Prevention Of postpartum complications

Prevention Of postpartum complications_medline1

Prevention and treatment of postpartum endometritis.

French L.

Department of Family Practice, College of Human Medicine, Michigan State University, B101 Clinical Center, East Lansing, MI 48824, USA. Linda.French@ht.msu.edu

Postpartum endometritis is an important cause of maternal morbidity after cesarean section. Prophylactic antibiotic therapy reduces the risk by approximately 60%. The benefit of antibiotic therapy for laboring women has been established. For nonlaboring patients, there is still some uncertainty. Intravaginal metronidazole as surgical preparation and oral methylergometrine after delivery are two interventions that show promise as additional prophylactic interventions. The gold standard therapy, once endometritis has been diagnosed, is intravenous clindamycin and gentamicin. If an alternative regimen is chosen, it should have a similar spectrum, including good coverage for gram-positive anaerobes such as Bacteroides fragilis. Antibiotic therapy can be discontinued once the patient is afebrile without continued oral antibiotics. Treatment failure occurs in approximately 10% of cases and should trigger investigation of other infectious complications. Prolonged fever of undetermined etiology is not uncommon and requires prolonged antibiotic therapy, with or without heparin.

PMID: 12844449 [PubMed - in process]

2: Proc Natl Acad Sci U S A. 2003 Jul 8;100(14):8430-5. Epub 2003 Jun 13.

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Comment in:

Proc Natl Acad Sci U S A. 2003 Jul 22;100(15):8621-3.

Transforming growth factor beta signaling impairs Neu-induced mammary tumorigenesis while promoting pulmonary metastasis.

Siegel PM, Shu W, Cardiff RD, Muller WJ, Massague J.

Cell Biology Program and Howard Hughes Medical Institute, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

The influence of transforming growth factor beta (TGF-beta) signaling on Neu-induced mammary tumorigenesis and metastasis was examined with transgenic mouse models. We generated mice expressing an activated TGF-beta type I receptor or dominant negative TGF-beta type II receptor under control of the mouse mammary tumor virus promoter. When crossed with mice expressing activated forms of the Neu receptor tyrosine kinase that selectively couple to the Grb2 or Shc signaling pathways the activated type I receptor increased the latency of mammary tumor formation but also enhanced the frequency of extravascular lung metastasis. Conversely, expression of the dominant negative type II receptor decreased the latency of Neu-induced mammary tumor formation while significantly reducing the incidence of extravascular lung metastases. These observations argue that TGF-beta can promote the formation of lung metastases while impairing Neu-induced tumor growth and suggest that extravasation of breast cancer cells from pulmonary vessels is a point of action of TGF-beta in the metastatic process.

PMID: 12808151 [PubMed - indexed for MEDLINE]

3: Am J Clin Nutr. 2003 Jul;78(1):145-53.

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Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial.

Makrides M, Crowther CA, Gibson RA, Gibson RS, Skeaff CM.

Child Nutrition Research Centre, Child Health Research Institute, and Department of Paediatrics, University of Adelaide, Women's & Children's Hospital, North Adelaide, SA, Australia. makridesm@mail.wch.sa.gov.au

BACKGROUND: Iron deficiency anemia (IDA) is common in pregnant women, but previous trials aimed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects. OBJECTIVE: The objective was to assess the effect on maternal IDA and iron deficiency (ID, without anemia) of supplementing pregnant women with a low dosage (20 mg/d) of iron. Effects on iron status were assessed at the time of delivery and at 6 mo postpartum. Gastrointestinal side effects were assessed at 24 and 36 wk of gestation. DESIGN: This was a randomized, double-blind, placebo-controlled trial of a 20-mg daily iron supplement (ferrous sulfate) given from 20 wk of gestation until delivery. RESULTS: A total of 430 women were enrolled, and 386 (89.7%) completed the follow-up to 6 mo postpartum. At delivery, fewer women from the iron-supplemented group than from the placebo group had IDA [6/198, or 3%, compared with 20/185, or 11%; relative risk (RR): 0.28; 95% CI: 0.12, 0.68; P < 0.005], and fewer women from the iron-supplemented group had ID (65/186, or 35%, compared with 102/176, or 58%; RR: 0.60; 95% CI: 0.48, 0.76; P < 0.001). There was no significant difference in gastrointestinal side effects between groups. At 6 mo postpartum, fewer women from the iron-supplemented group had ID (31/190, or 16%, compared with 51/177, or 29%; RR: 0.57; 95% CI: 0.38, 0.84; P < 0.005). The rate of IDA between the groups did not differ significantly at 6 mo postpartum. CONCLUSION: Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12816784 [PubMed - indexed for MEDLINE]

: Management of venous thromboembolism during pregnancy.

Ginsberg JS, Bates SM.

Department of Medicine, McMaster University, Hamilton, Ontario, Canada. dinningf@mcmaster.ca

The incidence of venous thromboembolism (VTE) probably increases 2-4-fold in pregnancy and is higher after a caesarean section than after vaginal delivery. Management of VTE in pregnancy is challenging. Many diagnostic tests are less accurate in pregnant than in non-pregnant patients and some radiologic procedures expose the fetus to ionizing radiation, although this can be reduced by taking appropriate precautions. Compression ultrasonography (CUS) is the test of choice for deep vein thrombosis (DVT), whereas for PE, V/Q lung scan is the first-line test, followed by CUS if the results are non-diagnostic. Anticoagulants that have been evaluated for the prevention and treatment of VTE in pregnancy include heparin and heparin compounds, and coumarin derivatives. When determining the optimal treatment regimens, it is important to consider: (i) the safety of the drug for the fetus and mother; (ii) the efficacy of the regimen; and (iii) the dose regimens for acute and secondary treatment, and during delivery and postpartum. Heparins are safer than coumarins for the fetus, as they do not cross the placental barrier. Heparins, particularly unfractionated heparin (UFH) and low molecular weight heparin (LMWH) tend also to be safer for the mother than other compounds. Of the two, LMWHs, although more expensive, are associated with lower rates of bleeding complications, and heparin-induced thrombocytopenia and osteoporosis, than UFH, and should therefore be the treatment of choice in VTE during pregnancy. Patients with prior VTE or a hypercoagulable state have an increased risk of VTE during pregnancy. Depending on the presence of one or both of these factors, clinical surveillance, with anticoagulant treatment where necessary, is recommended.

PMID: 12871278 [PubMed - in process]

5: Best Pract Res Clin Obstet Gynaecol. 2003 Jun;17(3):471-89.

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Inherited thrombophilias and anticoagulation in pregnancy.

Bowles L, Cohen H.

Department of Haematology, University College London Hospitals, WC1E 6DB, London, UK.

