INTRODUCTION: Zika virus infection is an emerging health threat in pregnant women. It is important that obstetric patients or women considering pregnancy can access up-to-date information about Zika. Our objective was to evaluate the availability of patient-level information about the Zika virus and perinatal risks on state health department websites in the United States and its territories. METHODS: We reviewed each U.S. state, District of Columbia and its territories (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites and abstracted patient information available on the Zika virus, pregnancy risks, prevention measures, mosquito repellants, sexual transmission, endemic areas, and travel guidance. In cases where information did not appear immediately on the main webpage, an internal search of the site using the term “Zika” was performed. RESULTS: 96.4% of the 56 state/territory health department websites contained patient information about Zika virus. Information was more commonly found on state websites than on territories websites (98.0% vs 60.0%). Among the state/territory websites with any Zika information, specific information noted details about the Zika virus (98.1%), pregnancy risks (84.6%), risk of microcephaly (76.9%), sexual transmission (82.7%), mosquito repellant use (71.2%), travel avoidance (84.6%), and Zika endemic areas (90.1%). CONCLUSION: Patient access to Zika virus information is available on most US state and territory health department websites, though less common on territory sites. Because patients need to easily access educational information about Zika virus infection in pregnancy, we should aim to have this information available on all state and territory sites.

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An outbreak of acute gastro-enteritis affecting at least eighteen individuals occurred in Avonmouth during the night of September 11, 1936. All the affected individuals had partaken of cockles sold by an itinerant vendor on the evening of that day, and only one person could be found who had eaten some of the cockles and wh'o had not been ill. After an incubation period varying from three to six hours the illness commenced with headache, nausea, abdominal pain, vomiting, diarrhoea,-and prostration. There was no pyrexia. With the exception of two cases the individuals affected were not seriously ill and had practically recovered within twenty-four or fortyeight hours. There were no deaths. The two patients who were seriously ill recovered in seven to ten days.Considerable difficulty was experienced in tracing the vendor of the cockles, but largely owing to the indefatigable efforts of the chief sanitary inspector, aided by the police and interested patients, he was finally traced. The vendor was in the habit of receiving seven or eight bags of cockles a week from South Wales. On their arrival at his premises his rout.;ae procedure was to steep the cockles overnight in water in a pan to which salt had been added. This removed the larger portion of the sand present. The following morning the cockles were placed in a bucket with a perforated bottom and lowered into water boiling in an ordinary washing copper. This reduced the temperature of the water, but as soon as the water boiled again the bucket was removed, emptied, and refilled, and the process repeated. The heating loosened the cockles in their shells and allowed of their being riddled into either a small or large galvanized iron bath containing water and salt. The empty shells which remained in the sieve were discarded.Close questioning elicited the fact that the'vendor, his wife, and family were in the habit of performing their personal ablutions in the larger of these two baths when it was not actually being used for the preparation of the cockles. In the process it will be seen, therefore, that the cockles were washed in three lots of water and that the only heat to which they were subjected was when they were brought to the boil-a procedure occupying at most about two or three minutes. Further, when the bath used for the personal washing of the vendor and his family was employed to hold the cockles the latter were not subsequently subjected to heat or otherwise cleaned before being sold.The premises in which the cockles were thus prepared consisted'of a small cellar nearly completely underground, ill ventilated, and containing an accumulation of litter and rubbish. Both floor and ceiling were defective and the walls were dirty. The vendor, his wife, and family of six children all appeared healthy and had no symptoms relating to enteritis. He had carried out the business of selling cockles in different parts of Bristol and the surrounding villages for twelve years, and up till now had not been questioned. Inquiries among practitioners of districts other th...

INTRODUCTION: Hepatic infarction is a rare pregnancy complication. We sought to review the literature to characterize risk factors, presentation, and outcomes associated with hepatic infarction in pregnancy. METHODS: We performed a systematic literature review using PUBMED and MEDLINE 1966-2017 with relevant search terms to identify reported cases of hepatic infarction in pregnancy. Maternal demographics, comorbidities, risk factors, presenting signs and symptoms, diagnostic tests, management, and outcomes were abstracted. RESULTS: We identified 45 cases (33 articles) of hepatic infarction in pregnancy. Average maternal age was 29 ± 5 years. Majority of cases occurred in nulliparous women (56%). Mean gestational age at presentation was 28 ± 8 weeks. The most common risk factors were preeclampsia/HELLP syndrome (67%) and antiphospholipid syndrome (53%). The most common presenting symptoms were abdominal pain (89%), elevated blood pressure (77%), nausea/vomiting (50%), and fever (34%). Abdominal pain was typically right upper quadrant (52%) or epigastric (39%). An upper abdominal ultrasound was performed in 50% of cases; however, 91% did not demonstrate hepatic infarction. Diagnosis was typically made with computerized tomography. Therapeutic anticoagulation and corticosteroids were the most common therapy used. Preterm birth occurred in 82% of cases and fetal demise was common (45%). CONCLUSION: Hepatic infarction is a rare complication of pregnancy that is associated with preeclampsia and antiphospholipid antibody syndrome and has a high rate of fetal demise. Additional imaging is required if initial ultrasound is normal and there is a concern for hepatic infarction.

INTRODUCTION: Zika virus is an emerging health threat in pregnant women. It is important that obstetric healthcare providers can access up-to-date information about Zika testing, resources, and cases. Our objective was to evaluate the availability of provider-level information about Zika virus on state and US territory health department websites. METHODS: We reviewed each U.S. state, District of Columbia, and US territory (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites and abstracted provider-level information on Zika testing, testing forms, links to Center for Disease Control (CDC) publications, blood bank/donation guidelines, local cases, and US Zika pregnancy registry information. In cases where information about Zika virus did not appear immediately on the main webpage, an internal search of the site using the term “Zika” was performed. RESULTS: Provider-level information about Zika virus was found on 82.1% of 56 websites reviewed. Of those sites with information, information was more common on state websites (88.2%) than on territory sites (20.0%). Information available included Zika testing information (76.9%), access to in-state testing (73.1%), testing forms (59.6%), links to CDC publications (80.8%), blood bank/donation guidelines (25.0%), local cases (76.9%), and US Zika pregnancy registry information (32.7%). CONCLUSION: Provider-level information about Zika virus is available on most state, but not US territory websites. Testing information, CDC publications, blood bank/donation guidelines, local cases, and US Zika pregnancy registry information are not consistently available. State and territory sites should include such information to assist healthcare providers in optimal care of the obstetric population.