Skip header and navigation

3 records – page 1 of 1.

Management of suspected primary Toxoplasma gondii infection in pregnant women in Norway: twenty years of experience of amniocentesis in a low-prevalence population.

https://arctichealth.org/en/permalink/ahliterature290084
Source
BMC Pregnancy Childbirth. 2017 04 26; 17(1):127
Publication Type
Journal Article
Date
04-26-2017
Author
Gry Findal
Anne Helbig
Guttorm Haugen
Pål A Jenum
Babill Stray-Pedersen
Author Affiliation
University of Oslo, Institute of Clinical Medicine, Oslo, Norway. gryfi@medisin.uio.no.
Source
BMC Pregnancy Childbirth. 2017 04 26; 17(1):127
Date
04-26-2017
Language
English
Publication Type
Journal Article
Keywords
Abortion, Spontaneous - etiology
Adult
Amniocentesis - adverse effects
Female
Humans
Maternal Serum Screening Tests - methods
Norway
Pregnancy
Pregnancy Complications, Parasitic - diagnosis
Prenatal Diagnosis - adverse effects - methods
Retrospective Studies
Toxoplasmosis - diagnosis
Unnecessary Procedures - adverse effects - methods
Abstract
Primary infection with Toxoplasma gondii during pregnancy may pose a threat to the fetus. Women infected prior to conception are unlikely to transmit the parasite to the fetus. If maternal serology indicates a possible primary infection, amniocentesis for toxoplasma PCR analysis is performed and antiparasitic treatment given. However, discriminating between primary and latent infection is challenging and unnecessary amniocenteses may occur. Procedure-related fetal loss after amniocentesis is of concern. The aim of the present study was to determine whether amniocentesis is performed on the correct patients and whether the procedure is safe for this indication.
Retrospective study analysing data from all singleton pregnancies (n?=?346) at Oslo University Hospital undergoing amniocentesis due to suspected maternal primary toxoplasma infection during 1993-2013. Maternal, neonatal and infant data were obtained from clinical hospital records, laboratory records and pregnancy charts. All serum samples were analysed at the Norwegian Institute of Public Health or at the Toxoplasma Reference Laboratory at Oslo University Hospital. The amniocenteses were performed at Oslo University Hospital by experienced personnel. Time of maternal infection was evaluated retrospectively based on serology results.
50% (173) of the women were infected before pregnancy, 23% (80) possibly in pregnancy and 27% (93) were certainly infected during pregnancy. Forty-nine (14%) women seroconverted, 42 (12%) had IgG antibody increase and 255 (74%) women had IgM positivity and low IgG avidity/high dye test titre. Fifteen offspring were infected with toxoplasma, one of them with negative PCR in the amniotic fluid. Median gestational age at amniocentesis was 16.7 gestational weeks (GWs) (Q1?=?15, Q3?=?22), with median sample volume 4 ml (Q1?=?3, Q3?=?7). Two miscarriages occurred 4 weeks after the procedure, both performed in GW 13. One of these had severe fetal toxoplasma infection.
