Howard Ronald Cohen

Guidelines for the Management of Herpes Simplex Virus in Pregnancy

OBJECTIVE To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant. OUTCOMES More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant. EVIDENCE Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. VALUES Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.

Principles of human teratology: drug, chemical, and infectious exposure.

OBJECTIVE To provide a teratology update for prescription and non-prescription drugs and infections during pregnancy. OPTIONS Limited to teratology principles and possible common exposures during pregnancy. EVIDENCE A search of Medline and textbooks was conducted for information published to June 2006 on teratology exposure risks. This document represents an abstraction of the information. BENEFITS, HARMS, AND COSTS This consensus provides practitioners with a summary of information regarding teratology risks for drug, chemical, and infection exposures during pregnancy.

HIV Screening in Pregnancy

OBJECTIVE The purpose of this guideline is to provide recommendations to obstetric health care providers and to minimize practice variations for HIV screening, while taking provincial and territorial recommendations into account. OUTCOMES The risk of transmission of HIV from mother to fetus is significant if the mother is not treated. The primary outcome of screening for and treating HIV in pregnancy is a marked decrease in the rate of vertical transmission of HIV from mother to fetus. Secondary outcomes include confirmation of HIV infection in the woman, which allows optimization of her health and long-term management. EVIDENCE The Cochrane Library and Medline were searched for English-language articles published related to HIV screening and pregnancy. Additional articles were identified through the references of these articles. All study types were reviewed.

The role of cordocentesis in assessment of mosaicism found in amniotic fluid cell culture

Chromosomal mosaicism presents one of the most difficult problems in prenatal cytogenetic diagnosis, requiring the differentiation of true mosaicism from pseudomosaicism. To overcome associated problems and to prevent termination of normal pregnancies, we investigated 23 pregnancies in which true mosaicism has been found in amniotic fluid cell culture. A fetal blood sample was obtained by cordocentesis for rapid karyotyping, and meticulous sonographic examinations were carried out for detecting fetal abnormalities. The 23 cases in which mosaicisms were found in amniocytes involved five cases with sex chromosomal abnormalities, twelve with autosomal trisomy, four with autosomal structural defects, one with a supernumerary marker and one with tetraploidy. The karyotype from fetal leukocytes confirmed the diagnosis of mosaicism in only three out of 23 cases. These three included: two autosomal trisomies (47,XY+ 13/47,XY + 21 and 46,XY/47,XY + 21) and one sex chromosome mosaicism (45,X/46,XY). These were all selected for elective termination of pregnancies by the parents’ request. Post abortion karyotype re‐confirmed previous karyotype. The other twenty lymphocyte karyotypes were normal, and of these, 19 patients gave birth at term, and one delivered prematurely due to premature rupture of membranes. All 20 born infants were found normal by both neonatal examination and re‐karyotypes.

Prenatal diagnosis of congenital dysgranulopoietic neutropenia

Summary. Congenital dysgranulopoietic neutropenia is a severe life‐threatening disease characterized by specific dysmorphic granulocytes. Prenatal diagnosis of congenital neutropenia was reported first in 1983. In 1989 we reported a family with congenital dysgranulopoietic neutropenia in two siblings (one male and one female): in 1992 the mother became pregnant and prenatal diagnosis was performed by cordocentesis. The results we obtained from the fetus at risk enabled us to suggest that it was not affected, and we advised the parents that the pregnancy could continue: a healthy female was born. The neutrophil count at 2 and 4 months was normal.