PRENATAL MANAGEMENT OF 746 PREGNANCIES AT RISK FOR CONGENITAL TOXOPLASMOSIS
PRENATAL MANAGEMENT OF 746 PREGNANCIES AT RISK FOR CONGENITAL TOXOPLASMOSIS
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DOI：
10.1056/nejm198802043180502
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发表时间：
1988-02-04
影响因子：
158.5
通讯作者：
COX, WL
中科院分区：
文献类型：
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作者：
DAFFOS, F;FORESTIER, F;COX, WL
怀孕期间感染刚地弓形虫有可能导致严重的先天性弓形虫病。我们发展了一种在子宫内诊断和治疗先天性弓形虫病的方法。诊断的基础是确定母体急性感染，随后进行胎儿血和羊水培养，检测胎儿血中弓形虫特异性IgM和非特异性感染，以及胎儿脑超声检查。治疗包括对所有在怀孕期间确诊急性感染的母亲使用抗生素，对那些有感染胎儿并选择继续妊娠的母亲进行更强化的抗生素治疗。我们报告了一项前瞻性研究，记录了746例母体弓形虫感染病例，其中婴儿随访至少三个月。42例胎儿中有39例被产前诊断为感染。39例妊娠中有24例终止妊娠，15例继续妊娠。所有母亲在怀孕期间均接受螺旋霉素治疗；如果证实胎儿感染，则在方案中加入乙胺嘧啶和磺胺多辛或磺胺嘧啶。在15例先天性弓形虫病胎儿中，除2例有脉络膜视网膜炎外，其余胎儿在随访期间均表现良好。我们的结论是，先天性弓形虫病的产前诊断是可行的，对希望继续怀孕的妇女进行产前治疗可降低疾病表现的严重程度。
When infection with Toxoplasma gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxine or sulfadiazine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during follow-up. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease.