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1/69. herpes simplex hepatitis in pregnancy: a case report and review of the literature.

    Fulminant hepatic dysfunction in the third trimester of pregnancy accompanied by fever may result from disseminated herpes simplex virus. Since 1969, 24 cases of herpes simplex hepatitis, including the current case, have been reported. Mucocutaneous lesions are present in only half of cases; therefore, suspicion for diagnosis of this disease is low. Twenty-five percent of cases were not diagnosed until autopsy. Maternal and perinatal mortality are high, approaching 39 percent for both mother and fetus. Early recognition with initiation of antiviral therapy appears to be most important in maximizing survival.
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2/69. Successful treatment of generalized primary herpes simplex type 2 infection during pregnancy.

    Generalized herpes simplex virus infections constitute a severe threat to mother and child during pregnancy. Before antiviral treatments were available, both mother and foetus had a high mortality rate. The following case illustrates a successful outcome after long-term antiviral treatment. It is of great importance to suspect, diagnose and treat patients with HSV 2 early, especially during pregnancy.
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3/69. A perinatal pathology view of preterm labor.

    The development and widespread use of tocolytic agents over the past 2 decades has not appeared to substantially affect the overall incidence of preterm delivery in the united states. Preterm delivery, therefore, remains one of the most poorly controlled and poorly understood mechanisms of perinatal morbidity and mortality and a significant strain on public health resources. The purpose of this review is to examine what is currently understood about the clinical manifestations and indicators of preterm delivery, and what, if any, may be the contribution of placental pathology to the understanding of the structural and functional abnormalities that may precede these clinical signs. Two case studies will be used to show how placental pathology may document a pattern of reproductive failure that eludes current methods of clinical screening. A retrospective analysis of what may have gone wrong in the pregnancies, focusing on the placental lesions, may contribute to a greater understanding of the heterogeneous overall processes behind recurrent idiopathic preterm delivery. Such analysis, in conjunction with known clinical factors, may guide the development of better-directed diagnostics and therapies.
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4/69. q fever during pregnancy: an emerging cause of prematurity and abortion.

    BACKGROUND: Although the pathogenic role of coxiella burnetii infection during pregnancy is controversial, some cases of stillbirth and abortion occurring after an acute or chronic infection have been mentioned in the literature. Recently, Q fever has been advocated as a significant cause of morbidity and mortality in pregnancy CASE: We describe an 18-year-old primipara woman admitted to our hospital for high fever and pancytopenia during an acute C. burnetii infection. She was successfully treated with clarithromycin, overcoming fever and pancytopenia. Finally, she gave birth to a healthy infant, and 1 year later both remained well. CONCLUSION: q fever is a potentially serious disease in pregnancy owing to the possibility of placenta infection and fetal transmission affecting its outcome. q fever infection should be suspected in unexplained febrile episodes or abortion during pregnancy, when epidemiologic and clinical data are present. We believe that C. burnetii serology should be tested in cases of fever of known origin or unexplained abortions, as the TORCH infections are.
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5/69. pneumocystis carinii pneumonia in pregnancy.

    OBJECTIVE: To report five new cases of pneumocystis carinii pneumonia (PCP) and to review and analyze the existing reports on the subject. METHOD: Five new cases of PCP during pregnancy are described. The cases, case series, and related articles on the subject in the English language were identified through a comprehensive medline search and reviewed. RESULTS: More than 80% of women with AIDS are of reproductive age, and PCP is the most common cause of AIDS-related death in pregnant women in the united states. Among 22 reviewed cases, the mortality rate was 50% (11 of 22 patients), which is higher than that usually reported for hiv-infected individuals with PCP. Respiratory failure developed in 13 patients (59%), and mechanical ventilation was therefore required, and the survival rate in patients requiring mechanical ventilation was 31%. Maternal and fetal outcomes were better in cases of PCP during the third trimester of the pregnancy. A variety of treatment regimens were used, including sulfamethoxazole-trimethoprim (SXT) alone or in combination with pentamidine, steroids, and eflornithine. The survival rate in patients treated with SXT alone was 71% (5 of 7 patients) and for those treated with SXT and steroids was 60% (3 of 5 patients), with an overall survival rate in both groups of 66.6% (8 of 12 patients). CONCLUSION: PCP has a more aggressive course during pregnancy, with increased morbidity and mortality. Maternal and fetal outcomes remain dismal. Treatment with SXT, compared to other therapies, may result in an improved outcome. Withholding appropriate PCP prophylaxis may adversely affect maternal and fetal outcomes.
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6/69. Pulmonary abscesses in congenital syphilis.

