real effect of toxoplasmosis on the outcome of pregnancy

A prospective study was carried out on 250 cases of pregnant women attending medical centre of Basrah University in their 1st trimester of pregnancy with an age range of 15-45 years from 1/7/1993-10/8/1996, to find out the real effect of toxoplasmosis on the outcome of pregnancy. The subject comprises of [150] cases of acute maternal toxoplasmosis during pregnancy, [115] of them had history of habitual abortion [history of 3 or more consecutive abortions] and 35 cases of sporadic abortion, the other [100] were taken as a control group [normal pregnant women]. All recently infected patients were treated with spiramycin or sulfadiazine according to the availability of drugs, in a dose of 250mg four times daily 14 days or 500mg twice daily for spiramycin or sulfadiazine respectively. The study shows that 54% of habitual abortion group their pregnancy ended by abortion, 10.5% of them go into preterm labor and 30.5% term pregnancy [6 of them lost follow up]. The study also show significant increase in the incidence of C/S [caesarean section] 15.2% in the habitual abortion group as compared to 6% among normal pregnant women, with also significant increase in the perinatal mortality rate among habitual abortion group as compared to normal pregnant women. 50% chance of congenital anomaly among perinatal death in habitual abortion group as compared to 25% among normal pregnant women

Sexually transmitted diseases among women with habitual abortion

Sexually transmitted disease as a risk factor for habitual abortion was investigated in a case-control study in Basra between October 1994 and May 1995. Of 81 women with habitual abortion, 41 [50.6%] had a sexually transmitted disease. In the normal pregnancy group, 64 of 119 women [53.8%] had a sexually transmitted disease [X[2] = 0.712, P > 0.05]. The isolation rates of Candida spp., Trichomonas vaginalis, Gardnerella vaginalis and Neisseria gonorrhoeae in women with habitual abortion were not significantly different from those in normal pregnant women. No association was found between the presence of a sexually transmitted disease and habitual abortion [odds ratio = 0.9]. No positive case of syphilis was diagnosed using VDRL and TPHA tests. There was a significant relation between the presence of a sexually transmitted disease and the presence of vaginal discharge, vaginal pH > 4.5 and the frequency of sexual activity/week > 2

Toxoplasmosis and abortion: serological co-relation

This study involved the analysis of serum samples and product of conception in 105 females for Toxoplasmosis. The serum analysis for IgM and IgG were done by enzyme immuno assay [EIA] in our population. All human sera were also screened for human immnuno deficiency virus [HIV] to rule out that toxoplasma infection was not due to immuno suppression. The product of conception was used for making wet mount, stained preparation and mice innoculation [with saline control]. One group of mice was sacrificed on 3rd or 4th day and the other on or about 3rd week. Out of the 105 samples tested for IgM antibodies specific to Toxoplasma, 16 [15.2%] were sero-positive [both groups]. Fourteen [25.9%] sera were positive for IgM antibodies in 54 patients having had spontaneous abortion and 35 [33.3%] samples were sero-positive for IgG antibodies out of a total of 105 cases. In AB group there were 27 [50.0%] sero-positive out of 54 screened and in TA group out of 51 cases tested 8 [15.7%] were sero-positive. HIV screening by EIA in both AB and TA groups did not reveal any sero-positive case. HIV result showed that sero-positivity of Toxoplasma was not due to immuno suppression. Product of conception was subjected to wet mount and stained preparation [Alkaline Methylene Blue and Giemsa] in which we observed parasite in 2 cases. Serum study done in mice sacrificed on 3rd or 4th day showed no sero-positivity for IgG and IgM type of antibodies, whereas mice sacrificed on 3rd week gave 2 [3.1%] sero-positivity of IgM and IgG specific to Toxoplasma in AB group out of 54 cases. Wet mount and stained preparation revealed parasites from peritoneal wash of mice sacrificed on 3rd or 4th day. Toxoplasmosis situation in our country is acute and needs launching of national programme for sero-diagnosis of pregnant women and adopting preventive measures to overcome serious consequences of disease

Role of syphilis and cytomegalovirus in cases of repeated abortion in Qalubia governorate

Serum samples were collected from 100 women suffering from recurrent spontaneous albumen and their history of abortion ranged from 2 to 5 timesThe screening of collected sera against Treponema pallidum antigen by VDRL test revealed prevalence rate of 6% and using TPHA as confirmation gave a positive rate of 4% The collected sera were screened against CMV antigen by the IFA technique to detect the presence of IgM and IgG antibodies; the total percent of detected antibodies was 57% and IgM was present in 10%, while IgG in 47% Confirmation of the presence of these antibodies was performed using CF test which was positive in 30% of the studied patients

Role of maternal serum alpha fetoproteins in prenatal diagnosis of neural tube defects and down's syndrome

Maternal blood was collected from pregnant women [n=38] of rural areas of our region, where consanguineous marriages are predominant [92.11%], and screened for Alpha Fetoprotein [AFP] levels in the serum. The results, from a preliminary study, indicated one case with elevated levels of AFP in the first trimester and two in the second trimester, while one with extremely depressed levels in the second trimester. The patient with an increased AFP level in the first trimester delivered a dead born child, which was microcephalic

