Preventing Transmission of Zika Virus in Labor & Delivery

Because patients with Zika virus infection may be asymptomatic, Standard Precautions should be in place at all times, regardless of whether the infection is suspected or confirmed.  The implementation of Standard Precautions in labor and delivery settings can help prevent the transmission of Zika virus infection, according to recommendations from the Centers for Disease Control and Prevention (CDC). Although there are no reports of transmission of Zika virus from infected patients to health care personnel or other patients, minimizing exposures to body fluids is important to reduce the possibility of such transmission. CDC recommends Standard Precautions in all health care settings, including:

• Hand hygiene.

• Use of personal protective equipment (PPE).

• Respiratory hygiene and cough etiquette.

• Safe injection practices.

• Safe handling of potentially contaminated equipment or surfaces in the patient environment.

Relationship between signs and symptoms of early pregnancy and pregnancy loss

Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not.

Human Reproduction, 03/04/2016Sapra KJ, et al.

CDC: Stillbirths Now Outnumber Infant Deaths in U.S.

(HealthDay News) — Stillbirths have eclipsed infant deaths for the first time in the United States, according to new research published in the U.S. Centers for Disease Control and Prevention's July 23 National Vital Statistics Report.
"The number of fetal deaths is now slightly higher than the number of infant deaths," report coauthor Elizabeth Gregory, M.P.H., a health statistician at the CDC's National Center for Health Statistics, told HealthDay. In 2013, there were 23,595 fetal deaths at 20 weeks of gestation or more, compared to 23,446 infant deaths. The report did not include abortions, Gregory said.
Although fetal death rates overall have remained largely unchanged, they are higher for certain populations, including teens, women aged 35 and over, and unmarried women, along with male fetuses and multiple fetuses, the researchers found. But significant racial disparities also emerged in the report.
In 2013, the fetal death rate for black women stood at 10.5 per 1,000 pregnancies, which was more than twice the rate for white women and Asian or Pacific Islander women, researchers found. The fetal death rate for American Indian or Alaska Native women was 27 percent higher than the rate for white women, while it was 7 percent higher for Hispanic women.

Zika Virus linked to Stillbirth

PLOS Neglected Tropical Diseases.,  February 26, 2016 —
Zika virus may be associated with hydrops fetalis and fetal demise, according to a case report published online.
Manoel Sarno, MD, PhD, from the Hospital Geral Roberto Santos in Salvador, Brazil, and colleagues present the case of a 20-year-old pregnant women with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. She was referred after a large Zika virus outbreak in Brazil.
The researchers note that severe microcephaly, hydranencephaly, intracranial calcifications, and destructive lesions of posterior fossa were identified in ultrasound examinations in the second and third trimesters; in addition, hydrothorax, ascites, and subcutaneous edema were observed. At the 32nd gestational week they performed an induced labor due to fetal demise and delivered a female fetus. Zika virus-specific real-time polymerase chain reaction amplification products were obtained from cerebral cortex, medulla oblongata, and cerebrospinal and amniotic fluid extracts; there were no detectable products from extracts of heart, lung, liver, vitreous body of the eye, or placenta.
"Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that Zika virus infection imparts on these outcomes," the authors write

Lawyer mother booked under PC&PNDT

Gujarat files case under PNDT against mom

TNN | Mar 22, 2015, 04.35 AM IST

SURAT: In a first in Gujarat, a case of violation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act was filed against a mother — Swati Dinesh Patil, resident of Nandurbar in Maharashtra — and her sister-in-law for sex determination of her foetus in Surat on Saturday. Until now, only doctors have been booked for PCPNDT violations in the state.

The FIR accusing a parent and family for PCPNDT violation is the fallout of the crackdown in an interstate sex determination racket being run by a homeopath doctor in Pandersara area.

Ramesh Kapadia, a quack, is a history-sheeter. "There are two PCPNDT violation cases pending against Kapadia in Gujarat high court. We have seized a mobile-sized sonography machine from him which he had hid in a helmet. The sonography was to be done in a flat. Such hush-hush operations indicate that the rot has set deep in society," said Dr Megha Mehta, chief district health officer (CDHO) Surat.

Dr Mehta said the operation has exposed a racket being run by an agent identified as Samadhan in Nandurbar who had tied up with Dr Kapadia and had sent women from Maharashtra for sex determination.

