RESUMO
Neonatal herpes simplex virus (HSV) infection (HSV infection in infants less than 6 weeks of age) is rare but mortality and morbidity rates are high after disseminated disease and encephalitis. In France, the epidemiology is poorly described, and two decades ago, incidence was estimated to be 3 per 100,000 live births a year. We describe determinants, epidemiologic and clinical characteristics of neonatal HSV infection in a managed-care population attending in two major obstetric and paediatric centres, Paris, France, over a 10-year period. This retrospective case series study was conducted from 2013 to 2023, in infants less than 42 days of age who had virologically confirmed HSV infection. We report an overall rate of neonatal herpes of 5.5 per 100,000 live births a year and an incidence of symptomatic cases of 1.2 per 100,000 live births a year. HSV-1 was the major serotype involved (84.2%) and post-natal acquisition through the orolabial route reached 63.2%. All neonates who had neonatal HSV PCR screening (owing to clinical signs in parents) and who received prompt acyclovir treatment remained asymptomatic. Symptomatic forms accounted for 21.1% cases of the total and mortality was high (62.5% of symptomatic forms). Conclusion: This case series confirms that neonates at risk for HSV disease and poor outcome are those born to HSV-seronegative mothers, preterm infants, and those who received acyclovir after onset of symptoms (mainly because mothers did not present evidence of acute HSV infection). Our study confirms the major role of HSV-1 and the frequency of its early post-natal acquisition. What is known: ⢠Neonatal herpes simplex virus infection is rare but motality and morbidity rates are high after disseminted disease and encephalitis. National recommendations exist worldwide but mangement of this disease is not always easy. What is new: ⢠As in France epidemiology of neonatal herpes is poorly described, our report is potentially an important addition to the existing literature. Moreover, we describe local practice that may be useful to physicians.
RESUMO
Evaluation of fertility after operative hysteroscopy to remove retained products of conception. OBJECTIVE: To study fertility after operative hysteroscopy for the management of prolonged trophoblastic retention, and the complications of this procedure. STUDY DESIGN: Retrospective cohort in a university hospital. RESULTS: 115 patients underwent operative hysteroscopy for the treatment of prolonged post-partum and post-abortum retention between January 2008 and December 2011. Of the 115 patients included in this study, 53 desired a postoperative pregnancy. Using the survival model, the conception rate was 71.1% (95%CI; 58.1-82.9) at 6 months and 83.5% (95%CI; 71.8-92.2) at 1year. The overall rate of intraoperative complications was 15%. The rate of complications≥grade 3 was 5%. Logistic regression analysis showed that only retentions of greater than 25mm were associated with complications generally (aOR=7.4; 95%CI; 2.3-24.5) and with Clavien-Dindo complications≥grade 3 (OR=27.2; 95%CI; 2.8-263). CONCLUSION: The management of prolonged retention by operative hysteroscopy allows the preservation of future fertility. There are more complications when the retentions are >25mm.