Half of our study population were infected before pregnancy. In order to reduce the unnecessary amniocenteses we advise confirmatory serology 3 weeks after a suspect result and suggest that the serology is interpreted by dedicated multidisciplinary staff. Amniocentesis is safe and useful as a diagnostic procedure in diagnosing congenital toxoplasma infection when performed after 15 GW.
Notes
Cites: PLoS One. 2015 Dec 29;10(12):e0145519 PMID 26714282
Cites: APMIS. 1998 Jul;106(7):680-6 PMID 9740505
Cites: BJOG. 2005 Apr;112(4):394-402 PMID 15777434
Cites: Clin Infect Dis. 2013 May;56(9):1223-31 PMID 23362291
Cites: Ultrasound Obstet Gynecol. 2016 Jan;47(1):38-44 PMID 26581188
Cites: Ann Ist Super Sanita. 2004;40(1):81-8 PMID 15269456
Cites: Clin Microbiol Infect. 2015 Feb;21(2):191.e1-8 PMID 25596783
Cites: Obstet Gynecol. 2001 Feb;97(2):296-300 PMID 11165598
Cites: J Infect Dis. 2001 Apr 15;183(8):1248-53 PMID 11262207
Cites: Diagn Microbiol Infect Dis. 2009 Jul;64(3):267-74 PMID 19395217
Cites: Am J Perinatol. 2006 Jan;23(1):25-30 PMID 16450269
Cites: Clin Infect Dis. 2008 Aug 15;47(4):554-66 PMID 18624630
Cites: PLoS One. 2016 Apr 07;11(4):e0149938 PMID 27055272
Cites: Lancet. 1986 Jun 7;1(8493):1287-93 PMID 2423826
Cites: PLoS Med. 2010 Oct 12;7(10):null PMID 20967235
Cites: Int J Parasitol. 2009 Oct;39(12):1385-94 PMID 19433092
Cites: Prenat Diagn. 2007 May;27(5):395-403 PMID 17380472
Cites: Scand J Infect Dis. 1979;11(2):159-65 PMID 462133
Cites: Clin Infect Dis. 1994 Jun;18(6):853-61; quiz 862 PMID 8086543
Cites: Clin Vaccine Immunol. 2012 Nov;19(11):1838-43 PMID 22993406
Cites: BJOG. 2003 Apr;110(4):392-9 PMID 12699801
Cites: Epidemiol Infect. 1998 Feb;120(1):87-92 PMID 9528822
Cites: Am J Obstet Gynecol. 2010 Dec;203(6):552.e1-6 PMID 20633868
Cites: Arch Gynecol Obstet. 2009 Mar;279(3):357-60 PMID 18665378
Cites: J Clin Microbiol. 1998 Oct;36(10):2900-6 PMID 9738041
Cites: Padiatr Padol. 1972;7(1):14-9 PMID 4670273
Cites: Clin Vaccine Immunol. 2013 Feb;20(2):197-204 PMID 23239801
Cites: Prenat Diagn. 1998 Aug;18(8):773-8 PMID 9742564
Cites: J Clin Microbiol. 1997 Aug;35(8):1972-7 PMID 9230365
Cites: Eur J Clin Microbiol Infect Dis. 1996 Oct;15(10):799-805 PMID 8950557
Cites: Fetal Diagn Ther. 2010;27(1):1-7 PMID 20051662
Cites: APMIS. 2015 Apr;123(4):321-5 PMID 25628065
Cites: N Engl J Med. 1988 Feb 4;318(5):271-5 PMID 3336419
Cites: Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):230-3 PMID 23664797
Cites: Lancet. 2007 Jan 13;369(9556):115-22 PMID 17223474
Cites: Scand J Public Health. 2011 Jul;39(5):464-70 PMID 21339369
Cites: Science. 1948 Dec 10;108(2815):660-3 PMID 17744024
Cites: Obstet Gynecol. 2008 Mar;111(3):589-95 PMID 18310360
Cites: Lancet. 1999 May 29;353(9167):1829-33 PMID 10359407
PubMed ID
28441952 View in PubMed
Less detail