Thromboprophylaxis, primary or secondary, should be considered in selected pregnant women with inherited thrombophilias; such women may be divided into high-, medium- and low-risk categories on the basis of the specific thrombophilic defect and any personal or family history of venous thromboembolism (VTE). Women at high risk of VTE should receive treatment doses of low-molecular-weight heparin (LMWH) throughout pregnancy and should remain on anticoagulation for 6 weeks postpartum, or, where appropriate, long-term. Women at moderate risk should be treated with prophylactic fixed-dose LMWH throughout pregnancy and for 6 weeks postpartum. Women at low risk should receive prophylactic fixed-dose LMWH for 6 weeks postpartum, and low-dose aspirin LDA should be considered during pregnancy. LWMH offers important advantages over unfractionated heparin (UFH); heparin-induced thrombocytopaenia (HIT) and osteopaenia are rarely seen. For treatment doses of LMWH, dosage adjustment based on anti-Xa levels is usually required as pregnancy progresses. Warfarin should be avoided throughout pregnancy. LMWH, UFH and warfarin are safe for breast-feeding mothers.

Publication Types:

Review
Review, Tutorial

PMID: 12787539 [PubMed - indexed for MEDLINE]

: Reactions to awareness of activated protein C resistance carriership: a descriptive study of 270 women.

Lindqvist PG, Dahlback B.

Department of Obstetrics and Gynecology, University Hospital MAS, Malmo, Sweden. pelle.lindqvist@obst.mas.lu.se

BACKGROUND: Around 25 million Caucasian women are carriers of the FV Leiden mutation that causes activated protein C (APC) resistance. This is a heritable condition with a lifelong increased risk of venous thromboembolism. We performed this study to investigate women's reactions to their awareness of being APC-resistant and the consequences of this awareness. METHODS: All APC-resistant women (n = 270) included in a prior study on APC resistance and pregnancy (n = 2480) were invited by written questionnaire to describe their reactions to having APC resistance, how this had changed their lives, and how they experienced our information. Answers were obtained from 215 of the 270 women (80%). RESULTS: More than 94% of the APC-resistant women were satisfied with knowing themselves to be APC-resistant and pleased that they had enrolled in the study. Of the women on combined oral contraceptives (COC), 84% changed their method of contraception, but 16% continued on COC. One-third of the women reported becoming more worried or afraid of getting pregnant again as a result of their awareness of being APC-resistant. The proportion of women who sought legal abortions during a 2-year period after receiving this information was similar in both subgroups: 4.4% (12/270) vs. 4.3% (94/2210), p = 0.9. CONCLUSIONS: We conclude that most APC-resistant women were pleased to learn of their APC resistance status, that there was not an increased incidence of legal abortions, but almost one-third reported being more worried or afraid of getting pregnant again.

PMID: 12752078 [PubMed - indexed for MEDLINE]

: Strain predominance following exposure of vaccinated and naive pregnant gilts to multiple strains of porcine reproductive and respiratory syndrome virus.

Lager KM, Mengeling WL, Wesley RD.

Virus and Prion Diseases of Livestock Research Unit, National Animal Disease Center, USDA, Agricultural Research Service, 2300 Dayton Avenue, P.O. Box 70, Ames, Iowa 50010, USA. klager@nadc.ars.usda.gov

Two studies were performed in order to test the relative ability of different strains of porcine reproductive and respiratory syndrome virus (PRRSV) to replicate and cross the placental barrier in pregnant gilts. Study 1 comprised 6 nonvaccinated gilts. Study 2 comprised 8 nonvaccinated gilts and 12 gilts that were vaccinated twice before conception. On, or about, gestation day 90 all gilts were simultaneously exposed to 20 field strains of PRRSV (all strains were distinguishable by restriction fragment length polymorphism (RFLP) patterns). Gilts of study 1 were euthanized on day 7 postpartum. Gilts of study 2 were euthanized on, or about, gestation day 111. All gilts, pigs, and fetuses were tested for the presence and type of strain of PRRSV. Of 128 samples shown to contain PRRSV, 118 contained a single strain, 4 contained 2 strains, and 2 contained a strain or strains for which the RFLP pattern was undecipherable. Only 8 of the 20 strains were isolated from nonvaccinated gilts and their litters. And only 2 of the 20 strains (notably 2 of the same strains isolated from nonvaccinated gilts and their litters), were isolated from vaccinated gilts and their litters. Moreover, 1 of the 2 strains accounted for most (31 of 37; 84%) of the isolates from the vaccinated group. Collectively these results indicate that strains differ in their ability to replicate in pregnant gilts and cross the placental barrier. And they suggest that maternal immunity, although sometimes insufficient to prevent transplacental infection, can exert additional selective pressure.

PMID: 12760477 [PubMed - indexed for MEDLINE]

: Providing assisted reproductive care to male haemophiliacs infected with human immunodeficiency virus: preliminary experience.

Pena JE, Klein J, Thornton MH 2nd, Sauer MV.

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Columbia-Presbyterian Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Outlined is our experience with couples in whom the male was both human immunodeficiency virus (HIV) seropositive and a haemophiliac who underwent assisted reproductive technologies (ART) in order to attain family goals while minimizing the risk of HIV transmission. We report their demographics, attitudes towards assisted reproduction, and ART performance and outcomes. The study included HIV serodiscordant couples (n = 11) who underwent ART at a university-based infertility practice from August 1997 to May 2002. Prior to treatment, couples prospectively completed a survey regarding their demographics and attitudes towards assisted reproduction. All couples underwent ART and pregnancy outcomes were analysed. The majority of the patients were fully employed, college-educated, in good health, married and motivated to have a child while minimizing the risk of HIV transmission. Eleven couples underwent 25 cycles of ART [19 in vitro fertilization (IVF) cycles; five frozen embryo transfer cycles; and one oocyte donation cycle] resulting in nine successful pregnancies. The ongoing/delivered pregnancy rate per initiated IVF cycle was 42.1% per embryo transfer. Eight of 11 (72.7%) couples achieved a successful pregnancy. More than half (six of 11; 54.5%) the couples conceived during their initial attempt. Four of nine (44.4%) pregnancies were multiple gestations, including three sets of triplets. All female recipients tested seronegative for HIV at 3 and 6 months post-embryo transfer. All delivered babies (n = 8) tested seronegative for HIV at birth and 3 months postpartum. Four pregnancies are currently ongoing. ART should be considered for HIV serodiscordant couples with haemophilia who desire to have children in order to minimize the risk of viral infection.

PMID: 12694523 [PubMed - indexed for MEDLINE]

: Infant feeding practices of HIV-positive mothers in India.

Suryavanshi N, Jonnalagadda S, Erande AS, Sastry J, Pisal H, Bharucha KE, Shrotri A, Bulakh PM, Phadke MA, Bollinger RC, Shankar AV.

Johns Hopkins University, Pune, India.

