Vaccination in pregnancy - The when, what and how?

Immunization is a fundamental component of preventive healthcare. This gain special significance in pregnancy. Maternal antigen-specific IgG, is actively transported across the placenta during pregnancy. This significantly, contributes to infant immunity in the first few months of life. Vaccination during pregnancy has the potential to indirectly protect the most vulnerable infants during the first few months of life, when vaccine responses are generally poor and it is difficult to achieve rapid protection through immunization. This is especially relevant when there is prior exposure to infection in woman or vaccine administration. A vaccine given during pregnancy in these women would result in a booster response and a relatively high level of IgG protecting their children in initial few months of life. Passive antibody transfer from mother to fetus can protect fetuses from infection until their own immunization schedule is initiated. Lack of administration of appropriate vaccination to women during pregnancy lead to an increase in maternal and fetal morbidity and mortality from preventable infections like influenza, pertussis. Various preventable infections can lead to intensive care unit admission for mothers, preterm birth, and low birth weight babies. Recent covid pandemic has brought issue of vaccine use in pregnancy at forefront of all expectant mothers. Immunization with inactivated virus, bacterial vaccine and toxoids showed no evidence of adverse fetal effects. As a rule, live attenuated vaccines are not recommended in pregnancy. This paper gives snapshot of all vaccines, which can be used in pregnancy along with brief details regards various bacterial and viral infections , their common clinical features and effects on pregnancy outcome as well as fetus. This is will provide a useful guide for healthcare providers.

Dengue in pregnancy: Review article.

Dengue is the most common viral mosquito- borne disease. It is a major public health problem, especially in tropical and sub-tropical areas worldwide. According to the World Health Organization (WHO), approximately 40% of the world's population (over 2.5 billion people) live in areas with high risk of contracting dengue infection. Adults of childbearing age and pregnant women are travelling more frequently to tropical areas. Therefore exposing themselves to specific arboviral infections such as dengue, which may impact ongoing and future pregnancies. Clinical manifestations of dengue are wide ranging from asymptomatic to needing intensive care in cases of hemorrhagic dengue fever. The effects of dengue during and on pregnancy are unclear, moreover there is a lack of a cohesive reference to inform women of reproductive age who live in or travel to endemic areas and are at risk of contracting dengue. Here we present review of literature specifically looking at etiology, pathogenesis, clinical manifestations, management of dengue in pregnancy as well as its effect on maternal health and fetal outcomes. There is clear evidence to suggest adverse maternal outcomes in women with symptomatic dengue in low resource countries. A high index of clinical suspicion and early referral to tertiary center will prevent maternal -fetal serious adverse events in endemic areas. This review will help Clinicians in advising as well as managing women who travel during pregnancy to endemic areas as well as clinicians based in endemic areas who are managing women with dengue in pregnancy.

What is the role of amnioinfusion in modern day obstetrics?

Amniotic fluid (AF) is a dynamic medium that plays a significant role in fetal well-being. It is production and amount varies with gestational age. It plays a vital role in fetal life as it contains antimicrobial factors, growth factors and it help the fetal lung to grow and expand. Amnioinfusion can be performed either transabdominally or transvaginal. Amnioinfuion can be done antenatally and during labor. Aminoinfusion can be used for diagnostic purposes to enable better visualization of the fetus as liquor is very important acoustic widow for better fetal examination. Amnioinfusion have some therapeutic benefits in conditions like early premature rupture of membrane and may help cases of external cephalic version for breech presentation at term. Amnioinfusion has been shown to reduce the incidence of variable deceleration due to cord compression, reduces the risk of meconium aspiration and it will help reduce cesarean delivery.

Promotion of bone morphogenetic protein signaling by tetraspanins and glycosphingolipids.

Bone morphogenetic proteins (BMPs) belong to the transforming growth factor ß (TGFß) superfamily of secreted molecules. BMPs play essential roles in multiple developmental and homeostatic processes in metazoans. Malfunction of the BMP pathway can cause a variety of diseases in humans, including cancer, skeletal disorders and cardiovascular diseases. Identification of factors that ensure proper spatiotemporal control of BMP signaling is critical for understanding how this pathway is regulated. We have used a unique and sensitive genetic screen to identify the plasma membrane-localized tetraspanin TSP-21 as a key new factor in the C. elegans BMP-like "Sma/Mab" signaling pathway that controls body size and postembryonic M lineage development. We showed that TSP-21 acts in the signal-receiving cells and genetically functions at the ligand-receptor level. We further showed that TSP-21 can associate with itself and with two additional tetraspanins, TSP-12 and TSP-14, which also promote Sma/Mab signaling. TSP-12 and TSP-14 can also associate with SMA-6, the type I receptor of the Sma/Mab pathway. Finally, we found that glycosphingolipids, major components of the tetraspanin-enriched microdomains, are required for Sma/Mab signaling. Our findings suggest that the tetraspanin-enriched membrane microdomains are important for proper BMP signaling. As tetraspanins have emerged as diagnostic and prognostic markers for tumor progression, and TSP-21, TSP-12 and TSP-14 are all conserved in humans, we speculate that abnormal BMP signaling due to altered expression or function of certain tetraspanins may be a contributing factor to cancer development.