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
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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
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PubMed ID
28441952 View in PubMed
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