Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome

An Erratum has been published for this article in Prenatal Diagnosis 21(7) 2001, 605. Prenatal diagnosis (PD) of fetal cytomegalovirus (CMV) infection was performed in 242 pregnancies, with known outcome in 189 cases. In 141/189 pregnancies, PD was carried out on account of suspicious maternal CMV serology up to gestational week (WG) 23, and in 48 cases on account of abnormal ultrasonic findings detected between WG 18 and 39. Chorionic villus samples (n=6), amniotic fluid (AF, n=176) and/or fetal blood specimens (n=80) were investigated for detection of virus by cell culture, shell vial assay, PCR and/or CMV-specific IgM antibodies. Of 189 fetuses correctly evaluated by CMV detection either in fetal tissue following therapeutic abortion/stillbirth (n=24) or in urine of neonates within the first 2 weeks of life (n=33), 57 were congenitally infected. In women with proven or suspected primary infection, the intrauterine transmission rates were 20.6% (7/34) and 24.4% (10/41), respectively. Of the congenitally infected live-born infants, 57.6% (19/33) had symptoms of varying degree. The overall sensitivity of PD in the serologic and ultrasound risk groups was 89.5% (51/57). A sensitivity of 100% was achieved by combining detection of CMV-DNA and CMV-specific IgM in fetal blood or by combined testing of AF and fetal blood for CMV-DNA or IgM antibodies. There was no instance of intrauterine death following the invasive procedure. The predictive value of PD for fetal infection was 95.7% (132/138) for negative results and 100% (51/51) for positive results. Correct results for congenital CMV infection by testing AF samples can be expected with samples obtained after WG 21 and after a time interval of at least 6 weeks between first diagnosis of maternal infection and PD. In case of negative findings in AF or fetal blood and the absence of ultrasound abnormalities at WG 22–23, fetal infection and neonatal disease could be excluded with high confidence. Positive findings for CMV infection in AF and/or fetal blood in combination with CMV suspicious ultrasound abnormalities predicted a high risk of cytomegalic inclusion disease (CID). Furthermore, detection of specific IgM antibodies in fetal blood was significantly correlated with severe outcome for the fetus or the newborn (p=0.0224). However, normal ultrasound of infected fetuses at WG 22–23 can neither completely exclude an abnormal ultrasound at a later WG and the birth of a severely damaged child nor the birth of neonates which are afflicted by single manifestations at birth or later and of the kind which are not detectable by currently available ultrasonographic techniques. Copyright © 2001 John Wiley & Sons, Ltd.     

The psychosocial sequelae of a second-trimester termination of pregnancy for fetal abnormality

A retrospective study to investigate the psychosocial sequelae of a second-trimester termination of pregnancy (TOP) for fetal abnormality (FA) is described. After appropriate consent was obtained, 84 women and 68 spouses were visited 2 years after the event and asked to complete an extensive questionnaire. Most couples reported a state of emotional turmoil after the TOP. There were differences in the way couples coped with this confusion of feelings. After 2 years about 20 per cent of the women still complained of regular bouts of crying, sadness, and irritability. Husbands reported increased listlessness, loss of concentration, and irritability for up to 12 months after the TOP. In the same period, there was increased marital disharmony in which 12 per cent of the couples separated for a while and one couple obtained a divorce. These problems could be attributed to a lack of synchrony in the grieving process. Confusing and conflicting feelings led to social isolation and lack of communication. Difficulties in coming to terms with the fetal loss were not found to be linked to the type of fetal abnormality or religious beliefs but were related to parental immaturity, inability to communicate needs, a deep-rooted lack of self-esteem before the pregnancy, lack of supporting relationships, and secondary infertility. Suggestions for improved management are given.     

Analysis of bicycle crashes in Sweden involving injuries with high risk of health loss

Objective: The objectives of the present article were to (a) describe the main characteristics of bicycle crashes with regard to the road environment, crash opponent, cyclist, and crash dynamics; (b) compare individuals who describe their health after the crash as declined with those who describe their health as not affected; and (c) compare the number of injured cyclists who describe their health as declined after the crash with the predicted number of permanent medical impairments within the same population.

