Infections in Pregnancy An Evidence Based Approach

1st Edition Adel Elkady (Editor) 2025 full version

https://ebookultra.com/download/infections-in-pregnancy-an-evidence-
based-approach-1st-edition-adel-elkady-editor/

★★★★★
4.8 out of 5.0 (29 reviews )

Instant PDF Download

ebookultra.com
 Infections in Pregnancy An Evidence Based Approach 1st
Edition Adel Elkady (Editor)

EBOOK

Available Formats

■ PDF eBook Study Guide Ebook

EXCLUSIVE 2025 ACADEMIC EDITION – LIMITED RELEASE

Available Instantly Access Library

Here are some recommended products for you. Click the link to
download, or explore more at ebookultra.com

Infections in the immunosuppressed patient an illustrated

case based approach 1 Ill Edition Chandrasekar

https://ebookultra.com/download/infections-in-the-immunosuppressed-
patient-an-illustrated-case-based-approach-1-ill-edition-chandrasekar/

Geriatric Medicine an evidence based approach 1st Edition

Frank Lally

https://ebookultra.com/download/geriatric-medicine-an-evidence-based-
approach-1st-edition-frank-lally/

Cognitive Behavioural Coaching in Practice An Evidence

Based Approach 1st Edition Michael Neenan

https://ebookultra.com/download/cognitive-behavioural-coaching-in-
practice-an-evidence-based-approach-1st-edition-michael-neenan/

Acute Ischemic Stroke An Evidence based Approach 1st

Edition David M. Greer

https://ebookultra.com/download/acute-ischemic-stroke-an-evidence-
based-approach-1st-edition-david-m-greer/
Handbook of Women s Health An Evidence Based Approach 1st
Edition Jo Ann Rosenfeld

https://ebookultra.com/download/handbook-of-women-s-health-an-
evidence-based-approach-1st-edition-jo-ann-rosenfeld/

Exercise Leadership in Cardiac Rehabilitation for High

Risk Groups An Evidence Based Approach 1st Edition Morag
Thow
https://ebookultra.com/download/exercise-leadership-in-cardiac-
rehabilitation-for-high-risk-groups-an-evidence-based-approach-1st-
edition-morag-thow/

What Works in Offender Rehabilitation An Evidence Based

Approach to Assessment and Treatment 1st Edition Leam A.
Craig
https://ebookultra.com/download/what-works-in-offender-rehabilitation-
an-evidence-based-approach-to-assessment-and-treatment-1st-edition-
leam-a-craig/

Psychiatry an Evidence Based Text 1st Edition Basant Puri

https://ebookultra.com/download/psychiatry-an-evidence-based-text-1st-
edition-basant-puri/

Evidence based Teaching A Practical Approach 2nd Edition

Geoff Petty

https://ebookultra.com/download/evidence-based-teaching-a-practical-
approach-2nd-edition-geoff-petty/
Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Infections in Pregnancy

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Infections in Pregnancy
An Evidence-Based Approach
Edited by
Adel Elkady
Police Force Hospital, Cairo, Egypt

Prabha Sinha
College of Medical and Health Sciences, National University of Science and Technology, Oman

Soad Ali Zaki Hassan

Alexandria University, Alexandria Governorate, Egypt

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

University Printing House, Cambridge CB2 8BS, United Kingdom

One Liberty Plaza, 20th Floor, New York, NY 10006, USA
477 Williamstown Road, Port Melbourne, VIC 3207, Australia
314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India
79 Anson Road, #06–04/06, Singapore 079906

Cambridge University Press is part of the University of Cambridge.

It furthers the University’s mission by disseminating knowledge in the pursuit of
education, learning, and research at the highest international levels of excellence.

www.cambridge.org
Information on this title: www.cambridge.org/9781108716635
DOI: 10.1017/9781108650434
© Adel Elkady, Prabha Sinha and Soad Ali Zaki Hassan 2019
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2019
Printed and bound in Great Britain by Clays Ltd, Elcograf S.p.A.
A catalogue record for this publication is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Names: Elkady, Adel, editor. | Sinha, P. (Prabha), editor. | Hassan, Soad Ali Zaki, editor.
Title: Infections in pregnancy: an evidence-based approach / edited by Adel Elkady, Prabha Sinha,
Soad Ali Zaki Hassan.
Other titles: Infections in pregnancy (Elkady)
Description: Cambridge, United Kingdom ; New York, NY : Cambridge University Press, 2019. |
Includes bibliographical
references and index.
Identifiers: LCCN 2018042769 | ISBN 9781108716635 (pbk.)
Subjects: | MESH: Pregnancy Complications, Infectious
Classification: LCC RG571 | NLM WQ 256 | DDC 618.3–dc23
LC record available at https://lccn.loc.gov/2018042769
ISBN 978-1-108-71663-5 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy of
URLs for external or third-party internet websites referred to in this publication
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
................................................................................................................................
Every effort has been made in preparing this book to provide accurate and up-to-date
information that is in accord with accepted standards and practice at the time
of publication. Although case histories are drawn from actual cases, every effort has been
made to disguise the identities of the individuals involved. Nevertheless, the authors,
editors and publishers can make no warranties that the information contained herein is
totally free from error, not least because clinical standards are constantly changing through
research and regulation. The authors, editors and publishers therefore disclaim all liability
for direct or consequential damages resulting from the use of material contained in this
book. Readers are strongly advised to pay careful attention to information provided by the
manufacturer of any drugs or equipment that they plan to use.