Exclusive breast-feeding is widely accepted and advocated in India; however, clinicians are now faced with advising women infected with human immunodeficiency virus (HIV) about the risks and benefits of other infant feeding options. This study assessed factors that influence the infant feeding decisions of HIV-infected mothers in Pune, India. From December 2000 to April 2002, HIV-positive (HIV(+)) pregnant women (n = 101) from a government hospital antenatal clinic were interviewed prepartum about infant feeding intention, feeding practice immediately postpartum and feeding after a minimum of 2 wk postpartum. Of the HIV(+) sample, the last 39 were interviewed more intensively to examine factors affecting feeding decision making. We found that an equal number of HIV(+) women intended to breast-feed (44%) or give top milk (44%) (diluted animal milk). Women who chose to top feed were also more likely to disclose their HIV status to family members. Mixed feeding occurred frequently in our sample (29%); however, for the majority of those (74%), it lasted only 3 d postpartum. The hospital counselor had an important role in assisting women in their intended feeding choice as well as actual practice. The time immediately after delivery was noted as critical for recounseling about infant feeding and further support of the woman's decision, thus lowering the risk of mixed feeding. Lack of funds, poor hygienic conditions and risk of social repercussions were more commonly noted as reasons to breast-feed. Top milk, the alternative for breast-milk used in this population, however, must be investigated further to assess its nutritional value and safety before it can be endorsed widely for infants of HIV(+) women.

PMID: 12730418 [PubMed - indexed for MEDLINE]

10: J Obstet Gynaecol Can. 2003 May;25(5):385-9.

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Comment in:

J Obstet Gynaecol Can. 2003 May;25(5):350-6.

Eclampsia in Southern Alberta: is there a role for seizure prophylaxis in all women with gestational hypertension?

Foong SC, Pollard JK.

Department of Obstetrics and Gynaecology, University of Calgary-Foothills Hospital, Calgary, AB, Canada.

OBJECTIVE: To evaluate the predictability of eclampsia and explore the role for seizure prophylaxis in a population with a low frequency of seizure prophylaxis. METHODS: A retrospective review was conducted of all women with eclampsia registered at the Foothills Hospital in Calgary, Alberta, between 1991 and 2000. The data collected included timing of seizure in relation to diagnosis of gestational hypertension (GHTN) and delivery, method of seizure prophylaxis (if any), and maternal characteristics. RESULTS: During the study period, 3075 of 38,577 women (8.0%) were diagnosed with GHTN, with or without proteinuria or adverse conditions. Three percent had received magnesium sulfate for seizure prophylaxis. Of these 3075 women, 17 (0.6%) developed eclampsia, none of whom was receiving magnesium sulfate for seizure prophylaxis at the time. Of these, 10 women (59%) exhibited GHTN prior to their first seizure, including 6 women with GHTN with adverse conditions, 3 with GHTN with proteinuria but without adverse conditions, and 1 with GHTN without proteinuria or adverse conditions. Five of the 17 women had seizures that occurred prior to labour, 6 were intrapartum, and 6 were postpartum. Nine (53%) of the 17 women with eclampsia had their initial seizure after the diagnosis of GHTN and before 24 hours postpartum. CONCLUSION: Seizure prophylaxis for all the women with GHTN, from the time of diagnosis through 24 hours postpartum, may have been able to prevent as many as 53% of eclamptic episodes. Three hundred and seven women with GTHN would have to receive seizure prophylaxis to prevent one seizure.

PMID: 12738979 [PubMed - indexed for MEDLINE]

: Global infertility and the globalization of new reproductive technologies: illustrations from Egypt.

Inhorn MC.

Department of Health Behavior and Health Education, Center for Middle Eastern and North African Studies, University of Michigan, HBHE, SPH II, Rm, M5140, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA. minhorn@umich.edu

Infertility is a problem of global proportions, affecting on average 8-12 percent of couples worldwide. In some societies, however-particularly those in the "infertility belt" of sub-Saharan Africa-as many as one-third of all couples are unable to conceive. Factors causing high rates of tubal infertility in parts of the developing world include sexually transmitted, postpartum, and postabortion infections; however, male infertility, which is rarely acknowledged, contributes to more than half of all cases. Unfortunately, the new reproductive technologies (NRTs) such as in vitro fertilization (IVF), which are prohibitively expensive and difficult to implement in many parts of the developing world, represent the only solution to most cases of tubal and male infertility. Not surprisingly, these technologies are rapidly globalizing to pronatalist developing societies, where children are highly desired, parenthood is culturally mandatory, and childlessness socially unacceptable. Using Egypt as an illustrative case study, this paper examines five of the major forces fueling the global demand for NRTs; these include demographic and epidemiological factors, the fertility-infertility dialectic, problems in health care seeking, gendered suffering, and adoption restrictions. Following this overview, a detailed examination of the implications of the rapid global spread of NRTs to the developing world will be offered. By focusing on Egypt, where nearly 40 IVF centers are in operation, this article will demonstrate the considerable constraints on the practice and utilization of NRTs in a developing country on the "receiving end" of global reproductive technology transfer. The article concludes by stressing the need for primary prevention of infections leading to infertility, thereby reducing global reliance on NRTs.

PMID: 12650724 [PubMed - indexed for MEDLINE]

12: Clin Infect Dis. 2003 Apr 15;36(8):1053-62. Epub 2003 Apr 02.

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Effect of providing vitamin supplements to human immunodeficiency virus-infected, lactating mothers on the child's morbidity and CD4+ cell counts.

Fawzi WW, Msamanga GI, Wei R, Spiegelman D, Antelman G, Villamor E, Manji K, Hunter D.

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. mina@hsph.harvard.edu

A total of 1078 human immunodeficiency virus (HIV) type 1-infected women from Tanzania were randomized in a placebo-controlled trial using a factorial design to examine the effects of supplementation with vitamin A (preformed vitamin A and beta carotene) and/or multivitamins (vitamins B, C, and E). Supplements were given during pregnancy and lactation. Children of women in the multivitamin arms had a significantly lower risk of diarrhea than did those in the no-multivitamin arm (P=.03). The mean CD4+ cell count was 151 cells/microL higher among children in the multivitamin arms than among those in the no-multivitamin arm (P=.0006). HIV-positive children experienced a benefit apparently similar to that in HIV-negative children (P=.34, by test for interaction). Maternal receipt of vitamin A significantly reduced the risk that the child would have cough with a rapid respiratory rate, a proxy for pneumonia (P=.03), but receipt of vitamin A had no effect on diarrhea or CD4+ cell count. Provision of multivitamin supplements (including those with vitamins B, C, and E) to HIV-infected, lactating women may be a low-cost intervention to improve their children's health.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12684919 [PubMed - indexed for MEDLINE]

13: AIDS. 2003 Apr 11;17(6):867-77.

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Maternal health factors and early pediatric antiretroviral therapy influence the rate of perinatal HIV-1 disease progression in children.

Abrams EJ, Wiener J, Carter R, Kuhn L, Palumbo P, Nesheim S, Lee F, Vink P, Bulterys M; Perinatal AIDS Collaborative Transmission Study (PACTS) Group.

Harlem Hospital Center and Columbia University, College of Physicians & Surgeons, New York, New York 10037, USA.