Methods: A sample of individuals with specific injury diagnoses was drawn from the Swedish Traffic Accident Data Acquisition (STRADA) database (n?=?2,678). A survey form was used to collect additional information about the crash and the health-related outcomes. The predicted number of impaired individuals was calculated by accumulating the risk for all individuals to sustain at least a 1% permanent medical impairment, based on the injured body region and injury severity.

Results: Nine hundred forty-seven individuals (36%) responded, of whom 44% reported declined health after the crash. The majority (68%) were injured in single bicycle crashes, 17% in collisions with motor vehicles, and 11% in collisions with another cyclist or pedestrian. Most single bicycle crashes related to loss of control (46%), mainly due to skidding on winter surface conditions (14%), followed by loss of control during braking (6%). There was no significant difference in crash distribution comparing all crashes with crashes among people with declined health. The predicted number of impaired individuals (n?=?427) corresponded well with the number of individuals self-reporting declined health (n?=?421).

Conclusions: The types of crashes leading to health loss do not substantially differ from those that do not result in health loss. Two thirds of injuries leading to health loss occur in single bicycle crashes. In addition to separating cyclists from motorized traffic, other preventive strategies are needed.     

Very low versus undetectable maternal serum alpha-fetoprotein values and fetal death

Very low maternal serum alpha-fetoprotein (MSAFP) levels (<10 ng/mL) are known to be associated with non-viable pregnancies, including conditions such as fetal death, molar pregnancies, and non-pregnancies. There has not been agreement, however, as to whether very low MSAFP levels indicate already existing fetal deaths or are actually predictive. We analysed 230 pregnancies with MSAFP levels <10 ng/mL from among 15 807 women (1.5 per cent) screened consecutively during a three-year period and identified 26 non-viable pregnancies, 22 of which were diagnosed sonographically as part of the screening process (17 missed abortions, 3 blighted ova, 2 non-pregnancies). Furthermore, 20 of these 22 pregnancies were associated with essentially undetectable MSAFP levels (<5 ng/mL). Our data indicate that pregnancies with MSAFP values <5 ng/mL are the group most strongly associated with fetal non-viability and that very low MSAFP values are not strongly predictive for fetal death.     

不利风向条件下北部湾人为源对海口市PM2.5浓度影响的模拟研究

通过分析2013—2017年海口市风向频率、地面PM_(2.5)浓度及海口市所处北部湾地理位置,确定12月为北部湾对海口市最不利风向时间段.利用中尺度气象模式(WRF,Weather Research Forecast)驱动空气质量模型(CMAQ,Community Multi-scale Air Quality),设置一系列数值模拟情景,深入分析北部湾人为源对海口市PM_(2.5)浓度影响.结果表明:WRF/CMAQ能很好地再现北部湾气象场和PM_(2.5)浓度的时空分布.2013年12月,北部湾人为源对海口市PM_(2.5)平均贡献率约为45.4%,其中约有90%来源于海口市自身人为源,约有10%来源于广东广西片区,海南片区除海口外其余市县贡献可忽略不计.污染时段,北部湾和海口市自身贡献率均下降,平均贡献率分别为40%和36%,表明污染时段海口市PM_(2.5)主要源区不仅来自北部湾.通过分析后向轨迹,发现污染时段均会经过一个关键区——珠三角区域,表明珠三角区域很有可能也是造成2013年12月海口市PM_(2.5)污染的主要源区.清洁时段,北部湾和海口市自身贡献率均上升,平均贡献率分别为52%和48%,表明北部湾对海口市PM_(2.5)浓度影响在清洁时段更显著.因此,北部湾未来产业规划值得关注,因为这些产业很有可能使目前海口市清洁时段变为污染时段,导致空气质量下降.     

邯郸市妇女空气污染暴露对妊娠期高血压的影响

选择河北省邯郸市某医院孕妇数据,探讨了6项空气污染物暴露对孕妇患妊娠期高血压(GH)的影响和不同人群的效应差异,采用传统Logistic回归模型评估了各项污染物的效应,采用主成分改进的Logistic回归模型评估了各项污染物在额外调整其它污染物后的效应.结果显示,单污染物模型中,妊娠期前26周每20μg/m3增量的O3...