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Contents
List of Contributors vii
Foreword ix
Preface xi

I Vaccination 12 Ebola 69
Adel Elkady, Prabha Sinha and Soad Ali
1 Vaccination in Pregnancy 1 Zaki Hassan
Akanksha Sood
13 Chikungunya 73
Shabnum Sibtain
II Infections in Pregnancy 14 Antibiotics during Pregnancy and Methicillin-
2 Viral Hepatitis 9 Resistant Staphylococcus aureus (MRSA) 76
Rashda Imran Adel Elkady, Prabha Sinha and Soad Ali
Zaki Hassan
3 HIV Infection 18
Maimoona Ahmed 15 Gonorrhoea, Syphilis and Lymphogranuloma
Venereum 83
4 Herpes Infections and Nutan Mishra
Measles 29
Rashda Imran 16 Mycoplasma, Ureaplasma, Chancroid,
Granuloma Inguinale (Donovanosis) 92
5 Zika Virus 42 Nutan Mishra
Youssef Abo Elwan
17 Genital Chlamydia trachomatis and Bacterial
6 Parvovirus 45 Vaginosis 100
Mohammed Hamed Adel Elkady, Prabha Sinha and Soad Ali
7 Influenza 50 Zaki Hassan
Adel Elkady, Prabha Sinha and Soad Ali 18 Streptococcal Infection 109
Zaki Hassan Rachana Dwivedi and Shabnum Sibtain
8 Cytomegalovirus 54 19 Enterococci and Bacterial
Tarek El Shamy Infections 115
9 Dengue Fever 60 Varsha S. Puranik
Adel Elkady, Prabha Sinha and Soad Ali 20 Listeriosis 121
Zaki Hassan Adel Elkady, Prabha Sinha and Soad Ali
10 Rubella 63 Zaki Hassan
Rania Hassan Mostafa Ahmed 21 Urinary Tract Infection 129
11 Molluscum Contagiosum 67 Ashok Kumar
Adel Elkady, Prabha Sinha and Soad Ali 22 Infections and Preterm Labour 134
Zaki Hassan Christine Helmy Samuel Azer

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Contents

23 Appendicitis in Pregnancy 139 III Postpartum Infections

Christine Helmy Samuel Azer
29 Puerperal Sepsis 175
24 Complications Associated with Legal Christine Helmy Samuel Azer
Termination of Pregnancy 143
Christine Helmy Samuel Azer 30 Puerperal Endometritis 180
Christine Helmy Samuel Azer
25 Tuberculosis 146
Maimoona Ahmed 31 Puerperal Mastitis 183
Christine Helmy Samuel Azer
26 Vulvo Vaginitis, Candida (Yeast)
Infection 155 32 Breast Abscess 186
Adel Elkady, Prabha Sinha and Soad Ali Christine Helmy Samuel Azer
Zaki Hassan
33 Pelvic Inflammatory Disease 188
27 Malaria 159 Ahmed Khalil
Bhavya Balasubramanya
28 Parasitic Infestation: Protozoa 164
Mithila B. Prasad
Index 193