Toxoplasma antibodies in clinically suspected cases of Toxoplasmosis

107 cases, 35 males and 72 females aging from 3 months to 32 years old were divided into 4 groups [ocular, neurological, cases with abortion and cases having Down's syndrome]. 47 apparently healthy individuals were taken as controls. All were serologically tested for toxoplasma antibodies using IFAT and ELISA for detection of IgG. The positive cases as well as cases below one year old were tested by ELISA IgM for the detection of acute or congenital toxoplasmosis. Toxoplasma antibodies [IgG] were found in 28 [26%] and 43 cases [40%] by IFAT and ELISA, respectively. ELISA IgM was positive in 12 [20%] out of 60 serum samples. 2 cases [11%] among 27 patients below one year old were positive. Statistical significance was reported concerning the positive cases in the ocular group as well as patients with abortions. Results revealed that ELISA is more sensitive and specific than IFAT

Prenatal diagnosis of beta thalassemia

Seventy one women were screened for prenatal diagnosis of Beta-Thalassaemia by using chorionic villus sampling technique. Sixteen fetuses [21.6%] were found homozygous for B-thalassaenia. Out of 17 live births, 11 have undergone blood tests and the results of blood test corresponded to prenatal diagnosis made through chorionic villus sampling

Some alterations concomitant with prolonged administration of estrogen

The study was done for deeper underst and ing of adverse effects concomitant with repeated administration of estrogens. It was found that, prolonged treatment, particularly with high doses, leads to deleterious effects represented by immunosuppresion, alteration of cellular structure of different organs as well as deviation of hepatorenal performance. Cautious use of estrogenic agents to avoid their drastic effect is recommended

Recurrent familial hydatidiform mole

Gestational trophoblastic disease is rare. Recurrent gestational trophoblastic disease occurs in 0.6-2.6% of subsequent pregnancies. The rate.for a third hydatidiform mole [H.M.] goes up to 15-28%. There are no reliable data on the incidence of consanguinity or family history on the incidence of hydatidiform mole. There have been reports of familial occurence of gestational trophoblastic disease [GTD] in literature. In the case reports presented here two out of a total of four sisters suffered from recurrent hydatidiform molar pregnancies. A third sister was found to have characteristic appearance of a molar pregnancy on ultrasound scan but she ref used treatment. None of these sisters have given birth to a live child

Role of ultrasound in evaluation of empty gestational sac before threatened abortion

Threatened abortion occurs during the first 20 weeks of pregnancy when vaginal bleeding is encountered with closed cervical os. This occurs in 20 to 52% of pregnancies. Ultrasound provides a simple and unique method of visualizing pregnancy in early stages. If the viability of pregnancy can be accurately determined a more active line of management can take place. Nonviable pregnancies are managed by uterine evacuation, whereas viable pregnancies are observed

Rate of Listeria abortion in Tehran

The rate of listeria abortion in Tehran was investigated, Abortion samples [200] were cold enriched at 4°C and subcultured on selective culture media containing acriflavin, nalidixic acid and potassium thiocyanate. Sera of patients were tested serologically [IF method] for screening, and results were confirmed by culturing the positive samples. Antibody against L. monocytogenes was obtained in 70.7% of sera but the bacteria was isolated from five samples only

Seroprevalence of toxoplasma antibodies among pregnant women in Kermanshah

Sera from 495 pregnant women were examined for toxoplasma antibodies by indirect fluorescent antibody testing [IFAT]. Antibodies were positive in 32.7%. Seropositivity was not increased significantly with age but showed a statistically significant rise in accordance with frequency of parity, abortion and contact with cats. The high rate of seronegativity [67.3%] observed in pregnant women represents a high risk group for acquiring toxoplasma infection and also congenital toxoplasmosis

Should we Screen patients with recurrent fetal loss for protein C deficiency?

Hereditary protein C deficiency has been reported as a predeposing factor to thrombotic events. Protein C deficiency is associated with odd-site thrombosis and can theoretically results in placental infarcts. 20 habitual aborters and 10 age-sex matched female controls were studied. They were subsected to thorough history and examination to rule out birth tract anomalies and infections and were subjected to assay of lupus anticoagulant using the diluted PTT test to exclude patients with lupus anticoagulants. In two patients Protein C was found to bed deficient with a frank family history of thromboembolism in one patient. While none of the controls showed any abnormalities in protein C. In habitual aborters with past or family history of thromboembolism assay of protein C antigen and activity should be carried out after ruling out lupus anticoagulant. Further pathologic studies are needed to correlate the deficiency with placental changes

Embryonic Bradycardia: a predictor of spontaneous abortion

The predictive value of embryonic cardiac activity has been evaluated in 113 cases for evolution of early pregnancy using M-mode of transvaginal sonography [TVS]. The results revealed that embryonic heart rate [EHR] varied considerably, from 78 to 172 beat/min. at 5-12 weeks gestation and the mean EHR has increased significantly from 86 beat/min at fifth week to 158 beat/min at ninth week. It also disclosed that 16.6% of cases recorded persistent and progressive embryonic bradycardia [a cutoff level of 100 beat/min] and of these, 88.89% aborted spontaneously. On the other hand, incidental bradycardia is an insignificant signal and does not predict spontaneous abortion [P >0.05]. The study concluded that persistent embryonic bradycardia is a reliable predictor of spontaneous abortion in the first trimester. The issue should be addressed to all obstetricians