Probably for the first time, a patient from Pune has been booked under PCPNDT Act along with her mother, husband, and two gynecologists who allegedly aided the woman in an abortion of her own unborn female child. All of them were booked after an investigation which lasted for about 6 months. We have often seen radiologists and gynecologists being targeted indiscriminately by the government authorities under PCPNDT act. However, probably for the first time, the mother of two, who also is a lawyer by profession has been charged under PCPNDT act. The incident took place last year in Pune. An informant lodged a complaint with the police commissioner against the lawyer woman last year on August 19. The complaint was sent to local civic administration (Pune Municipal Corporation) for further legal action. After a long investigation, the authorities found that there was a substance in the complaint. The authorities investigated the documents which were seized and recorded the statements of various people as a part of an investigation. The qualified members from medical community were consulted which found that the foetus was normal and there was no evidence of bleeding or placental abnormality from USG which would warrant an abortion. The investigators also found that hospital sent the death information form to the municipal corporation on 23 June 2015, which mentioned the sex of the foetus as ‘female’. The medical records also showed that woman, who is a mother of two girls, frequently visited the alleged hospital for the treatment during the entire pregnancy. The abortion of the foetus was carried out on 23 June 2015 by one of the gynecologists. The woman was accompanied by her mother and the husband for the procedure. The case has been filed in the Judicial Magistrate First Class Court, Shivajinagar, Pune this year, alleging the violation of PCPNDT act 1994 and Rules 1996. The woman who is a practicing lawyer, is booked under 4(2), 6(B), 23 (3), Rule 18 (i), 18 (iii) and 18 (X) for not giving mandatory declaration under Rule 10 (1-A) and is liable for 3 years of imprisonment and/or ₹ 50,000 in fine. Mother and the husband of the woman have been booked for violating (2), 6(B), 23 (3), Rule 18 (i), 18 (iii) and 18 (X) for participating in sex determination and foeticide. The woman gynecologist (also the owner of hospital) is booked for violation of Section 4(3), 5,6,29 Rule 9(1), 9 (4), 9(6), 10(1-A), Rule 18 of PCPNDT Act for not keeping mandatory records and for violation of Section 5 (2), 6 and Rule 18 for communicating the sex of the Foetus with woman and her relatives. The gynecologist who performed an abortion has been booked for female foeticide under Rule 18 (X). As mentioned earlier, this is probably the first time authorities booked all the participants of the heinous act of female foeticide. The incident highlights the importance of proper documentation from the doctors. It also suggests that authorities need to take stern action against all the participants, especially the persons who coerce the doctors for participating in such criminal acts. Source: TNN

Read more at: http://www.docplexus.in/news/ab8e01d2-4297-49c3-a459-6319322b7f44/lawyer-mother-booked-under-pcpndt-act?utm_term=Email-Digest-0-morn&utm_campaign=Email-Digest&utm_medium=Email&utm_source=Docplexus.in&utm_content=CTA
Copyright 2015 © Docplexus Online Services Pvt LtdTNN | Mar 22, 2015, 04.35 AM IST

SURAT: In a first in Gujarat, a case of violation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act was filed against a mother — Swati Dinesh Patil, resident of Nandurbar in Maharashtra — and her sister-in-law for sex determination of her foetus in Surat on Saturday. Until now, only doctors have been booked for PCPNDT violations in the state.

The FIR accusing a parent and family for PCPNDT violation is the fallout of the crackdown in an interstate sex determination racket being run by a homeopath doctor in Pandersara area.

Ramesh Kapadia, a quack, is a history-sheeter. "There are two PCPNDT violation cases pending against Kapadia in Gujarat high court. We have seized a mobile-sized sonography machine from him which he had hid in a helmet. The sonography was to be done in a flat. Such hush-hush operations indicate that the rot has set deep in society," said Dr Megha Mehta, chief district health officer (CDHO) Surat.

Dr Mehta said the operation has exposed a racket being run by an agent identified as Samadhan in Nandurbar who had tied up with Dr Kapadia and had sent women from Maharashtra for sex determination.

Probably for the first time, a patient from Pune has been booked under PCPNDT Act along with her mother, husband, and two gynecologists who allegedly aided the woman in an abortion of her own unborn female child. All of them were booked after an investigation which lasted for about 6 months. We have often seen radiologists and gynecologists being targeted indiscriminately by the government authorities under PCPNDT act. However, probably for the first time, the mother of two, who also is a lawyer by profession has been charged under PCPNDT act. The incident took place last year in Pune. An informant lodged a complaint with the police commissioner against the lawyer woman last year on August 19. The complaint was sent to local civic administration (Pune Municipal Corporation) for further legal action. After a long investigation, the authorities found that there was a substance in the complaint. The authorities investigated the documents which were seized and recorded the statements of various people as a part of an investigation. The qualified members from medical community were consulted which found that the foetus was normal and there was no evidence of bleeding or placental abnormality from USG which would warrant an abortion. The investigators also found that hospital sent the death information form to the municipal corporation on 23 June 2015, which mentioned the sex of the foetus as ‘female’. The medical records also showed that woman, who is a mother of two girls, frequently visited the alleged hospital for the treatment during the entire pregnancy. The abortion of the foetus was carried out on 23 June 2015 by one of the gynecologists. The woman was accompanied by her mother and the husband for the procedure. The case has been filed in the Judicial Magistrate First Class Court, Shivajinagar, Pune this year, alleging the violation of PCPNDT act 1994 and Rules 1996. The woman who is a practicing lawyer, is booked under 4(2), 6(B), 23 (3), Rule 18 (i), 18 (iii) and 18 (X) for not giving mandatory declaration under Rule 10 (1-A) and is liable for 3 years of imprisonment and/or ₹ 50,000 in fine. Mother and the husband of the woman have been booked for violating (2), 6(B), 23 (3), Rule 18 (i), 18 (iii) and 18 (X) for participating in sex determination and foeticide. The woman gynecologist (also the owner of hospital) is booked for violation of Section 4(3), 5,6,29 Rule 9(1), 9 (4), 9(6), 10(1-A), Rule 18 of PCPNDT Act for not keeping mandatory records and for violation of Section 5 (2), 6 and Rule 18 for communicating the sex of the Foetus with woman and her relatives. The gynecologist who performed an abortion has been booked for female foeticide under Rule 18 (X). As mentioned earlier, this is probably the first time authorities booked all the participants of the heinous act of female foeticide. The incident highlights the importance of proper documentation from the doctors. It also suggests that authorities need to take stern action against all the participants, especially the persons who coerce the doctors for participating in such criminal acts. Source: TNN

