Ebook Neurology and pregnancy - Clinical management: Part 2
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Ebook Neurology and pregnancy - Clinical management: Part 2
Infections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2ilities, infectious diseases in pregnancy continue to contribute significantly to maternal and neonatal morbidity and mortality (1). These are most common in the developing world. About 99% ot maternal deaths in the world in 2005 occurred in developing I'lHinlrx-s and 25% of maternal deaths in the d Ebook Neurology and pregnancy - Clinical management: Part 2eveloping world an* due to infections in pregnancy mainly due to puerperal sepsis and septic abortion.Obstetric sepsis was the leading cause of maternEbook Neurology and pregnancy - Clinical management: Part 2
al mortality in the United Kingdom until the intnxluction of antibiotics into c linical practice in the late 1930s. Tile IIX ideniv has now declined rInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2dential Enquiry into Maternal Deaths (CFMD), the majority associated with lx4.i-h.iemo-lytic streptococcus Lanccticld group A and Escherichia coii infection (2). Eight out of the 18 deaths occurred during labour or before- delivery. Tile CFMD identified risk factors for maternal sejisis which includ Ebook Neurology and pregnancy - Clinical management: Part 2ed di.ilieles, anaemia, history of |K-lvic infection, impaired immunity, history of group B streptococcal infection, amniocentesis and other invasiveEbook Neurology and pregnancy - Clinical management: Part 2
intrauterine pro-Cedures, cervical cerclage, prolonged s|Kinlaneoiis nqitiin- of membranes, caesarean section and retained products of conception postInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2ghlighted the need to avoid complacency in maternal infection and made a number of key s|Hx iiic recommend.il ions. fl emphasised the importance of increased awareness by health care professionals of symptoms and signs of sepsis and septic shock and the mqxirl.mie of regular frequent observations if Ebook Neurology and pregnancy - Clinical management: Part 2 |X‘lvic sepsis was suspected. 11 also stressed the importance of implementation of guidelines within individual maternity units for the management ofEbook Neurology and pregnancy - Clinical management: Part 2
genital bad sepsis. Prompt treatment with high-dose bnMcl-s|ieclriim antibiotics should lie shirted prior to obtaining microbiology results.Maternal Infections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2irth, intrauterine growth restriction, congenital anomalies and neonatal infection. In addition, increased foreign travel of pregnant women and the increase in immigrants from developing countries pose challenges to obstetricians and neonatologists in the overall management of infectious diseases in Ebook Neurology and pregnancy - Clinical management: Part 2 the United Kingdom. Early involvement of a multidisciplinary team involving microbiologists, maternal-fetal medicine specialists, pharmacists and theEbook Neurology and pregnancy - Clinical management: Part 2
critical care team is essential. With evidence of sexually transmitted infections (STIs), genitourinary medicine specialists should be involved, and Infections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2complicate pregnancy, although when they do the effects can be severe.This chapter is divided into two sections. The first discusses the screening and prevention of maternal infections and outlines some of the more common infections in pregnancy encountered in the developed world and their consequen Ebook Neurology and pregnancy - Clinical management: Part 2ces. Investigations and management to improve fetal and maternal outcomes are also discussed. Tile second section deals with the CMS infections that cEbook Neurology and pregnancy - Clinical management: Part 2
an complicate pregnancy, including acute and chronic meningitis, encephalitis, brain abscess anil spinal curd infection.Management recommendations andInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2tection Agency (HPA), Deparliix-nl of Health (DOH), British Association for Sexual Health and 111V (BAS1111), British 111V Association (Bl 11VA), U.S. Centers for Disease Control and Prevention (CDC) and World 1 lealth Organization (VV1 IO), when available.GENERAL INFECTION IN PREGNANCYThe U.K. Ante Ebook Neurology and pregnancy - Clinical management: Part 2natal Screening ProgrammeSince 2003. the U.K. DOH has recommended screening all pregnant women with a single blood sample for human immunodeficiency vEbook Neurology and pregnancy - Clinical management: Part 2
