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A case of body stalk anomaly diagnosed prenatally by ultrasound during the 24th week of pregnancy in a cocaine abusing mother is presented. Accurate visualization of the fetal organs was difficult due to the severe oligohydramnios caused by premature rupture of membranes, probably related to the cocaine use. The sonographic findings were an omphalocoele, fetal attachment to the placenta, kyphoscoliosis, and absence of a floating umbilical cord. The prenatal diagnosis of the syndrome and the possible relationship with cocaine abuse are discussed.

Some studies and case reports suggest that mother-to-infant transmission of hepatitis C virus (HCV) is uncommon. However, the real extent of vertical and perinatal transmission of HCV is unknown. We prospectively followed-up 38 infants born to HCV seropositive mothers, and 105 infants born to both anti-HCV and anti-HIV positive mothers. The mean time of follow-up was 29 ± 16 months. Two of 38 (5.2%) infants born to anti-HCV-positive mothers were HCV-infected, while 19 of 105 (18.1%) born to both anti-HCV and anti-HIV-positive mothers were HCV-infected (P < 0.02). Furthermore, 9 of 17 (52.9%) infants who developed AIDS were also infected with HCV, but only 10 of 88 (11.4%) HIV- uninfected infants were HCV-infected (P < 0.00002).

Fundamento Averiguar si es necesario el cribado prenatal de la toxoplasmosis en nuestro hospital desde un punto de vista seroepidemiologico Pacientes y metodo Se ha analizado retrospectivamente la prevalencia de IgG anti-T. gondii en 7.090 mujeres en edad fertil visitadas en el Hospital Clinic de Barcelona desde febrero de 1992 hasta abril de 1999. Se ha comprobado la asociacion entre la seroprevalencia y las variables ano, edad, lugar de nacimiento (provincia de Barcelona/otras provincias) y de residencia (urbano/rural) Resultados Se observo una tendencia decreciente de la prevalencia a lo largo del tiempo (p Conclusiones Es aconsejable realizar el cribado prenatal de la toxoplasmosis por la alta tasa de mujeres seronegativas expuestas a la infeccion y la existencia de un numero elevado de primoinfec-ciones en el periodo fertil de la vida

Objective To assess the prevalence of human immunodeficiency virus (HIV) antibody in infertility. Design Prospective cross-sectional blind study. Setting An infertility clinic in Barcelona. Patients Three hundred thirty-five consecutive patients (308 infertile women and 27 spontaneous recurrent aborters) were seen between January 1989 and May 1990. Main Outcome Measure Human immunodeficiency virus serostatus. Results The rate of seropositivity in the group of patients studied was 0.3% (95% confidence interval 0% to 0.9%). Conclusion Further studies are desirable to establish the value of routine HIV testing in infertility patients as a population of women actively seeking pregnancy.

To the Editors: The observation by the Dutch group 1 and our observation in a Mediterranean population 2 stress the fact that current strategies for the prevention of neural tube defects (NTDs) fail in 2 culturally different European settings. Interestingly, the awareness of the potential benefit of this supplementation was similar in both areas (54% and 50%, respectively). In our study, the questionnaire was personal and conducted in the immediate postpartum period, suggesting that the results in the Dutch study were probably not overestimated. However, the final number of women that actually supplemented their diet with folic acid around conception was 42% in the Netherlands and a disappointing 7% in our population. This discrepancy between awareness and actual intake suggests that other factors than an inappropriate counseling may explain this low intake. Even women aware about the need of folic acid intake may not be compliant. In our setting, preconceptional counseling had an insufficient impact on real intake and often the need of folic acid was not even mentioned or remembered. The fact that a large number of pregnancies were never planned had a further negative impact on the final results. Although many women knew about the potential benefits of folic acid supplementation, the difficulty in pinpointing the relatively short period of action around conception, even before the first medical appointment, seems to partially explain these discouraging results. Furthermore, Botto et al 3 and Busby et al 4 have recently reported that in the last few years, NTD rates observed in different settings have remained virtually unchanged. Therefore, the number of NTDs prevented cases with this policy, although not evaluated in the former 2 studies, 1,2 seems to be unacceptably limited. 3,4 Only very selected populations such as patients with a previous history of NTD or patients under clinical trials with very strict compliance may benefit with this policy. Unfortunately, this seems not to happen in a practical setting, and cultural differences do not seem to be the main reason of the failure. 3,4 The principle of the strategy itself may inappropriate. Indeed, other strategies such as food supplementation do not seem to assure the proper dose to the target population. All these observations reinforce the suspicion that for several identified or nonidentified reasons, the current approach to prevent NTDs in Europe is far from effective.

Class I human leucocyte antigens (HLA-A, -B) and class II (HLA-DR) antigens were determined in 57 couples with primary recurrent abortions of unknown origin and in 57 normal fertile couples. No difference between abortion and control fertile couples was observed regarding HLA sharing. Analysis of 10 series in the literature, including our own results, is against the concept that compatibility in determinants of the major histocompatibility complex has a major role in recurrent spontaneous abortion (RSA).

BACKGROUND Pre-eclampsia and/or fetal death have increased sharply in HIV-infected pregnant women receiving HAART. METHODS The occurrence of pre-eclampsia or fetal death was analysed in women who delivered after at least 22 weeks of gestation for all women (January 2001 until July 2003) and for HIV-infected women (November 1985 until July 2003). RESULTS In 2001, 2002 and 2003, the rates per 1000 deliveries of pre-eclampsia and fetal death, respectively, remained stable in all pregnant women at 25.4, 31.9 and 27.7 (P = 0.48) and 4.8, 5.8, and 5.0 (P = 0.89) (n = 8768). In 1985-2000 (n = 390) to 2001-2003 (n = 82), rates per 1000 deliveries in HIV-infected women rose from 0.0 to 109.8 (P < 0.001) for pre-eclampsia and from 7.7 to 61.0 (P < 0.001) for fetal death. In all pregnant women, factors associated with pre-eclampsia or fetal death were multiple gestation [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI), 2.3-5.6; P < 0.001], HIV infection (adjusted OR, 4.9; 95% CI, 2.4-10.1; P < 0.001), multiparity (adjusted OR, 0.76; 95% CI, 0.58-0.98; P = 0.040) and tobacco smoking (adjusted OR, 0.65; 95% CI, 0.46-0.90; P = 0.010). The use of HAART prior to pregnancy (adjusted OR, 5.6; 95% CI, 1.7-18.1; P = 0.004) and tobacco smoking (adjusted OR, 0.183; 95% CI, 0.054-0.627; P = 0.007) were risk factors in HIV-infected women. CONCLUSIONS HIV infection treated with HAART prior to pregnancy was associated with a significantly higher risk for pre-eclampsia and fetal death.