Prenatal screening for and diagnosis of aneuploidy in twin pregnancies.

https://arctichealth.org/en/permalink/ahliterature133013
Source
J Obstet Gynaecol Can. 2011 Jul;33(7):754-67
Publication Type
Article
Date
Jul-2011
Author
François Audibert
Alain Gagnon
Author Affiliation
Montreal QC.
Source
J Obstet Gynaecol Can. 2011 Jul;33(7):754-67
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Amniocentesis - adverse effects
Aneuploidy
Biological Markers - blood
Canada
Chorion
Chorionic Gonadotropin, beta Subunit, Human - analysis
Chromosomes, Human, Pair 18
Diseases in Twins - diagnosis
Down Syndrome - diagnosis
Female
Gestational Age
Humans
Maternal Age
Nuchal Translucency Measurement
Pregnancy
Pregnancy, Multiple
Pregnancy-Associated Plasma Protein-A - analysis
Prenatal Diagnosis - adverse effects - methods
Randomized Controlled Trials as Topic
Review Literature as Topic
Trisomy - diagnosis
Twins, Dizygotic
Twins, Monozygotic
Ultrasonography, Prenatal
Abstract
To provide a Canadian consensus document with recommendations on prenatal screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies.
The process of prenatal screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to screening and diagnosis in a twin pregnancy.
Clinicians will be better informed about the accuracy of different screening options in twin pregnancies and about techniques of invasive prenatal diagnosis in twins.
PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline.
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).
There is a need for specific guidelines for prenatal screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of prenatal care of women with twin pregnancies. SUMMARY STATEMENTS 1. Fetal nuchal translucency combined with maternal age is an acceptable first trimester screening test for aneuploidies in twin pregnancies. (II-2) 2. First trimester serum screening combined with nuchal translucency may be considered in twin pregnancies. It provides some improvement over the performance of screening by nuchal translucency and maternal age by decreasing the false-positive rate. (II-3) 3. Integrated screening with nuchal translucency plus first and second trimester serum screening is an option in twin pregnancies. Further prospective studies are required in this area, since it has not been validated in prospective studies in twins. (III) 4. Non-directive counselling is essential when invasive testing is offered. (III) 5. When chorionic villus sampling is performed in non-monochorionic multiple pregnancies, a combination of transabdominal and transcervical approaches or a transabdominal only approach appears to provide the best results to minimize the likelihood of sampling errors. (II-2) Recommendations 1. All pregnant women in Canada, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies. In addition, they should be offered a second trimester ultrasound for dating, assessment of fetal anatomy, and detection of multiples. (I-A) 2. Counselling must be non-directive and must respect a woman's right to accept or decline any or all of the testing or options offered at any point in the process. (III-A) 3. When non-invasive prenatal screening for aneuploidy is available, maternal age alone should not be an indication for invasive prenatal diagnosis in a twin pregnancy. (II-2A) If non-invasive prenatal screening is not available, invasive prenatal diagnosis in twins should be offered to women aged 35 and over. (II-2B) 4. Chorionicity has a major impact on the prenatal screening process and should be determined by ultrasound in the first trimester of all twin pregnancies. (II-2A) 5. When screening is done by nuchal translucency and maternal age, a pregnancy-specific risk should be calculated in monochorionic twins. In dichorionic twins, a fetus-specific risk should be calculated. (II-3C) 6. During amniocentesis, both amniotic sacs should be sampled in monochorionic twin pregnancies, unless monochorionicity is confirmed before 14 weeks and the fetuses appear concordant for growth and anatomy. (II-2B) 7. Prior to invasive testing or in the context of twins discordant for an abnormality, selective reduction should be discussed and made available to those requesting the procedure after appropriate counselling. (III-B) 8. Monitoring for disseminated intravascular coagulopathy is not indicated in dichorionic twin pregnancies undergoing selective reduction. (II-2B).
PubMed ID
21749753 View in PubMed
Less detail

Prenatal screening for fetal aneuploidy in singleton pregnancies.