OBJECTIVE: To determine the relationship of maternal health factors and infant antiretroviral treatment to the risk of pediatric disease progression to AIDS or death by 24 months of age. DESIGN: Prospective perinatal HIV-1 transmission and pediatric natural history study. SETTING: Urban medical centers in four cities in the USA. PARTICIPANTS: A total of 2656 pregnant and postpartum HIV-infected women enrolled in the Perinatal AIDS Collaborative Transmission Study (PACTS) and 360 children determined to be HIV-infected. MAIN OUTCOME MEASURES: Pediatric AIDS or death by 24 months of age. RESULTS: Children born to mothers with class C disease, CD4 cell count < 200 x 106/l, or HIV-1 RNA viral load > 100 000 copies/ml progressed more rapidly than children born to mothers with less advanced disease. In a multivariate analysis, there was an increased risk of progression if mothers had Class C disease [relative risk (RR), 1.7; 95% confidence interval (CI), 1.0-2.7] or HIV-1 RNA > 100 000 copies/ml (RR, 2.4; 95% CI, 1.2-4.6) controlling for child antiretroviral therapy and year of birth. Earlier years of birth significantly increased the likelihood of rapid progression (P = 0.01) in this multivariate model. Children who received combination antiretroviral therapies with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor were significantly less likely to progress compared with those receiving no therapy (P = 0.03). CONCLUSIONS: HIV-1-infected infants born to women with advanced HIV-1 disease were at increased risk for rapid disease progression. More recent birth year and early treatment with potent antiretroviral therapy significantly diminished the likelihood of developing AIDS or dying during early childhood.

Publication Types:

Multicenter Study

PMID: 12660534 [PubMed - indexed for MEDLINE]

: Anorexia nervosa during pregnancy.

Goldman RD, Koren G.

Motherisk Program, Hospital for Sick Children, Toronto, Ont.

QUESTION: A 22-year-old patient in my clinic was diagnosed with anorexia nervosa (AN) 7 years ago. She is now married and planning her first pregnancy. She is still underweight. What should she expect during pregnancy, and are there any implications for her unborn baby? ANSWER: Women with AN are at higher risk of complications during pregnancy, mainly because of low body weight. Apgar scores and birth weights of infants born to mothers with AN have been found to be significantly lower than those of infants born to healthy women. Rates of cesarean delivery, postnatal complications, and postpartum depression are higher among mothers with AN. Complications include hypothermia, hypoglycemia, infections, and increased rates of perinatal death. It is important to ensure appropriate intake of not only calories and proteins but also micronutrients, such as folic acid, to prevent neural tube defects.

PMID: 12729237 [PubMed - indexed for MEDLINE]

: Glanzmann's thrombasthenia proposed optimal management during surgery and delivery.

Bell JA, Savidge GF.

Centre for Haemostasis and Thrombosis, The Haemophilia Reference Centre, St. Thomas' Hospital, London, UK.

Glanzmann's thrombasthenia (GT) is an autosomal recessive disorder of platelet function. Conventional management is by platelet transfusion, given before invasive interventions. Alloimmunization resulting in platelet refractoriness and an unpredictable response to platelet infusion have provided particular management difficulties in the past. More recently recombinant (r)VIIa (Novoseven) has a valuable role in the treatment of platelet function disorders. Treatment of a patient with GT during two pregnancies and spinal surgery is reported. An algorithm is presented to provide a structured and consistent approach to treatment.

PMID: 12812388 [PubMed - indexed for MEDLINE]

: Vaccination and perinatal infection prevention practices among obstetrician-gynecologists.

Schrag SJ, Fiore AE, Gonik B, Malik T, Reef S, Singleton JA, Schuchat A, Schulkin J.

National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, 30333, USA. zha6@cdc.gov

OBJECTIVE: To assist efforts to improve adult vaccination coverage by characterizing vaccination and infectious disease screening practices of obstetrician-gynecologists. METHODS: A written survey of demographics, attitudes, and practices was mailed to 1063 American College of Obstetricians and Gynecologists Fellows, including the Collaborative Ambulatory Research Network (n = 413) and 650 randomly sampled Fellows. RESULTS: Seventy-four percent of Collaborative Ambulatory Research Network members and 44% of nonmembers responded. A majority (Collaborative Ambulatory Research Network members: 60%; nonmembers: 49%) considered themselves primary care providers. Fewer than 60% routinely obtained patient vaccination or infection histories. Most screened prenatal patients for hepatitis B surface antigen (89%) and rubella immunoglobulin G antibody (85%). Sixty-four percent worked in practices that offered at least one vaccine; the most common were rubella (52%) and influenza (50%). Ten percent worked in practices that offered all major vaccines recommended for pregnant or postpartum women. Despite recommendations to provide influenza vaccine to pregnant women during influenza season, only 44% did so; among those who did not, 14% reported a belief that pregnant women do not need influenza vaccine. Provision of vaccine was associated with working in a multispecialty practice (adjusted odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6, 4.1) and identifying as a primary care provider (adjusted OR 1.9; 95% CI 1.3, 2.7). The most common reasons for not offering vaccines were cost (44%) and a belief that vaccines should be provided elsewhere (41%). CONCLUSION: The high proportion of obstetrician-gynecologists who do not offer vaccines or screen for vaccine and infection histories suggests missed opportunities for prevention of maternal and neonatal infections.

PMID: 12681874 [PubMed - indexed for MEDLINE]

17: Anesthesiol Clin North America. 2003 Mar;21(1):127-44, vii.

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Planning for hemorrhage. Steps an anesthesiologist can take to limit and treat hemorrhage in the obstetric patient.

Esler MD, Douglas MJ.

Department of Anesthesia, Division of Obstetric Anesthesia, University of British Columbia, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada. mesler@cw.bc.ca

Obstetric hemorrhage continues to be a significant cause of maternal mortality and morbidity. Blood transfusion in such circumstances may be life saving but involves exposing the patient to additional risks. Limiting blood transfusion and using autologous blood when possible may reduce some of these risks. This article outlines the techniques that may be used to limit and more effectively treat hemorrhage in the obstetric patient, with particular attention paid to reducing the use of allogeneic blood transfusion.

Publication Types:

Review
Review, Academic

PMID: 12698837 [PubMed - indexed for MEDLINE]

18: Anesthesiol Clin North America. 2003 Mar;21(1):111-25.

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Obstetric emergencies.

Crochetiere C.

Department of Anesthesiology, Sainte-Justine Hospital, University of Montreal, 3175 Cote-Ste-Catherine, Montreal, Quebec, Canada H3T 1C5. anesth-sj@citenet.net

Obstetric hemorrhage is still a significant cause of maternal morbidity and mortality. Prevention, early recognition, and prompt intervention are the keys to minimizing complications. Resuscitation can be inadequate because of under-estimation of blood loss and misleading maternal response. A young woman may maintain a normal blood pressure until sudden and catastrophic decompensation occurs. All members of the obstetric team should know how to manage hemorrhage because timing is of the essence. Good communication with the blood bank ensures timely release of appropriate blood products. A well-coordinated team is one of the most important elements in the care of a compromised fetus. If fetal anoxia is presumed, there is less than 10 minutes to permanent fetal brain damage. Antepartum anesthesia consultation should be encouraged in parturients with medical problems.

Publication Types:

Review
Review, Academic

PMID: 12698836 [PubMed - indexed for MEDLINE]

19: Epidemiology. 2003 Mar;14(2):247-50.

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Comment in:

Epidemiology. 2003 Mar;14(2):139-40.

Why is parity protective for uterine fibroids?

Baird DD, Dunson DB.

Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA. baird@niehs.nih.gov

Uterine fibroids are benign tumors, the etiology of which is not understood. Symptoms can be debilitating, and the primary treatment is surgery, usually hysterectomy. Epidemiologic data show that pregnancy is associated with reduced risk of fibroids. We hypothesize that this association is attributable to a protective effect of postpartum involution of the uterus. After each pregnancy the uterus rapidly returns to prepregnancy size by dramatic remodeling of the tissue. We hypothesize that small fibroids are eliminated during this process. We present preliminary epidemiologic evidence that is consistent with this hypothesis. If the hypothesis is supported by more direct evidence, it may have broader implications, supporting the idea that tissue remodeling may be a general mechanism for limiting tumor development.

PMID: 12606893 [PubMed - indexed for MEDLINE]

20: J Infect Dis. 2003 Mar 1;187(5):725-35. Epub 2003 Feb 24.

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Comment in:

J Infect Dis. 2003 Mar 1;187(5):721-4.

A multicenter randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1.

Moodley D, Moodley J, Coovadia H, Gray G, McIntyre J, Hofmyer J, Nikodem C, Hall D, Gigliotti M, Robinson P, Boshoff L, Sullivan JL; South African Intrapartum Nevirapine Trial (SAINT) Investigators.

Department of Obstetrics and Gynaecology, Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of Natal, KwaZulu Natal, Congella 4013, South Africa. moodleyj@nu.ac.za

To determine the efficacy and safety of 2 inexpensive and easily deliverable antiretroviral (ARV) regimens for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 during labor and delivery, HIV-infected pregnant women were screened at 11 maternity health institutions in South Africa and were enrolled in an open-label short course ARV regimen of either nevirapine (Nvp) or multiple-dose zidovudine and lamivudine (Zdv/3TC). The overall estimated HIV-1 infection rates in 1307 infants by 8 weeks were 12.3% (95% confidence interval [CI], 9.7-15.0) for Nvp and 9.3% (95% CI, 7.0-11.6) for Zdv/3TC (P=.11). Excluding infections detected within 72 h (intrauterine), new HIV-1 infections were detected in 5.7% (95% CI, 3.7-7.8) and 3.6% (95% CI, 2.0-5.3) of infants in the Nvp and Zdv/3TC groups, respectively, in the 8 weeks after birth. There were no drug-related maternal or pediatric serious adverse events. Common complications were obstetrical for mothers (Nvp group, 24.3%; Zdv/3TC group, 26.3%) and respiratory for infants (Nvp group, 16.1%; Zdv/3TC group, 17.0%). This study further confirms the efficacy and safety of short-course ARV regimens in reducing MTCT rates in developing countries.

Publication Types:

Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 12599045 [PubMed - indexed for MEDLINE]

: Postnatal morbidity after childbirth and severe obstetric morbidity.

Waterstone M, Wolfe C, Hooper R, Bewley S.

Department of Public Health Medicine, GKT School of Medicine and Dentistry, London, UK.

OBJECTIVE: To identify the impact of pregnancy and childbirth, and severe obstetric morbidity on outcome 6 to 12 months postpartum. DESIGN: Questionnaire assessment of postnatal outcome in a cohort study. SETTING: South East Thames, UK. POPULATION: All women resident in South East Thames and delivering between 1st March 1997 and 28th February 1998. METHODS: Questionnaire study of a cohort of women who experienced a severe obstetric morbidity during pregnancy or labour (cases), compared with a cohort of women who did not (controls). MAIN OUTCOME MEASURES: Assessment of postnatal depression risk [Edinburgh Postnatal Depression Scale (EPDS)], general health [Short Form 36 (SF-36)], sexual activity and use of health services between 6 and 12 months postpartum. RESULTS: There were 331 cases and 1339 controls out of 48,262 deliveries. Six to 12 months after delivery, 77 (23.3%) of cases and 272 (20.5%) of the controls were at risk of postnatal depression (P = 0.25; 95% CI for difference -2.2% to 7.9%), 43.1% of cases were having problems with sexual relations compared with 18.7% of controls (P < 0.001; 95% CI for difference 8.9% to 21.9%). There was evidence of poorer general health in cases. Some 31.5% of cases attended outpatients in the first six months and 9.4% required emergency admission to hospital compared with 17.0% (P < 0.001; 95% CI for difference 9.1% to 19.9%) and 3.7% (P < 0.001; 95% CI for difference 2.4% to 9.0%), respectively, in controls. CONCLUSION: Both control pregnancy and childbirth and severe obstetric morbidity are associated with significant postnatal morbidity. A severe obstetric morbid event significantly influences women's sexual health and wellbeing and increases health services utilisation. Prevention and appropriate management of severe obstetric morbid events may reduce these outcomes.

PMID: 12618155 [PubMed - indexed for MEDLINE]

22: J Acquir Immune Defic Syndr. 2003 Feb 1;32(2):170-81.

Related Articles, Links

Effect of cessation of zidovudine prophylaxis to reduce vertical transmission on maternal HIV disease progression and survival.

Bardeguez AD, Shapiro DE, Mofenson LM, Coombs R, Frenkel LM, Fowler MG, Huang S, Sperling RS, Cunningham B, Gandia J, Maupin R, Zorrilla CD, Jones T, O'Sullivan MJ; Pediatrics AIDS Clinical Trials Group 288 Protocol Team.

University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103, USA. bardegad@umdnj.edu

Zidovudine prophylaxis is recommended to reduce perinatal HIV-1 transmission, but there are limited data on long-term effects on women's health. Pediatrics AIDS Clinical Trials Group (PACTG) 288 was a prospective observational study among US women randomized to zidovudine or placebo in PACTG 076 that was designed to evaluate and compare postpartum clinical, immune, and viral parameters between randomized treatment arms. Forty-eight percent (226/474) of eligible women enrolled in the study (mean follow-up of 4.1 years). Progression and time to AIDS or death were similar in both groups, observed in 21 (19%) zidovudine group women and 29 (25%) placebo group women (RR = 0.73, 90% CI: 0.46-1.17). No significant differences in CD4 lymphocyte count or HIV RNA levels were detected. Genotypic zidovudine resistance was detected in 10% of 156 women (9% of zidovudine group women and 11% of placebo group women). Based on our data, ZDV monotherapy could be considered as chemoprophylaxis to reduce perinatal HIV transmission for minimally symptomatic HIV-infected pregnant women with a low viral load and normal CD4 cell count who do not want to receive highly active antiretroviral therapy because of concern about potential side effects or who wish to reduce fetal exposure to multiple drugs during pregnancy.

Publication Types:

Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 12571527 [PubMed - indexed for MEDLINE]

23: Minerva Ginecol. 2003 Feb;55(1):1-13.

Related Articles, Links

Chronic hypertension in pregnancy.

Livingston JC, Maxwell BD, Sibai BM.