Read more at: http://www.docplexus.in/news/ab8e01d2-4297-49c3-a459-6319322b7f44/lawyer-mother-booked-under-pcpndt-act?utm_term=Email-Digest-0-morn&utm_campaign=Email-Digest&utm_medium=Email&utm_source=Docplexus.in&utm_content=CTA
Copyright 2015 © Docplexus Online Services Pvt Ltd

Evidence Suggests Zika Virus Can Cross Placental Barrier, But Microcephaly Link Remains Unclear

NEW YORK -- February 17, 2016 -- Zika virus has been detected in the amniotic fluid of 2 pregnant women whose foetuses had been diagnosed with microcephaly, according to a study published today in The Lancet Infectious Diseases.
The report suggests that Zika virus can cross the placental barrier, but does not prove that the virus causes microcephaly, as more research is needed to understand the link.
Researchers also analysed the whole genome of the virus found in the 2 pregnant women and confirmed that the virus is genetically related to the strain identified during an outbreak of Zika virus in French Polynesia in 2013.
“Previous studies have identified Zika virus in the saliva, breast milk, and urine of mothers and their newborn babies, after having given birth,” said lead author Ana de Filippis, MD, Oswaldo Cruz Institute in Rio de Janeiro, Rio de Janeiro, Brazil. “This study reports details of the Zika virus being identified directly in the amniotic fluid of a woman during her pregnancy, suggesting that the virus could cross the placental barrier and potentially infect the foetus.”
“This study cannot determine whether the Zika virus identified in these 2 cases was the cause of microcephaly in the babies,” she noted. “Until we understand the biological mechanism linking Zika virus to microcephaly we cannot be certain that one causes the other, and further research is urgently needed.”
The number of reported cases of newborn babies with microcephaly in Brazil in 2015 has increased 20-fold compared with previous years. At the same time, Brazil has reported a high number of Zika virus infections, leading to speculation that the two may be linked. Microcephaly has previously been linked to a range of factors including genetic disorders, drug or chemical intoxication, maternal malnutrition and infections with viruses or bacteria that can cross the placental barrier such as herpes, HIV, or some mosquito borne viruses such as chikungunya.
Dr. de Filippis and colleagues investigated the case of 2 women, aged 27 and 35 years, from Paraiba, Brazil. Both women presented with symptoms of Zika virus infection including fever, muscle pain, and a rash during their first trimester of pregnancy. Ultrasounds taken at approximately 22 weeks of pregnancy confirmed the foetuses had microcephaly.
Samples of amniotic fluid were taken at 28 weeks of pregnancy and analysed for potential infections. Both patients tested negative for dengue virus, chikungunya virus, and other infections such as HIV, syphilis, and herpes. Although the women’s blood and urine samples tested negative for Zika virus, their amniotic fluid tested positive for Zika virus genome and Zika antibodies. The amniotic fluid was analysed using metagenomic analysis, which allows for detection of any microorganism that could be present in the samples, but only Zika virus genome was found. The RNA of the 2 Zika virus samples was then compared with samples from previous outbreaks, and was found to be genetically related to the strain identified in French Polynesia in 2013.
In an accompanying commentary, Didier Musso, MD, Institut Louis Malarde, Tahiti, French Polynesia, wrote: “Even if all these data strongly suggest that Zika virus can cause microcephaly, the number of microcephaly cases related to Zika virus is still unknown. The next step will be to do case-control studies to estimate the potential risk of microcephaly after Zika virus infection during pregnancy, other fetal or neonatal complications, and long-term outcomes for infected symptomatic and asymptomatic neonates.”
SOURCE: The Lancet Infectious Diseases