irus (HIV), hepatitis B, ndx-lla and syphilis during their first and all subsequent pregnancies (3). Other infections, not routinely investigated as pInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2ytomegalovirus (CMV), Chỉứtnựdiứ Irachùtnalis, factorial vaginosis, hepatitis c, group B streptococcus, toxoplasma, genital herpes simplex and human T-lymphotropic virus type-1. The important factors to consider when deciding to undertake screening Ilf any infectious agent during pregnancy are the i Ebook Neurology and pregnancy - Clinical management: Part 2ncidence of maternal infection, the risk of transmission to the fetus, the fetal damage if infection occurs, the availability of a reliable screeningEbook Neurology and pregnancy - Clinical management: Part 2
test and the availability of a safe and effective intervention to prevent fetal infection and reduce damage.Prevention of Infection in Pregnant WomenPInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2es anil inadequately cooked meat and avoiding contact with cal litter (4). To reduce the risk of listeriosis, pregnant women should avoid eating unpasteurised dairy products. Pregnant women should also avoid unprotected intercourse if their partners arc known to have HIV, hepatitis B, herpes simplex Ebook Neurology and pregnancy - Clinical management: Part 2 virus (HSV) or other STIs. Women from non-endemic areas should be advised against travel to a malaria-endemic area (5). If travel is unavoidable, advEbook Neurology and pregnancy - Clinical management: Part 2
ice should be given about personal protectionIN Ftand chemoprophylaxis. This advice also applies to previously immune women from malaria-endemic areasInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2fection may be achieved by active and passive immunisation and all health care providers should obtain an immunisation history from women accessing prenatal care. Live and/or live-attenuated vaccines are contraindicated in pregnancy due to theoretical concerns of teratogenicity. It immunisation is t Ebook Neurology and pregnancy - Clinical management: Part 2o be given in anticipation of later risks, it is preferable for administration after the first trimester. Immunisation programmes for rubella in childEbook Neurology and pregnancy - Clinical management: Part 2
hood should provide protection throughout the childbearing years. Following the mumps, measles and rubella (MMR) vaccine controversy, first reported iInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 25% coverage in 2008. Women without a previous history of varicella should Im- screened for varicella zoster virus (V7V) antibodies at Ixxiking or rapidly after exposure, that is, within -18 hours alter contact (5). Following exposure ot a pregnant woman to varicella, non-immune women should be otter Ebook Neurology and pregnancy - Clinical management: Part 2ed passive immunisation with varicella zoster immune globulin up to 10 days after contact. Pregnant women are al ini reused risk of complications ot iEbook Neurology and pregnancy - Clinical management: Part 2
nfluenza and all pregnant women should be ottered the inactivated vaccine during the influenza season. Women who are breastfeeding can still be immuniInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2an apparently adequate maternal defence against infection, continues Io intrigue immiiiiologisls. Evidence indicates that immunological toleranie of the fl-tils may occur by suppression Of maternal cell-mediated immunity while retaining normal humoral (antibody-mediated) immunity. This occurs as a r Ebook Neurology and pregnancy - Clinical management: Part 2esult of ihireasisl T-helper type 1 (Th-1 > lymphocyte responses (which stimulate cell-mediated immunity) with a shitt to 1 -helper type 2 (Th-2) domiEbook Neurology and pregnancy - Clinical management: Part 2
nance (which augment the humoral immune response) (6). Ihe cell-mediated immunity is responsible for controlling intracellular pathogens and the immunInfections in pregnancyIskandar Azwa, Michael s. Marsh, and David A. HawkinsINTRODUCTIONDespite the advent of antibiotics and improved diagnostic faci Ebook Neurology and pregnancy - Clinical management: Part 2ar bacteria and parasites.Effect of Infections on the FetusInfections that affect the fetus and neonate arc predominantly viral infections with a smaller number due to bacterial and protozoal infections. Infections can develop in the neonate transplacentally, perinatally (from vaginal secretions or Ebook Neurology and pregnancy - Clinical management: Part 2blood), or post-natally (from breast milk). Blood-borne viruses such as HIV, hepatitis B and c are mainly associated with perinatal infections, whereaEbook Neurology and pregnancy - Clinical management: Part 2
s rubella, CMV, parvovirus B19 and vzv are associated with in utero infection and placental transmission.Infections traditionally known to produce conGọi ngay
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