Prenatal Diagnostic Center, Carilion Health System, Roanoke, VA 24013, USA. jclivingston@carilion.com

Hypertension is the most common medical disorder during pregnancy. Chronic hypertension is a serious medical complication in pregnancy with increased maternal and perinatal morbidity and mortality. Those who develop uncontrolled severe hypertension, those with target organ damage, and those who are poorly compliant with prenatal visits are at high risk for poor perinatal outcome. Maternal complications include abruptio placenta, stroke, and superimposed pre-eclampsia. Fetal complications include prematurity, low birth weight, and perinatal death. Careful antepartum, intrapartum and postpartum management of women with high-risk chronic hypertension in pregnancies may reduce morbidity and mortality.

Publication Types:

Review
Review, Academic

PMID: 12598838 [PubMed - indexed for MEDLINE]

: Does cesarean delivery prevent anal incontinence?

Lal M, H Mann C, Callender R, Radley S.

Department of Obstetrics and Gynecology, Wordsley Hospital, Dudley Group of Hospitals, National Health Service Trust, Stourbridge, West Midlands, United Kingdom. mira@miralal.freeserve.co.uk

OBJECTIVE: To compare the incidence and severity of anal incontinence in primiparas after cesarean delivery versus spontaneous vaginal delivery. METHODS: A total of 184 primiparas who delivered by cesarean (104 emergency, 80 elective) and 100 who delivered vaginally were interviewed 10 +/- 2 months postpartum. A comprehensive bowel function questionnaire was completed. Bowel-specific questions included bowel habits, laxative use, urgency, flatus, urge and passive incontinence, soiling, and pad use, before and during pregnancy and postpartum. Obstetric details were confirmed from obstetric records. RESULTS: Anal incontinence was first present in nine (5%) mothers after cesarean delivery and eight (8%) after vaginal delivery (relative risk 0.611, 95% confidence interval 0.25, 1.53). Severe symptoms necessitating pad use affected two (3%) mothers after elective cesarean and one (1%) after vaginal delivery. Two (3%) mothers after elective cesarean, one (1%) after emergency cesarean, and two (2%) after vaginal delivery had at least two symptoms. Anal incontinence followed prelabor emergency cesarean in two mothers. Of the 22 mothers who sustained a second-degree tear, five (23%) had new anal incontinence compared with only one (3%) of 40 mothers with an intact perineum (Fisher exact test value = 9.697, P =.014). CONCLUSION: Because severe anal incontinence followed elective and prelabor emergency cesarean, it seems that pregnancy itself can lead to pelvic floor disorders. A high incidence of anal incontinence is associated with a second-degree tear. Measures to detect and reduce postpartum anal incontinence should target all pregnant women and mothers, even after prelabor cesarean delivery.

PMID: 12576254 [PubMed - indexed for MEDLINE]

: Pregnancy-related substance use in the United States during 1996-1998.

Ebrahim SH, Gfroerer J.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. sebrahim@cdc.gov

OBJECTIVE: To provide a baseline estimate of the national prevalence of pregnancy-related illicit drug use and abstinence rates. METHODS: We analyzed data collected between 1996 and 1998 from the National Household Survey on Drug Abuse, a nationally representative sample survey of 22,303 noninstitutionalized women aged 18-44 years, of whom 1,249 were pregnant. RESULTS: During 1996-1998, 6.4% of nonpregnant women of childbearing age and 2.8% of pregnant women reported that they used illicit drugs. Of the women who used drugs, the relative proportion of women who abstained from illicit drugs after recognition of pregnancy increased from 28% during the first trimester of pregnancy to 93% by the third trimester. However, because of postpregnancy relapse, the net pregnancy-related reduction in illicit drug use at postpartum was only 24%. Marijuana accounted for three-fourths of illicit drug use, and cocaine accounted for one-tenth of illicit drug use. Of those who used illicit drugs, over half of pregnant and two-thirds of nonpregnant women also used cigarettes and alcohol. Among the sociodemographic subgroups, pregnant and nonpregnant women who were young (18-30 years) or unmarried, and pregnant women with less than high school education had the highest rates of illicit drug use. CONCLUSION: The continued burden of illicit drug use during pregnancy calls for policy efforts to enable primary care providers to identify and refer women who use substances to treatment and support services. Prevention of uptake of illicit drug use should be an integral part of public health programs for young women.

PMID: 12576263 [PubMed - indexed for MEDLINE]

: [Intensive care management of 28 patients with severe eclampsia in a tropical African setting]

[Article in French]

Beye MD, Diouf E, Kane O, Ndoye MD, Seydi A, Ndiaye PI, Sall BK.

Service d'anesthesie et de reanimation, hopital Aristide Le Dantec, BP 15708 Dakar Fann, Senegal.

OBJECTIVE: To study the specific management problems of severe eclampsia under tropical latitudes. STUDY DESIGN: A two years retrospective study in a University hospital in the tropics. PATIENTS AND METHODS: In all patients admitted for eclampsia between January 1997 et December 1999, the following parameters were studied: age, parity, interval between disease et admission, post-eclampsia Glasgow Coma Scale (GCS), time of occurrence of eclampsia during pregnancy, delivery route, blood pressure data at admission, the occurrence of complications at admission or during hospital stay. RESULTS: Twenty-eight mainly primiparous patients (mean age: 26 +/- 6) were admitted with an average delay of 8.5 +/- 10.2 hours after the first symptoms. The time of occurrence was prepartum in 6, perpartum in 14 and postpartum in 8 cases. All patients were hypertensive and comatose with an average GCS of 8 +/- 2.2. Twenty patients had been previously intubated and ventilated. Delivery was natural in 22 and by caesarean section in 6 patients. The following complications were found: acute oliguric renal failure (9), HELLP-syndrome (4), cerebral haemorrhage (4), acute lung oedema (3) and acute respiratory distress syndrome (1). Maternal and child mortality were 35 and 42.8% respectively. CONCLUSION: Eclampsia is a major cause of both maternal and infantile mortality in developing countries. The authors insist that prevention and management require speedy transfers to adapted specialized obstetrical intensive care structures.

PMID: 12738016 [PubMed - indexed for MEDLINE]

27: Curr Neurol Neurosci Rep. 2003 Jan;3(1):27-31.

Related Articles, Links

Pregnancy and stroke.

Pathan M, Kittner SJ.

Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.

This review details the evidence that the risk of stroke is increased in the peripartum and postpartum period rather than the entire 9 months of pregnancy. In women with prior stroke, available evidence suggests that the excess risk of a stroke recurrence in pregnancy is approximately 1% to 2%. Although certain conditions have a particularly strong association with stroke in pregnancy, such as eclampsia, or with the postpartum period, such as cerebral venous thrombosis, the clinical and therapeutic approach to women with stroke during pregnancy should be similar to the approach to stroke in young adults. Strategies for stroke prevention should take into account the competing risks to mother and fetus.

Publication Types:

Review
Review, Tutorial

PMID: 12507407 [PubMed - indexed for MEDLINE]

28: J Midwifery Womens Health. 2003 Jan-Feb;48(1):67-8.

Related Articles, Links

An unexpected adverse drug effect.

Krulewitch CJ.

Adverse drug-drug interactions can occur between active and/or inactive ingredients in different formulations. The occurrence of a disulfiram reaction that developed postpartum following a 7-day course of metronidazole is presented. The case is presented, followed by a discussion of the mechanism of action and treatment. Recommendations for prevention of adverse drug effects are reviewed.