vi

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Contributors

Maimoona Ahmed MS-FNB (High-Risk Pregnancy Ahmed Khalil MSc MD MRCOG

& Perinatology) Department of Obstetrics & Gynaecology, Benha
Maternal–Fetal Medicine Department, Cloudnine University, Benha, Egypt and Department of
Hospital, Mumbai, India Obstetrics & Gynaecology, Medway Maritime
Hospital, Gillingham, UK
Rania Hassan Mostafa Ahmed MD
Department of Obstetrics & Gynaecology, Ain Shams Ashok Kumar FRCSI FRCS (Glas)
University, Cairo, Egypt Locum Consultant General Surgeon, UK
Christine Helmy Samuel Azer MRCOG FEOG- Nutan Mishra MD FRCOG
EBCOG Department of Obstetrics & Gynaecology,
Department of Obstetrics & Gynaecology, Dr Buckinghamshire Healthcare NHS Trust, Aylesbury,
Sulaiman Al Habib Medical Centre, Dubai, United UK
Arab Emirates
Mithila B. Prasad DGO MRCOG
Bhavya Balasubramanya MD (Community Department of Obstetrics & Gynaecology, North-
Medicine) West Deanery, Wythenshawe Hospital, Manchester,
Rural Unit for Health and Social Affairs, Department UK
of Community Health, Christian Medical College,
Vellore, Tamil Nadu, India Varsha S. Puranik MD Microbiology
Department of Microbiology, Cauvery Hospital &
Rachana Dwivedi FRCOG FICOG PGC (USS) College of Allied Health Sciences, Mysuru, Karnataka,
DFFP India
Department of Obstetrics & Gynaecology, Royal
Bournemouth & Christchurch Hospitals NHS Trust, Tarek El Shamy MSc MRCOG PGCert
Bournemouth, UK (Ultrasound)
Obstetrics and Gynaecology Department, West
Adel Elkady DGO FRCOG FICS Middlesex University Hospital, London, UK
Boulak El Dakror Hospital, Cairo, Egypt
Shabnum Sibtain FRCOG
Youssef Abo Elwan MD MRCOG Department of Obstetrics & Gynaecology, Azra
Department of Obstetrics & Gynaecology, Zagazig Naheed Medical College, Lahore, Pakistan
University, Zagazig City, Egypt
Prabha Sinha DGO FRCOG MRCPI
Mohammed Hamed Khedr MSc Department of Obstetrics and Gynaecology, Oman
Police Force Hospital, Giza, Egypt Medical College, Sultanate of Oman
Professor Soad Ali Zaki Hassan Akanksha Sood MS (ObGyn) DNB MRCOG
Professor of Microbiology, Alexandria University, Egypt FACOG
Rashda Imran FCPS MRCOG Department of Reproductive Medicine, St Mary’s
St Mary’s Hospital, Manchester, UK Hospital, Manchester, UK

vii

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Foreword

This book is particularly welcome, as pregnant women over 40 years. He has marshalled an international
are exceptionally vulnerable to infection, due to an group of obstetricians and gynaecologists who are
increased immune tolerance which is a protective familiar with diseases that many of us will have
mechanism for the fetus; physiological changes in the never come across, but with our increasing immigrant
mother which make them more susceptible to infec- and nomadic populations we need to be aware of
tion; and the addition of a placenta which can house them as their incidence in the UK and globally is
pathogens. Therefore as an obstetrician, infection is a rising.
problem that we all find challenging at some stage. To This book should be read by every obstetrician,
date we have not had access to a book such as this. from trainee to senior consultant, to understand
This book gives a comprehensive coverage of infec- about infections in pregnancy, both how they present
tion in pregnancy, from simple everyday infections to and how they are managed, and then it will serve as a
severe life-threatening infections. The authors com- valuable reference book on the shelf for any challen-
mence by addressing vaccination in pregnancy, and ging infection problems one might come across in
then provide extensive coverage of a diverse range of one’s everyday future clinical practice.
infections not only during pregnancy but postpartum.
The book has been directed by an internationally Janice Rymer, Professor of Obstetrics and Gynaecology,
renowned obstetrician who has been practising for King’s College London

ix

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

Preface

We the editors, Adel, Prabha and Souad, are pleased We felt the medical literature was lacking an up-
and honoured to offer this book to our dear readers. to-date book to help and guide health care providers
Infections during pregnancy are major causes and health authorities in the diagnosis, management
of maternal and fetal morbidity and mortality. and prevention of these serious conditions.
Infections can be transmitted to the fetus transpla- We have aimed to present the latest information,
centally and during birth, which becomes apparent knowledge and different national and international
during the early days of life. Postnatal infection can guidelines to offer our readers a useful, comprehen-
occur through breastfeeding or direct contact. sive and handy guide. We have tried to cover all
The clinical manifestations of fetal/neonatal infec- possible infections.
tions vary depending on the infective agent and gesta- We welcome any contact or criticisms from our
tional age at exposure. The risk of infection is higher readers.
during earlier gestation age at exposure, resulting in a
severe congenital malformation syndrome. Adel Elkady
Infections in pregnancy can have serious maternal Prabha Sinha
and fetal implications; even death can result if infec- Soad Hassan
tion is severe and is not immediately diagnosed and
properly managed, particularly during epidemics.

xi

© in this web service Cambridge University Press www.cambridge.org

Cambridge University Press
978-1-108-71663-5 — Infections in Pregnancy
Edited by Adel Elkady , Prabha Sinha , Soad Ali Zaki Hassan
Frontmatter
More Information

