. The recommendations of American College of Obstetricians would have obstetricians treat with antibiotics intrapartum in those women with a history of threatened preterm labor, intrapartum fever, and premature rupture of membranes that lasted longer than 18 hours. This policy in force from 1992 to 1995 was associated with an 94% decrease in the incidence of newborn GBS culture positivity from samples of cerebrospinal fluid and/or blood obtained from newborns during that time.
It is not certain that a causal relationship existed between antibiotic use and the decrease in newborn GBS culture positivity; a secular change might be responsible for what appears to be an interrelationship. The results also strongly suggest that an approach to treatment based on risk factors discernible in labor, without screening by culture, may reduce the likelihood of this devastating newborn complication.
William J, Ledger, Jan Jeremias, and Steven S. Witkin, [From the Division of Infection and Immunology, Department of Obstetrics -Gynecology Joan and Sanford I, Weill Medical College of Cornell University, New York -Presbyterian Hospital]
Testing for High-Risk Human Papillomavirus Types will become a Standard of Clinical Care
Am J. Obstet Gynecol April 2000, Volume 182, Number 4, Pgs. 860-865
Testing for high risk human papillomavirus types should become a standard of care for women in the United States because cervical cancer is an infectious disease. Current care is based on cytologic screening and a pathologic staging of cellular tissue changes. Before these cellular modifications, there is a demonstrable pattern of human papillomavirus types can lead to abnormal cervical cellular changes. When these cervical cellular changes occur, physician interventions hasten human papillomavirus elimination. Currently, adding human papillomavirus screening to the papanicolaou smear identifies a population for closer follow-up studies. In the future a vaccine should be introduced to prevent infections, and medical treatments to hasten the elimination of high risk human papillomavirus types should become part of standard medical practice.
K Elfgren, M Kalantari, et al (Stockholm, Sweden)
A population based five year follow up study of cervical human papillomavirus infection
Am J Obstet Gynecol Sept. 2000; 183: 561-7.
Objective: The purpose of this study was to determine the long-term tendency for cervical human papillomavirus infections to persist in the general population.
Study Design: From 500 women who participated in a 1991 population-based survey, 90 healthy women with normal results of cytologic examination (women with human papillomavirus deoxyribonucleic acid detected and age-matched control women without human papillomavirus deoxyribonucleic acid detected) were interviewed and examined 5 years after colposcopically, cytologically, and with human papillomavirus serologic testing and human papillomavirus deoxyribonucleic acid testing by polymerase chain reaction with 2 different consensus primer pairs, type-specific polymerase chain reaction, and deoxyribonucleic acid sequencing.
Results: The 5-year human papillomavirus clearance rate was 92%. Only human papillomavirus type 16 infections persisted. Colposcopic impression of grade 2 cervical intraepithelial neoplasia was associated with persistent human papillomavirus 16 infection (P <.03). Human papillomavirus detection was associated with sexual history. Human papillomavirus type was the only determinant of human papillomavirus persistence.
Conclusion: The high clearance rates in a population-based setting with a 5-year follow-up period imply that inclusion of human papillomavirus deoxyribonucleic acid testing in population-based cervical screening programs should target persistent infection.
O. Liesenfeld, J. G. Montoya, N. J. Tathineni, M. Davis, B. W. Brown, K. L. Cobb, J. Parsonnet, and J. S. Remington (Palo Alto and Stanford, California)
Confirmatory Serologic Testing for Acute Toxoplasmosis and Rate of Induced Abortions Among Women Reported to have Positive Toxoplasma Immunoglobulin M Antibody Titers
Am J Obstet Gynecol Jan. 2001; 184: 140-5
Objective : Results obtained with commercial testing kits for immunoglobulin M Toxoplasma antibodies may be inaccurate or may be inaccurately interpreted, which may influence whether a woman decides to terminate the pregnancy. This study was undertaken to determine whether confirmatory testing at a reference laboratory and communication of the results and an expert interpretation to the patients physician would affect the rate of induced abortions among pregnant women with positive results of testing for immunoglobulin M Toxoplasma antibodies in outside laboratories.
Study Design : This was a retrospective cohort study of 811 consecutive pregnant women for whom the toxoplasma serologic profile was performed at a reference laboratory. Almost all the patients had been informed by their physicians that a result of a test for immunoglobulin M Toxoplasma antibodies performed in an outside laboratory was positive.
Women were separated into those with a toxoplasma serologic profile result suggestive of a recently acquired infection (group 1) and those with a result suggestive of an infection acquired in the more distant past (group 2). Physician reports of induced abortions were used to determine rates of induced abortion in groups 1 and 2.
Results : Of the 811 women 321 (39.6%) were considered likely to have a recent infection (group 1) and 490 (60.4%) were considered likely to have a past infection (group 2). Physicians reported pregnancy outcomes for 433 (53.4%) of 811 women (65.1% and 45.7% in all groups 1 and 2, respectively). Whereas 36 of 209 women in group 1 (17.2%) terminated the pregnancy, only 1of 224 women in group 2 (0.4%) chose abortion (P < .001).
Conclusion : Confirmatory serologic testing in a reference laboratory and communication of the results and their correct interpretation by an expert to the patients physician decreased the rate of unnecessary abortions by approximately 50% among women for whom positive immunoglobulin M Toxoplasma test results had been reported by outside laboratories.
Comments : PCR of amniotic fluid performed in a reference laboratory has proved to be both sensitive and specific for the detection of infection in the fetus.
It is recommended that PCR be performed on amniotic fluid from all patients for whom confirmatory serologic testing indicates recent infection.
The US Food and Drug Administration has recently issued a health advisory warning about the use of Toxoplasma IgM commercial test kits as the sole determinant of recent infection among pregnant women.