Hepatitis C virus in pregnancy: seroprevalence and risk factors for infection.

OBJECTIVES: Our purpose was to define the prevalence of antibodies to hepatitis C virus among inner-city prenatal patients. We also sought to examine both the reliability of traditional hepatitis risk factors to predict evidence of infection among these women and the incidence of coinfection in this population with other blood-borne and sexually transmissible agents. STUDY DESIGN: An anonymous serosurvey was performed to define and compare anti-hepatitis C virus prevalences among women registering for prenatal care at both an inner-city, university hospital-based clinic and an academic private practice based at the same institution. RESULTS: Anti-hepatitis C virus antibodies were detected in 4.3% of 599 pregnant women screened. In comparison, 0.8% had positive antibody tests for human T-lymphotropic virus and 0.5% were positive for antibodies to human immunodeficiency virus. Evidence of chronic hepatitis B infection was seen in 0.8%. The relative risk of other coexisting infections was significantly higher among women with anti-hepatitis C virus antibodies than among those who were antibody negative. Substance abuse was the most commonly identified risk factor for anti-hepatitis C virus-positive status, although risk factor-targeted screening would have failed to detect half of the anti-hepatitis C virus-positive women in this study. CONCLUSIONS: Hepatitis C virus infection among inner-city pregnant women, with its potential for maternal-fetal transmission, represents a public health issue of sufficient magnitude to warrant more extensive study. More information is needed, given this documented reservoir of maternal seropositivity, regarding the vertical transmissibility of the virus and the effects of coinfections on neonatal disease.

Iloprost (ZK36374), a stable analogue of prostacyclin, preserves platelets during simulated extracorporeal circulation.

Contact between blood and synthetic surfaces of an extracorporeal circuit results in extensive alterations in platelet function. These platelet abnormalities have been reproduced in vitro by recirculating heparinized (5 units/ml) human blood at 37 degrees C in a silicone rubber circuit (0.1 m2) containing a spiral coil membrane oxygenator (0.9 m2). During control recirculation trials, platelet counts fell to 29% +/- 8% (mean +/- standard error of the mean) of initial levels within 30 minutes, and sensitivity to the soluble agonists, adenosine diphosphate and epinephrine, disappeared. Plasma levels of the platelet-specific protein platelet factor 4 rose to 2,600 +/- 200 ng/ml, indicating extensive platelet granule release. Similarly, plasma concentrations of thromboxane B2 rose from less than or equal to 100 pg/ml to 500 +/- 200 pg/ml at 120 minutes, and transmission electron microscopy demonstrated disruption of platelet subcellular architecture. In contrast, when ilioprost, a stable prostacyclin derivative (1 ng/ml), was added to the circuit prior to recirculation, the thrombocyte count remained at 85% +/- 4% of initial values. Platelets incubated or recirculated for 2 hours in the presence of iloprost responded normally to both adenosine diphosphate and epinephrine after separation from the drug by gel-filtration. Furthermore, plasma concentrations of platelet factor 4 remained below 300 ng/ml, plasma levels of thromboxane B2 failed to reach detectable levels, and platelet ultrastructure remained intact. Thus, iloprost effectively preserves the circulating platelet count, prevents platelet granule release, and preserves platelet functional and morphological integrity during simulated extracorporeal circulation.