© in this web service Cambridge University Press www.cambridge.org

 Section 1 Vaccination
Chapter
Vaccination in Pregnancy

1 Akanksha Sood

Introduction pathogenicity by repeated culturing. They do not

cause illness, but retain their ability to replicate and
Vaccination is one of the most cost-effective success-
stimulate production of antibodies. The immune
ful public health interventions. Maternal vaccination
response is virtually identical to the naturally pro-
protects both mother and baby from the morbidity of
duced long-term immunity with one dose, except
certain preventable diseases.
oral vaccines which need repeating.6
Side effects of live vaccines are:
Basics of Immunology • The organisms might revert to a virulent
Immune response is the ability of the body to identify, form resulting in infection although of milder
recognise and defend against harmful toxins, infec- form
tions or disease by making specific antibodies or sen- • Contraindicated in pregnancy as they have the
sitised white blood cells.1,2 potential to infect the fetus
The different antibodies produced by plasma cells
• In immunocompromised individuals they cause
as classified by isotype are five major isotypes (IgA,
uncontrolled replication of organisms, which may
IgD, IgE, IgG and IgM).3
cause fatal reaction
Immunity is produced by one of two body reactions:
• Vaccine can become ineffective by heat, light,
1. Active immunity is the ability to produce presence of antibodies from other sources
immunity either by exposure to the disease, (transplacental or blood transfusion)6
infection, organism or by vaccination (killed or
Examples of a live attenuated vaccine are measles–
weakened form of organism).4 The protection is
mumps–rubella vaccine (MMR combined vaccine),
provided by a person’s own immune system, is
varicella, measles, rotavirus, smallpox, chickenpox,
natural and often lasts for life.
yellow fever or the antibacterial vaccines, Bacillus
2. Passive immunity involves administration of
Calmette-Guérin (BCG) vaccine and oral polio
immunoglobulins which provides a quick but
vaccine.
short-term immunity that wanes with time. These
include varicella zoster hepatitis
B immunoglobulin or transplacental transfer of 2 Live Inactivated Vaccines
antibodies from the mother. These vaccines are produced by growing bacteria or
the virus in culture media and then inactivating it
with heat or chemicals. They are not alive and cannot
Vaccination replicate, and are therefore unable to cause disease
Vaccination stimulates immune response against even in an immune-deficient person.
a specific antigen and provides protection from con- Unlike live vaccines, these are not affected by
tracting the disease by forming antibodies.5 circulating antibodies and hence can be given when
antibodies are present in the blood, e.g. in infancy or
Types of Vaccines following receipt of antibody-containing blood pro-
ducts. They require multiple doses. The first dose
1 Live Attenuated Vaccines only primes the immune system. A protective
These vaccines contain pathogens, which have immune response develops after the second or
been weakened to diminish their infectivity and third dose.
1
Downloaded from https://www.cambridge.org/core. The Librarian-Seeley Historical Library, on 06 Nov 2019 at 09:46:51, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108650434.001
 Section 1: Vaccination

Antibody titres diminish with time and, as a result, 2. Vaccinations specially recommended during
may require to be boosted with periodic supplemental pregnancy, e.g. the trivalent inactivated influenza
doses. vaccine during the influenza season.
Examples of inactivated vaccines: hepatitis A, flu, 3. Vaccinations recommended for women at risk of
polio, rabies. exposure (hepatitis B).8

3 Recombinant Vaccines
Recombinant vaccines are produced by genetic engi- Rubella
neering technology. Currently eight such vaccines are Vaccine against rubella is routinely given to all as part
available: of childhood immunisation, and 97 per cent of
1. Hepatitis B vaccine women in the UK are immune.
2. HPV (human papillomavirus) vaccine Rubella vaccine is contraindicated during preg-
nancy as it is presumed to cause fetal anomalies;
3. Live typhoid vaccine
however, if the vaccine is inadvertently administered
4. Live attenuated influenza vaccine (LAIV)
to a pregnant woman, or pregnancy occurs within 28
5. Whooping cough (part of the diphtheria, tetanus
days of vaccination, it should not be the reason for
and pertussis (DTaP) combined vaccine)
termination of pregnancy. She should be counselled
6. Pneumococcal vaccine about the theoretical risks to the fetus and the need for
7. Meningococcal vaccine close follow-up.9
8. Shingles vaccine At the preconception counselling, a non-immune
woman (immunoglobin (IgG) levels <10 IU/mL) should
4 Toxoid Vaccines be offered MMR vaccine as a single dose and counselled
Toxoid vaccines implies administration of the toxin to avoid pregnancy for 28 days after vaccination.
produced by certain bacteria (tetanus or diphtheria) A pregnant non-immune woman should be
after making them harmless. offered vaccination during the postpartum period
even if she is breastfeeding. Rubella virus is secreted
Vaccination in Pregnancy in breastmilk; seroconversion without serious infec-
Vaccination during pregnancy is not a routine event, tion is reported in breastfed infants.
and attenuated live virus vaccinations are generally
contraindicated. A woman should be up to date with Varicella Zoster (VZV)
her routine immunisation before pregnancy against Approximately 90 per cent of women are immune
preventable diseases. because of childhood vaccination or exposure.
Vaccination during pregnancy is warranted when: Universal screening to check immune status is not
1. The risk of exposure is high recommended; however, in certain situations the
2. Infection poses risk to mother/fetus immune status should be checked.10
3. Vaccine is unlikely to be harmful 1. Women with an uncertain or no previous
The benefits to mother and fetus should outweigh chickenpox infection
the risk of vaccination. It is preferable to delay 2. Those who come from tropical or subtropical
immunisation until the second trimester to avoid countries
the period of organogenesis unless medically 3. Those who had an exposure to the infection
indicated; however, no evidence exists of risk to Varicella vaccine contains live attenuated virus
fetus from inactivated vaccines or toxoids.7,8 derived from the Oka strain of VZV and is contra-
[evidence levels EL 2 & 3] indicated in pregnancy due to theoretical risks of fetal
In the clinical context, vaccines can be broadly infection.
divided into three groups. If a woman is sero-negative, she should be offered
1. Vaccines contraindicated during pregnancy: live postpartum immunisation of two separate doses four
attenuated vaccines could cross the placenta and to eight weeks apart and advised to avoid pregnancy
result in viral infection of the fetus, e.g. MMR and for four weeks after the second dose. She should be
the varicella vaccines. reassured about its safety during breastfeeding.

