This review summarizes the epidemiology, clinical course, and diagnosis of malaria. The influence of infection during pregnancy upon maternal and neonatal anemia, stillbirth, preterm labor, low birth weight, and congenital malaria is discussed. Options for treatment and prophylaxis during pregnancy are presented.

Biliary tract disease is a relatively uncommon, heterogenous disease in pregnancy. Specifically, acute cholecystitis can be especially difficult to recognize in pregnancy. However, once diagnosed, the initial management plan should be conservative and include antibiotic therapy. Subsequent management depends on the gestational age at diagnosis. Surgical therapy, when indicated, should not be delayed and a planned intervention during the second trimester appears to offer a better outcome than surgery performed under emergent conditions.

Lyme disease is the most commonly transmitted vector-borne disease in the United States, with many regions of the country at risk. Like other spirochete-borne infections, Lyme disease progresses in stages, making diagnosis in the early stages of the illness and prompt treatment important for cure. An early diagnosis is made difficult by the less-than-ideal serologic tests and the varied clinical presentations of the disease. Although Lyme disease has been reported in pregnancy, the transmission rate to the fetus and potential harmful effects are largely unknown. This review discusses the diagnosis, clinical course, and treatment of Lyme disease with an emphasis on the pregnant patient.

Objective: The purpose of this study was to determine whether selected fetal heart-rate (FHR) patterns and the interval from diagnosis to delivery in pregnancies complicated by chorioamnionitis could predict neonatal outcome.

Methods: During a 6-month period, 217 consecutive patients with acute chorioamnionitis were prospectively identified in labor. Following delivery, the fetal monitor strips and hospital courses were reviewed for both the mother and neonate. Multiple logistic regression was used to analyze the presence of a nonreassuring FHR pattern and the effect on neonatal outcome. Fisher exact tests were used to analyze the time intervals from the diagnosis of chorioamnionitis to delivery and their significance on neonatal outcome parameters.

Results: The overall incidence of chorioamnionitis in our population was 2.3%. None of the independent variables analyzed following the diagnosis of chorioamnionitis until delivery were significantly associated with an umbilical artery (Ua) pH < 7.20. There were no differences in cord pH, Apgar scores, sepsis, admission to special-care nursery, and oxygen requirements in neonates based on the duration of time from the diagnosis of chorioamnionitis to delivery in our study. None of the newborns had pathologic fetal acidemia (Ua pH < 7.00). None of the FHR patterns we identified after the diagnosis of acute chorioamnionitis were significantly associated with neonates with a Ua pH < 7.20.

Conclusions: An interval from diagnosis to delivery of up to 12 h plays little if any role in neonatal outcome.

Objective: This prospective study was undertaken to examine the effects of subclinical intraamniotic infection on fetal behavioral patterns.

Methods: Amniotic fluid was obtained from four groups of patients (n = 99): group 1, patients with preterm premature rupture of the fetal membranes (PPROM) without infection; group 2, patients with PPROM and infection; group 3, patients with preterm labor (PTL) and without infection; and group 4, patients with PTL and infection. Fetal biophysical profiles were obtained on admission to the labor suite. Amniotic fluid was analyzed for the presence of microorganisms and endotoxin to confirm intraamniotic infection; cytokines interleukin (IL)-1β, IL-6, and IL-8 were also assayed.

Results: We found no association between low scores for biophysical parameters and subclinical infection in patients with PPROM or PTL.

Conclusions: We could not demonstrate that upon a patient's admission to the labor hall absent fetal breathing and absent fetal movement, as well as reactivity, correlate with subclinical intraamniotic infection. Elevated cytokines, i.e. IL-1β, IL-6, and IL-8 were associated with subclinical chorioamnionitis.