Publication Types:

Clinical Conference

PMID: 12589307 [PubMed - indexed for MEDLINE]

29: Obstet Gynecol. 2003 Jan;101(1):80-5.

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The effect of intraabdominal irrigation at cesarean delivery on maternal morbidity: a randomized trial.

Harrigill KM, Miller HS, Haynes DE.

Department of Obstetrics and Gynecology, University of Arizona Health Sciences Center, Tucson, Arizona 85712, USA. harrigill@dakotacom.net

To determine if intraabdominal irrigation with normal saline at cesarean delivery is associated with increased maternal morbidity.One hundred ninety-six women undergoing routine cesarean delivery at at least 37 weeks' gestation were prospectively randomized to receive 500-1000 mL of normal saline intraabdominal irrigation versus no irrigation after closure of the uterine incision, but before abdominal wall closure. Data were collected for comparison of demographic factors, intrapartum and postpartum complication rates, and maternal and neonatal outcomes. The primary outcome measure was the combined incidence of maternal morbidity, defined as at least one of the following: postoperative infectious morbidity, postpartum hemorrhage, severe anemia, and urinary retention.Ninety-seven patients were randomized to the irrigation group and 99 to the control group. The demographic characteristics of the two groups were similar. Thirteen patients (13.1%) in the control group and 14 patients (14.4%) in the irrigation group experienced maternal morbidity (P =.84). There were no statistically significant differences between the groups in estimated blood loss, operating time, incidence of intrapartum complications, hospital stay, return of gastrointestinal function, incidence of infectious complications, or neonatal outcomes.Routine intraabdominal irrigation at cesarean delivery in a low-risk population does not reduce intrapartum or postpartum maternal morbidity.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12517650 [PubMed - indexed for MEDLINE]

: First Breath prenatal smoking cessation pilot study: preliminary findings.

Jehn L, Lokker N, Matitz D, Christiansen B.

Wisconsin Women's Health Foundation, 2503 Todd Dr, Madison, Wis. 53713, USA.

Despite the many dangers associated with smoking during pregnancy, it remains a salient public health problem for Wisconsin women. The First Breath pilot program was developed in an attempt to reduce rates of smoking during pregnancy among low-income women. Preliminary results suggest that the First Breath counseling-based approach is effective, with a quit rate of 43.8% among First Breath enrollees at 1 month postpartum. Women receiving First Breath cessation counseling also had higher quit rates at every measurement period versus women in a comparison group who were receiving whatever cessation care was available in their county in the absence of First Breath. The First Breath pilot study has demonstrated success in helping pregnant women quit smoking and in creating a model for integration of cessation services into prenatal health care service provision. It is through this success that First Breath is expanding beyond the pilot study stage to a statewide program in 2003.

PMID: 12822287 [PubMed - indexed for MEDLINE]

31: Z Geburtshilfe Neonatol. 2003 Jan-Feb;207(1):1-5.

Related Articles, Links

[Are fatal hemorrhagic complications during and after birth preventable?]

[Article in German]

Rath W.

Frauenklinik fur Gynakologie und Geburtshilfe, Universitatsklinikum Aachen.

Publication Types:

Editorial

PMID: 12649779 [PubMed - indexed for MEDLINE]

: [Isolated ovarian abscess in the puerperium]

[Article in Hungarian]

Csorba R, Torok P, Darago P, Aranyosi J, Bodnar B, Borsos A.

Debreceni Egyetem, Orvos es Egeszsegtudomanyi Centrum, Altalanos Orvostudomanyi Kar, Szuleszeti es Nogyogyaszati Klinika.

Isolated ovarian abscess is the infection of the ovary without tubal involvement. A number of predisposing factors have been identified. The appearance after spontaneous vaginal birth is rare. The clinical presentation is varied, the symptoms are not specific. Proper diagnosis necessitates the complete evaluation of clinical signs, laboratory tests and imaging techniques. The effective treatment is mostly operative. The authors present the detailed management of a postpartum patient with an isolated abscess of the right ovary. Antenatal identification and treatment of cervico-vaginal infection along with strict antiseptic way of care during labor and delivery may result in less prevalent and less severe postnatal maternal inflammatory complications.

PMID: 12638311 [PubMed - indexed for MEDLINE]

: Effect of traditional food supplementation during pregnancy on maternal weight gain and birthweight.

Kaseb F, Kimiagar M, Ghafarpoor M, Valaii N.

National Nutrition and Food Research Institute, Beheshti University of Medical Sciences, P.O. Box 19395_4741, Tehran, I.R. Iran.

The effects of supplementary traditional food on pregnant women were investigated in a clinical trial in Islamshahr, a suburban area 35 km southwest of Tehran. The study comprised 53 healthy mothers who were neither addicts nor on medication and were free from genetic disorders. The pregnant mothers' health was evaluated by their weight gain, that of lactating mothers by breast milk adequacy, and that of newborns by their weight at birth. The experimental group received traditional food (rice-milk porridge, lentils, pottage, cheese, yogurt, eggs, and milk with bread), supplying an extra 400 kcal energy and 15 g protein from the fourth month of pregnancy until childbirth. All subjects were weighed monthly. To ascertain breast milk sufficiency, the duration of exclusive breastfeeding and the growth trend of infants were surveyed. The study showed the weight gain in the experimental and control groups to be 11.0 +/- 2.9 and 8.5 +/- 3 kg respectively; the difference was 29.4% and statistically significant (p < 0.02). The confounding variables (energy and protein intake, age, height, BMI, age at first pregnancy, parity, last pregnancy spacing, number of children, number of miscarriages, duration of residence in the area, family size, education, housing, occupation of the mother or her husband) did not reveal any significant differences. Maternal weight gain was higher in the experimental compared to the control group. Birth weights in experimental and control groups were 3.33 +/- 0.4 and 3.08 +/- 0.3 kg, respectively. This difference, which amounts to 8.1%, was statistically significant (p < 0.05). While the two groups of newborns had equal breastfeeding duration, heights and weights of newborns were significantly higher in the experimental group. This was also confirmed when compared to the NCHS figures.

PMID: 12596505 [PubMed - indexed for MEDLINE]

34: J Obstet Gynaecol Can. 2002 Dec;24(12):953-6.

Related Articles, Links

Acute uterine inversion: a review of 40 cases.

Baskett TF.

Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS.

OBJECTIVE: To determine the incidence, complications, and risk of recurrence of acute uterine inversion. METHODS: A retrospective chart review was conducted of all cases of acute uterine inversion recorded at the Grace Maternity Hospital in Halifax, Nova Scotia, from 1977 to 2000. RESULTS: During the 24-year period studied, 40 cases of acute uterine inversion occurred following 125,081 births. The incidence of acute uterine inversion following vaginal birth was 1 in 3737, and following Caesarean section, 1 in 1860. Post-partum hemorrhage complicated 65% of cases of acute uterine inversion, and 47.5% required blood transfusion. There was no recurrence in 26 subsequent deliveries. Following the institution of active management of the third stage of labour in 1988, the incidence of acute uterine inversion following vaginal delivery fell 4.4-fold. CONCLUSION: Acute uterine inversion is rare but accompanied by high risk of postpartum hemorrhage and the need for blood transfusion. Active management of the third stage of labour may reduce the incidence of uterine inversion.