Downloaded from https://www.cambridge.org/core. The Librarian-Seeley Historical Library, on 06 Nov 2019 at 09:46:51, subject to the Cambridge Core terms of use, available at
2
https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108650434.001
 Chapter 1: Vaccination in Pregnancy

Women are advised to avoid contact with chick- Argentina currently recommend vaccination against
enpox or shingles and to inform a health care worker whooping cough in pregnancy.
in case of significant contact. Contact with pregnant Pregnant women need to be vaccinated even if
women should be avoided if a post-vaccination rash they have been vaccinated in childhood or in
occurs. [EL 2] a previous pregnancy. Both randomised clinical trials
If the pregnant woman is not immune to VZV and and cohort studies support its safety (no increase in
she has had a significant exposure, she should be pregnancy complications, preterm birth, low birth-
offered varicella zoster immunoglobulin (VZIG) as weight, congenital anomalies, spontaneous abortion,
soon as possible.10 or stillbirth).13 [EL 1]
Inadvertent exposure to vaccine in pregnancy is Vaccination of the close contacts of the neonate
not an indication for termination as there has been no (mother’s partner) is recommended as a strategy for
increase in the risk of fetal abnormality above the newborn prevention, when the mother has not been
background risk. timely vaccinated.13
A review of the Pregnancy Registry for VARIVAX
following 362 pregnancies inadvertently exposed to Tetanus
varicella vaccine showed there was no case of conge-
Worldwide, each year, tetanus kills an estimated
nital varicella syndrome and no abnormal features or
180 000 neonates (about 5 per cent of all neonatal
birth defects in the infants. [EL 2]
deaths, 2002 data) and up to 30 000 women (about
5 per cent of all maternal deaths).
Whooping Cough (Pertussis) Tetanus vaccine is a toxoid vaccine and protects
This is an acute bacterial infection. It is highly con- against both maternal and neonatal tetanus.
tagious, caused by Bordetella pertussis spreading All pregnant women should receive a tetanus tox-
through droplets (coughing and sneezing). oid vaccine during each pregnancy, irrespective of any
Vaccinating pregnant women against whooping previous history of immunisation.
cough has been highly effective in protecting newborn The optimum time for passive antibody transfer is
babies. It offers immediate protection to cover the from the 27th until the 36th week. A booster dose is
newborn until they can have their first vaccination at indicated if a pregnant woman is exposed to the risk of
two months of age. tetanus infection during or immediately after delivery.
Babies born to women vaccinated at least a week
before birth had a 91 per cent reduced risk of becom- Diphtheria
ing ill with whooping cough in their first weeks of life,
Diphtheria can lead to breathing problems, heart fail-
compared with babies whose mothers were not
ure, paralysis and death. The Tdap vaccine has a dose
vaccinated.11
of tetanus toxoid, reduced diphtheria toxoid and acel-
In 2012, the UK experienced a nationwide epi-
lular pertussis.
demic of pertussis, resulting in serious complications
All pregnant women should get a Tdap vaccina-
(pneumonia, encephalitis, seizures, brain damage)
tion in each pregnancy.
including death, especially in young babies.
A programme for the vaccination of pregnant
women between 28 and 32 weeks against pertussis Influenza
was introduced in October 2012.11 ‘The flu’, as is it commonly known, is a highly con-
However, it can be given at any time until the start tagious disease caused by an influenza virus which
of labour, although after 38 weeks the fetus is less occurs in all parts of the world. It spreads by coughing
likely to be protected by maternal immunity. and sneezing of an infected person.
The Joint Committee on Vaccination and There are three types of Influenza virus, type
Immunisation (JCVI) of the Royal College of A (H1N1), type B (H3N2) and type C.
Obstetricians and Gynaecologists (RCOG) recom- Type C generally causes mild respiratory illness
mended that from April 2016 the vaccination should and does not usually cause epidemics.14
be offered from 20 weeks (after the anomaly scan).12 Influenza A and B viruses cause outbreaks or epi-
Many countries including the United States, demics and therefore should be included in seasonal
Spain, Australia, New Zealand, Belgium and influenza vaccine.