    Congenital syphilis remains a public health concern in the united states. Infants whose mothers are treated in the third trimester without adequate prenatal care have an increased risk of morbidity and mortality in the immediate perinatal period. The identification of treponema pallidum in tissue is definitive confirmation of infection. We report the case of a 32-week gestational age infant born to a mother treated for syphilis 7 days prior to delivery. The infant died 12.5 hours after birth. At autopsy, there was extensive acute hyaline membrane disease. In addition, there were bilateral pulmonary abscesses with spirochetes. The onset of maternal disease was unknown, but was probably early in or prior to the pregnancy. This is an unusual case of pulmonary involvement in congenital syphilis.
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7/69. Listeria infection during pregnancy: a 10 year experience.

    BACKGROUND: Although listeria monocytogenes is widely distributed in nature, it rarely causes clinical infection in previously healthy people. This microorganism, however, may cause severe invasive disease in pregnant women and newborns. OBJECTIVES: To investigate--in our pregnant population--the impact, severity and outcome of listeriosis on both mother and fetus. METHOD: The study was carried out at a level III, university two-hospital complex. In a retrospective chart review of 65,022 parturients during a 10 year period (1990-1999), we identified and evaluated 11 pregnant patients and their offspring with Listeria infection. RESULTS: chorioamnionitis with multiple placental abscesses were observed in all five placentae examined. Clinically, 4 of 11 parturients had a cesarean section for fetal distress (36.3%), as compared to the 14% mean CS rate in our general population. Two of 11 had a late abortion (18.1%), as compared with the 4% rate in our hospital. Four of 11 had premature labor (36%), which was about four times the rate in our population. Finally, although no intrauterine fetal death was recorded in our series, there was one neonatal death of a term infant (1/11, 9%), which is about 10 times higher than our corrected perinatal mortality rate. CONCLUSIONS: If not promptly and adequately treated, listeriosis in pregnancy may present serious hazards to the fetus and newborn through direct infection of the placenta and chorioamnionitis.
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8/69. influenza a virus infection and cardiac arrhythmia during the neonatal period.

    Influenza virus infection during pregnancy increases the risk of spontaneous abortion, preterm contractions, fetal compromise and early neonatal mortality. We describe a case of fetal and neonatal cardiac arrhythmia coinciding with an influenza a virus infection. Viral RNA was detected in the neonate's nasopharyngeal secretions and also in its serum, indicating influenza viremia. The cardiac arrhythmia resolved spontaneously without antiarrhythmic treatment.
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9/69. hydrops fetalis secondary to parvovirus B19 infections.

    BACKGROUND: Fetal infection by human parvovirus B19 is a common cause of fetal anemia, nonimmune hydrops fetalis, and spontaneous abortion and can result in fetal death. Recent improvements in diagnosing parvovirus infections and the availability of intrauterine transfusion have reduced the overall rate of fetal loss after maternal exposure. methods: We report two cases of maternal parvovirus infection with classic findings of hydrops fetalis and review various aspects of parvovirus infection with emphasis on the developing management options in pregnancy. RESULTS AND CONCLUSIONS: Different management led to different results. In the first case there was normal neonatal and infantile development, and in the second case, the fetus died. With accurate laboratory testing, obstetric sonography, and fetal transfusion, the fetal mortality from parvovirus infection has been reduced considerably, and most pregnancies complicated by maternal parvovirus infection result in healthy outcomes.
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10/69. Group A streptococcal toxic shock syndrome developing in the third trimester of pregnancy.

    BACKGROUND: Group A streptococcal (GAS) toxic shock syndrome (TSS) is an uncommon, but life-threatening infection during pregnancy and should be considered in rapid onset of shock. Most cases described in the literature have occurred in the puerperium. We report a case of GAS TSS occurring during the third trimester of pregnancy in a previously healthy woman. CASE: A 31-year-old female, who was 34 weeks pregnant, presented with fevers and a prodromal 'flu-like' illness. She rapidly developed shock and multiorgan failure. blood cultures revealed GAS bacteremia and the patient met criteria for streptococcal TSS. Despite her eventual recovery, her infant died on postpartum day 15 as a consequence of the mother's TSS. CONCLUSIONS: This case is unusual in that there were no identifiable initiating events or source of the streptococcal infection, and the TSS developed during pregnancy rather than after delivery. Early recognition of GAS infections is important given the rapid onset and high morbidity and mortality associated with these infections. This is the first reported case utilizing intravenous immunoglobulin for GAS TSS in the puerperium.
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