https://arctichealth.org/en/permalink/ahliterature133014
Source
J Obstet Gynaecol Can. 2011 Jul;33(7):736-50
Publication Type
Article
Date
Jul-2011
Author
David Chitayat
Sylvie Langlois
R Douglas Wilson
Author Affiliation
Toronto ON.
Source
J Obstet Gynaecol Can. 2011 Jul;33(7):736-50
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Aneuploidy
Biological Markers - blood
Canada
Chorionic Gonadotropin, beta Subunit, Human - blood
Chromosomes, Human, Pair 18
Down Syndrome - diagnosis
Female
Genetic Testing
Gestational Age
Humans
Maternal Age
Nuchal Translucency Measurement
Pregnancy
Pregnancy-Associated Plasma Protein-A - analysis
Prenatal Diagnosis - adverse effects - methods
Randomized Controlled Trials as Topic
Review Literature as Topic
Risk factors
Trisomy - diagnosis
Ultrasonography, Prenatal
alpha-Fetoproteins - analysis
Abstract
To develop a Canadian consensus document on maternal screening for fetal aneuploidy (e.g., Down syndrome and trisomy 18) in singleton pregnancies.
Pregnancy screening for fetal aneuploidy started in the mid 1960s, using maternal age as the screening test. New developments in maternal serum and ultrasound screening have made it possible to offer all pregnant patients a non-invasive screening test to assess their risk of having a fetus with aneuploidy to determine whether invasive prenatal diagnostic testing is necessary. This document reviews the options available for non-invasive screening and makes recommendations for Canadian patients and health care workers.
To offer non-invasive screening for fetal aneuploidy (trisomy 13, 18, 21) to all pregnant women. Invasive prenatal diagnosis would be offered to women who screen above a set risk cut-off level on non-invasive screening or to pregnant women whose personal, obstetrical, or family history places them at increased risk. Currently available non-invasive screening options include maternal age combined with one of the following: (1) first trimester screening (nuchal translucency, maternal age, and maternal serum biochemical markers), (2) second trimester serum screening (maternal age and maternal serum biochemical markers), or (3) 2-step integrated screening, which includes first and second trimester serum screening with or without nuchal translucency (integrated prenatal screen, serum integrated prenatal screening, contingent, and sequential). These options are reviewed, and recommendations are made.
Studies published between 1982 and 2009 were retrieved through searches of PubMed or Medline and CINAHL and the Cochrane Library, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline.
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.
This guideline is intended to reduce the number of prenatal invasive procedures done when maternal age is the only indication. This will have the benefit of reducing the numbers of normal pregnancies lost because of complications of invasive procedures. Any screening test has an inherent false-positive rate, which may result in undue anxiety. It is not possible at this time to undertake a detailed cost-benefit analysis of the implementation of this guideline, since this would require health surveillance and research and health resources not presently available; however, these factors need to be evaluated in a prospective approach by provincial and territorial initiatives. RECOMMENDATIONS 1. All pregnant women in Canada, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies in addition to a second trimester ultrasound for dating, assessment of fetal anatomy, and detection of multiples. (I-A) 2. Counselling must be non-directive and must respect a woman's right to accept or decline any or all of the testing or options offered at any point in the process. (III-A) 3. Maternal age alone is a poor minimum standard for prenatal screening for aneuploidy, and it should not be used a basis for recommending invasive testing when non-invasive prenatal screening for aneuploidy is available. (II-2A) 4. Invasive prenatal diagnosis for cytogenetic analysis should not be performed without multiple marker screening results except for women who are at increased risk of fetal aneuploidy (a) because of ultrasound findings, (b) because the pregnancy was conceived by in vitro fertilization with intracytoplasmic sperm injection, or (c) because the woman or her partner has a history of a previous child or fetus with a chromosomal abnormality or is a carrier of a chromosome rearrangement that increases the risk of having a fetus with a chromosomal abnormality. (II-2E) 5. At minimum, any prenatal screen offered to Canadian women who present for care in the first trimester should have a detection rate of 75% with no more than a 3% false-positive rate. The performance of the screen should be substantiated by annual audit. (III-B) 6. The minimum standard for women presenting in the second trimester should be a screen that has a detection rate of 75% with no more than a 5% false-positive rate. The performance of the screen should be substantiated by annual audit. (III-B) 7. First trimester nuchal translucency should be interpreted for risk assessment only when measured by sonographers or sonologists trained and accredited for this service and when there is ongoing quality assurance (II-2A), and it should not be offered as a screen without biochemical markers in singleton pregnancies. (I-E) 8. Evaluation of the fetal nasal bone in the first trimester should not be incorporated as a screen unless it is performed by sonographers or sonologists trained and accredited for this service and there is ongoing quality assurance. (II-2E) 9. For women who undertake first trimester screening, second trimester serum alpha fetoprotein screening and/or ultrasound examination is recommended to screen for open neural tube defects. (II-1A) 10. Timely referral and access is critical for women and should be facilitated to ensure women are able to undergo the type of screening test they have chosen as first trimester screening. The first steps of integrated screening (with or without nuchal translucency), contingent, or sequential screening are performed in an early and relatively narrow time window. (II-1A) 11. Ultrasound dating should be performed if menstrual or conception dating is unreliable. For any abnormal serum screen calculated on the basis of menstrual dating, an ultrasound should be done to confirm gestational age. (II-1A) 12. The presence or absence of soft markers or anomalies in the 18- to 20-week ultrasound can be used to modify the a priori risk of aneuploidy established by age or prior screening. (II-2B) 13. Information such as gestational dating, maternal weight, ethnicity, insulin-dependent diabetes mellitus, and use of assisted reproduction technologies should be provided to the laboratory to improve accuracy of testing. (II-2A) 14. Health care providers should be aware of the screening modalities available in their province or territory. (III-B) 15. A reliable system needs to be in place ensuring timely reporting of results. (III-C) 16. Screening programs should be implemented with resources that support audited screening and diagnostic laboratory services, ultrasound, genetic counselling services, patient and health care provider education, and high quality diagnostic testing, as well as resources for administration, annual clinical audit, and data management. In addition, there must be the flexibility and funding to adjust the program to new technology and protocols. (II-3B).
Notes
Comment In: J Obstet Gynaecol Can. 2011 Nov;33(11):1092; author reply 1093-422082780
Comment In: J Obstet Gynaecol Can. 2011 Nov;33(11):1093; author reply 1093-422082781
PubMed ID
21749752 View in PubMed
Less detail