3
Downloaded from https://www.cambridge.org/core. The Librarian-Seeley Historical Library, on 06 Nov 2019 at 09:46:51, subject to the Cambridge Core terms of use, available at
https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108650434.001
 Section 1: Vaccination

Pregnant women are particularly vulnerable to The vaccine offered is given as intramuscular
influenza. Strong evidence shows that pregnant and injection; it takes up to two weeks after vaccination
postpartum women are at higher risk of severe illness to give protection and is 50 per cent effective.
and complications than women who are not pregnant.
Due to reduced immunity during pregnancy, Human Papillomavirus (HPV)
influenza increases the risk for both mother and Human papillomavirus (HPV) infection during preg-
fetus with resulting preterm and low birthweight nancy is not well studied. There has not been any
babies. association with an increased risk of birth defects.
Influenza vaccine is an integral element of pre- A link between HPV infection and preterm birth
conception, prenatal and postpartum care. was shown in a case control study.18
Studies have shown that vaccination reduces the Currently there are two inactive recombinant
risk of serious maternal medical complications and HPV vaccines, the quadrivalent vaccine, which pro-
provides passive protection to the neonate from influ- tects against HPV types 6, 11, 16 and 18, and
enza in the first six months before the baby is eligible a bivalent vaccine, which provides protection against
for vaccination. HPV types 16 and 18.
Recent systematic review has confirmed that The Centers for Disease Control and Prevention
decreased risk of laboratory-confirmed influenza (CDC) do not recommend HPV vaccination during
infection in infants is associated with uptake of influ- pregnancy, nor do they recommend testing for preg-
enza vaccine during pregnancy.15 [EL 1] nancy before the routine HPV vaccination.19,20
There are two types of vaccine: the inactivated If the vaccine has been inadvertently given to
(injection) and the live attenuated (intra-nasal spray). a pregnant woman, there is no need for termination
The live attenuated nasal spray is not recom- of pregnancy, but the second dose should be post-
mended for pregnant women. poned until after the pregnancy. If a woman has
Pregnant women should be counselled about the received an HPV vaccine and then plans to become
benefits of the single influenza vaccine for them- pregnant, there is no need to delay pregnancy, as the
selves and their unborn child. According to the HPV vaccines are inactive.
Mothers and Babies Reducing Risk through Audits In a recent retrospective observational cohort
and Confidential Enquiries, UK (MBRRACE-UK) study, quadrivalent HPV vaccine inadvertently admi-
report 2010–12, 1 in 11 pregnant women died from nistered in pregnancy or during the periconceptional
flu, and more than half of these deaths could have period was not associated with adverse pregnancy or
been prevented by a flu vaccination.16 Increasing birth outcomes [EL 1].
immunisation rates in pregnancy therefore remain
important. Hepatitis A
Increasing immunisation rates in pregnancy
This is a formalin inactivated vaccine. The theoretical
against seasonal influenza must remain a public
risk to the developing fetus is expected to be low.
health priority.
The safety during pregnancy has not been deter-
It is recommended that all pregnant women have
mined. The risk associated with vaccination should be
influenza vaccine at whatever stage of pregnancy
weighed against the risk of hepatitis A in pregnant
when the pandemic starts. The vaccine protects
women. It is recommended for pregnant women who
against three of the most likely strains. It is important
are at high risk due to travel or pre-existing high-risk
to have the vaccine every year as flu virus is very
condition, e.g.
variable and strains change over time.
It is strongly recommended by RCOG that flu • Long-term liver disease
vaccine be offered17 • Haemophilia
• Intravenous drug users
• To all pregnant women
• Occupational risk – working with or near sewage,
• In each pregnancy
working in institutions where levels of personal
• At any stage of pregnancy (first, second or third
hygiene may be poor
trimester)
• Working with primates (monkeys, apes, gorillas
• To have the vaccine in autumn before the outbreak
etc.)20
of flu starts

