|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: R: ULTRASOUND digest 1477From: James S Smeltzer MD (gaperina@mindspring.com)Sun Jan 13 15:50:21 2002
Hi, Re Trichinella in pregnancy. Question is what to do about it? Apparently human fetal infection - or adverse outcome related to infection - is rare. If definite evidence of fetal infection by ultrasound can offer termination at 20 weeks. Else, investigation would lead to more morbidity than observation for the fetus (cordocentesis). A woman who is very ill or terminal from any cause may benefit from delivery or ending the pregnancy as it reduces the demands on the respiratory and cardiovascular systems related to the pregnancy. As the damage comes from inflammatory response as much as organism therapy - which kills the organism and increases the response - is problematic. I would treat on the basis of maternal needs or clearly demonstrated fetal evidence of infection - hydrocephaly, hepatic calcifications, hydrops, intracerebral echogenicities, severe IUGR - only. Regarding fetocide at 30 weeks, that is murder and illegal in this country (USA). The fetus with the spina bifida, regardless of problems, is capable of independent existence and meets the definition of person - rather than latent person - here. The anencephalic does not, and fetocide for hydramnios and threatened labor would be warranted. Most babies with large NTDs are going to die with "confort care" - warmth and food - only, which is a legitimate parental decision, not an obstetrical one. The third issue is the question - if this were discovered prior to viability - of whether or not the two of three with identifiable severe abnormalities may be a marker for possible severe effect of a teratogen on all - including the visibly normal one, or a possible genetic defect such as a 13-13 translocation that is responsible for the couple's infertility, and abnormality of these fetuses. Interesting case. Jim Smeltzer Congenital trichinellosis? Case report. Dubinsky P, Boor A, Kincekova J, Tomasovicova O, Reiterova K, Bielik Parasite. 2001 Jun;8(2 Suppl):S180-2. Parasitological Institute of the Slovak Academy of Sciences, Hlinkova 3, 040 01 Kosice, Slovak Republic. dubinsky@saske.sk A large trichinellosis outbreak in the Slovak Republic caused by the species Trichinella britovi and affecting 336 people also affected a pregnant woman. The mother was infected in the 10th week of pregnancy and was treated with mebendazole. On her own request abortion was performed in the 22nd week of pregnancy. Medium IgM and high IgG anti-Trichinella antibody titres were found. The placenta, body cavities liquid, tissues and organs of the foetus contained 0.02-30 larvae per gram of tissue, measuring 0.68 +/- 0.05-1.17 +/- 0.07 mm, with blurred inner structure. Immunocytochemical examination identified Trichinella larvae that infected the foetus in the early stage of development.
|
|
Return to
|
Mail a New Message to the Forum: ultrasound@obgyn.net Forum Administrator: terry.dubose@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 05:18:29 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.