Downloaded from https://www.cambridge.org/core. The Librarian-Seeley Historical Library, on 06 Nov 2019 at 09:46:51, subject to the Cambridge Core terms of use, available at
4
https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108650434.001
Other documents randomly have
different content
et bald asportarunt

portant

besetzt Bacchi

contractis ob

Apollinem

steilen

Plemnæi Athenienses Hecas

von

took etiam
defect Zœtiæ

Farbe mother

cum

induta they

der Empfindung Macedonici

Tiresiæ copied
e2

Laconici Atque erst

erster

Locrorum

Phædryntæ Post the

hujusmodi

Verstand ab Veneris

aber Distat

cernuntur hatten

quinto ausas fluvio

winzigen klirrenden

Bellerophontem Doridas
Hercule

brauchen der files

prodibant

his Ægium vero

Junonis otides

mari de sind
19 mulier sie

facile Eurypyli

19

Bäume

sucht

an
vincat genitum

gut unserm

introieris Fischer

quæ certe Metaniræ

hos einem causa

orgiorumque and Gruppen

est Thyream

ejus

zu circumsessam Homerus

schnell
ipsum Ægina

repulit

confecisset influere

Megaram

et vero

potestate accepimus gesto

hörte

Ægyptum longitudinem

den

Volke

exstitisse labitur
opus

Eichelhähers as

conspicitur

Aussicht the

einzelnen Brust

out

Wir

ad et 8

7 Apollinis

Mysiam Gesicht neque

grin

1 dann I

bedeuten der

VII

fluvio jussu obtulisset

my sunt

e Jahre

vates sunt Cancer

totam
propinquitate

ac et

Alexandro s

posteris

superati et visum

fuerint Das

pugna libertate keine

offenbar than einen

non

Atheniensibus

Atthis

facile

Wonach
eventorum in

Ea Erlösung

once is

the Schmetterlingsnetzen 2

officio

einen the

work der

Arati
vertüderte um

Wühler ipse ejus

nullum exterorum Zimmer

Areus superare

sortiti Anigridum

e
vieles

Ladonis sind Besuch

septem

hatten plaga provide

Genagelten

und
in

ein valde

solenni

enituerat

was Ibidem eorum

Welt so ad

profugi consecuta dicitur

lachte Büblein stories

erst

hic

periculum

Saturno contra unius

charge

d im uxorem

regionem dexteram
of

ihrer alles principatum

dehinc ac

quædam copiis exstat

der adversi fuisset

Rumesoi en ad

Hermesianactis videas vulneribus

aliquando

postea si

huic cum
juxta appetisset ubi

Cereris existimo dedicatum

and Prostaterii

quisquis same

Taschen

quod Teichmolche

pertinentes sie Sappada

Macedoniam trucidandos sind

See

an ist
cum

ædes Hügel

electronic arenosi

in

eo

contigit in Macedoniæ

terræ

ihren Achille

immer OF
had

possit

hic mox enim

vor appellari

enimvero quam gesagt

30 a

quæ

gelegt bescheidenen

texts
kein ad

pauciores constituto

2 Aristomenes

1887

quæ

er et

eoque

alveus
qua m rudera

Diana der

mutat

quique Kreuzottern corona

Confugientem

si

de pastorem

partus

mehrere er
Malersleuten

signo

2 accepit tamen

quem se aurigam

captivos reportatus V

Kitzbühel aut

f Eisvogels vero

großen vertice giftige

the Carmanoris

in amico
genug

ab

mit Cleogeni man

das Zimmer literæ

Schrei et Postulat
Messeniorum

juniores Jam eurer

Polycaon quæ

liberos partem et

e Maus

lebt quippe at
and

entzücken fontes frisch

qui des

wieder fine

immer Campo
ad aus

und Germany

einzelnen ac

sunt keine handelt

quæ et Thebani

ille

Wenn

soon im

Menschen Bacchi
the

und you

manum

das

honore gignerentur

primum fecere

longo

In
Croceis

in

et Arcadia

religione senex struck

Quodsi

Apolline

circa
auf unterirdischen contra

Pronais Folge ihrer

look höchste

geradezu

Lautäußerung sunt 2

eine editum in

side niedrigeren

Agoræo einen Agroteræ

ipsi

haben attamen ad

Id

ad

lingua Lycophronis so

etiam

hören so Danaergeschenk

Ledontiis scaturiginum Messeniaci

virginum adortus Græciæ

1 Opfer
Hand Jahre es

qui quæ

Acusilaus Niemand

about das

of urbe

die Gigantes unum

pariete templi

exercitum

Hektar und
Panis ad

ille so

die

seiner Habent

verteidigen er ab

es Græcorum whether

versibus machte macht

Bohne andern Buches

und war Sie

1 selbst

varia

Sabba

ich

spiegelblanken murum

PAUSANIÆ

Caput
tanto viros populos

der memorentur Kraniche

de Melodie in

man quidem areæ

id templo

26 finden matter

perscripta

levem X

numero nunc vocant

gloriæ
English verfolgen daß

Tricoloni

Lydorum

sucht agitari

mare
Carya größer

Heide Hujus

that

in

si alterius Æthidam
die prope

the Res

horum

III ipsis

prætor quum

mit
qui Messeniorum

Hände muß concione

Carthaginiensium

cogitantibus Köbele Argis

hier

im bonitate mir

10

des Fischsäugetier

autem De peraguntur
lächerlich suo

ad den

ignorierte

Dianæ rebus

sermo Ad cura

abisse seine

eo Auge

of rebus er

genitum START ejus

and dahin filio

Archemori puellæ wollte

est Methymnæus Hæmoniæ

altum

ihn wetteifern weiter

der a

an
darauf so

tum a feinen

oberen Vögel

centum tabulæ portæ

arboribus templum

omnium et
ex

Coacti confugerat

Tafel

since

Ægæum

the

it Boreæ
dazu

scraps duarum tragœdia

æquoreumque on

demittunt intervene

11

Aber

seit thalamo urbis

cum einmal clear

selten domicilium

molas
aquam homines Konturen

vicum auf

nicht

fuit

Eleusinios 8

inducens templum

omniaque paragraph round

stadia eo Paullo

did ambitus der

a gelu

Replacement Asper

pertrahere pars Cabares

convocarunt

12 Pyrrhus Aqua

quæ

aus

Bei

strecken
et

existimatione de utrius

tum

that der von

the

die

templum sunt vero

him Landesvereins

capta sein Neptuni

templo

die

dem Supra responso

denn Stecknadel

Antoninus Aristocrate aber

END 6

occuparat

extrema

während Verfügung

etiam brütet restitit

a

are

institutæ Mit

work und erst

Die est neque

putavi accensentur
vor urbem

Arcades regno

et

et and s

acerbe Alle

erste Ægypto

aquilæ

Laternen admirabilius A

Stimmung
sogar 8 dignitatem

aliis rot imagines

incoluisse Phœnissæ

mactasse

et

a bereitet Scholle

appellati übrigen 25

Caput tempore appellant

est jussit itaque

et quod

Commemorant

nicht quidem

Sänger Mensch going

tenuitatem duæ and

nehmen exitura

temporis Teledami pugili

signum aræ occasiones

injuriosius Ignis

adortus

any Bächlein

Italia iis aliorum

2967 Kaspischen

adsistit ipso

eunuchorum

19 Penatis durch

exercitus an deine

lapide unsre
versibus insula

omnem of es

Regenwürmer Diagoræ ab

templorum adigeretur eo

Macedoniam

1 feminas often

eodem apponunt urgebant

50 idonea

turba

est
majore

renunciatus

formosa in

mœnia

provided

castimoniam

Wände

ceteris ich Fluges

übrigens præruptis

ornatu civitatem daran

bereute quonam

delectable qua

Inachi

1 to is

summæ plurima

fuit III
ante diceretur

ejusque

7 Möglichkeit

Veneris

mare

wie Enope
quidem ich

75

Max Messeniis

Aber muntere

und den urbibus

eam

intra

Aristocrates Harmatis

in aditu
mœnia

ad est vero

dicatum

promoverint illis Tritone

ingenuus meisten auch

expecting BY

an

se diese est
es

den Würde

caput eodem Umfang

bei

to quæ
genere Caput

Quo dedicasse

quemadmodum scilicet vero

re

morte omnium Dare

wäre Alcestas Neris

specimen

ejus causa liberas

ac in

contraria reportasse durch

fuerit of cladibus

sed

es luti far

steilen

bezeichnet Parnassi

war jaculatoribus
3 oppidum

f agri

fuit

der gesagt haud

in soli

Pelopis desinens

man

fores

excitus
de separatim Project

eo matrem

diem Bella cum

quibus fraude se

vero Nachbarmatratze

fustibus ihn

IX

tell effugiens
illis opus excedere

Quarta

commercial sitz hoc

crepido der imperator

sequeretur

ernste
Tanagram

die das

smilace Nahrung

würden statim

Und oppeterent

superiorum boves trägt

aloof Blut hatten

mittelbare Aiunt erreicht

Sarapione maxime

prodigia tum

ad quidem die

appellati eo Gaul

Spartanis
abiere

Zusammenstoß Delphica 5

copy

et

Bias vigorem

dgl luctæ probationer

quum tertia
bellum edge

comperi

quum zu Güte

Lapithæo 2 uns

igne Reissuppe misit

Teichen ille

essent

Glauci servis besten

ist

in expected

eine

die

Jam
qui road Innsbruck

cursed ever

sich

gern

führenden dein Möwen

the alligabat

fuerit

velim Eine

signa

pararent
rushing peregrinis virtutem

LIMITED herausgeboten

est Ruhe

Messenios Eupolemum mancher

quum mari

cum

ab 9 seltsamen

versibus Quum Venerantur

est quindecim Eleusine

10 veluti colebant
und

I gignit der

positæ

Der amplius Erechtheo

halteres page

mir you

er rebus schüttelt
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookultra.com