Publication Types:

Review
Review of Reported Cases

PMID: 12464994 [PubMed - indexed for MEDLINE]

35: Obstet Gynecol. 2002 Dec;100(6):1417.

Related Articles, Links

ACOG Committee Opinion: number 281, December 2002. Rubella vaccination.

American College of Obstetricians and Gynecologists.

The incidence of rubella decreased from 0.45 per 100,000 in 1990 to 0.1 per 100,000 in 1999. Although there is a nationwide shortage of rubella vaccine, women who are rubella susceptible during pregnancy should receive MMR (measles-mumps-rubella) vaccination postpartum. In October 2001, the federal Centers for Disease Control and Prevention changed the recommendations concerning the pregnancy interval after receiving rubella vaccine. This interval has been reduced from 3 months to 1 month.

Publication Types:

Guideline
Practice Guideline

PMID: 12468198 [PubMed - indexed for MEDLINE]

: [Ovarian vein thrombophlebitis and post-partum fever]

[Article in French]

Kettaneh A, Tourret J, Fain O, Tigaizin A, Seror O, Aurousseau MH, Batallan A, Stirnemann J, Sellier N, Uzan M, Thomas M.

Services de medecine interne, hopital Jean-Verdier, 93143 Bondy cedex, assistance publique/hopitaux de Paris, UPRES EA 3409, faculte de medecine Leonard-de-Vinci, universite Paris-nord, France. adrien.kettaneh@jvr.ap-hop-paris.fr

INTRODUCTION: Ovarian vein thrombophlebitis (OVT) is a rare but potentially threatening complication of the postpartum period. Diagnosing it may be of some difficulty especially in case of symptoms mimicking appendicitis or pyelonephritis. EXEGESIS: We report 2 patients with postpartum right OVT. The clinical presentation included high grade fever, and pain, lumbar in one case, of the right flank in the other. Pulmonary embolism complicated both cases. CONCLUSION: Diagnostic and therapeutic management of OVT was transformed by progresses in medical imaging during the 1980's. However, optimal duration of anticoagulant treatment and secondary prevention indications have to be determined.

PMID: 12504238 [PubMed - indexed for MEDLINE]

: Field acceptability and effectiveness of the routine utilization of zidovudine to reduce mother-to-child transmission of HIV-1 in West Africa.

Meda N, Leroy V, Viho I, Msellati P, Yaro S, Mandelbrot L, Montcho C, Manigart O, Dabis F; DITRAME-ANRS 049 Study Group.

Centre MURAZ, Bobo-Dioulasso, Burkina Faso, West Africa. nmeda.muraz@fasonet.bf

OBJECTIVE: To ascertain the field acceptability and effectiveness of the routine utilization of zidovudine in reducing mother-to-child transmission (MTCT) of HIV in breastfed children after a randomized clinical trial demonstrated its efficacy in Cote d'Ivoire and Burkina Faso. METHODS: Pregnant women aged 18 years or older, who had confirmed HIV-1 infection, haemoglobinemia greater than 7 g/dl were enrolled in an open label cohort at 36-38 weeks' gestation to receive an oral short course of zidovudine. Paediatric HIV infection was defined as a positive HIV-1 polymerase chain reaction, or if aged 15 months or older, a positive HIV serology. RESULTS: The acceptability of HIV pretest counselling was significantly higher in the cohort (90.3%) than in the trial (83.7%) (P < 0.001), but the return rate for HIV test results and for inclusion was low. A similar proportion of women accepted starting zidovudine in the cohort, 30.4% compared with 27.3% in the trial (P = 0.13). The proportions of women who took more than 80% of the expected zidovudine regimen were 81.8% before labour, 86.7% during labour, and 88.1% during the postpartum period, compared with those observed during the trial, 78.1, 81.1, and 85%, respectively. The MTCT probability at age 15 months was 19.6% in the cohort (n = 185) versus 21.2% in the trial (P = 0.52). CONCLUSION: The major drawback with the implementation of a short zidovudine regimen to reduce MTCT is HIV counselling and testing procedures. For women who consent, zidovudine is well accepted and efficacious under routine circumstances. Copyright 2002 Lippincott Williams & Wilkins

PMID: 12441805 [PubMed - indexed for MEDLINE]

38: Ugeskr Laeger. 2002 Nov 18;164(47):5495-7.

Related Articles, Links

Comment in:

Ugeskr Laeger. 2002 Nov 18;164(47):5489.

[Vertical transmission of HIV in Denmark]

[Article in Danish]

Kvinesdal BB, Valerius NH, Herlin T, Hansen IM, Hornstrup MK, Christensen HO, Nielsen HI, Olofsson MJ.

H:S Hvidovre Hospital, infektionsmedicinsk afdeling, paediatrisk afdeling og familieambulatoriet ved gynaekologisk obstetrisk afdeling.

INTRODUCTION: Vertical transmission of HIV can be reduced if the pregnant woman and new born child receive antiretroviral treatment. Delivery by caesarean section and avoidance of breast feeding further reduce vertical transmission. The aim of this study was to describe the treatment of HIV-positive pregnant women in Denmark and the risk of vertical transmission. MATERIAL AND METHODS: We retrospectively describe the risk of vertical transmission of HIV among HIV-positive women giving birth in Denmark during the period, mid-1994 to February 2000. RESULTS: Fifty children were born. One mother gave birth twice during the study period, and one had twins. Five (10%) children were infected. All five were born by vaginal delivery. Three of the five mothers and three of the children did not receive antiretroviral treatment. The remaining two mothers were only given intrapartum treatment. In none of the five mothers was the HIV-infection known until the time of delivery or later. Transmission of HIV did not occur in the 34 mother-child pairs who received antepartum and intrapartum antiretroviral treatment, who had a caesarean delivery, who did not breast-feed, and whose children were given postpartum antiretroviral treatment. DISCUSSION: It is important to identify HIV-infection in pregnant women in order to provide the relevant treatment and prevent vertical transmission of HIV.

PMID: 12523022 [PubMed - indexed for MEDLINE]

39: Addict Behav. 2002 Nov-Dec;27(6):887-910.

Related Articles, Links

Voucher-based incentives. A substance abuse treatment innovation.

Higgins ST, Alessi SM, Dantona RL.

Department of Psychiatry, University of Vermont, 38 Fletcher Place, Burlington, VT 05464, USA. stephen.higgins@uvm.edu

In this report we provide an overview of research on the voucher-based incentives approach to substance abuse treatment. This approach was originally developed as a novel method for improving retention and increasing cocaine abstinence among cocaine-dependent outpatients. The efficacy of vouchers for those purposes is now well established, and plans are underway to move the intervention into effectiveness testing in community clinics. The use of vouchers also has been extended to the treatment of alcohol, marijuana, nicotine, and opioid dependence. Particularly noteworthy is that vouchers hold promise as an efficacious intervention with special populations of substance abusers, including pregnant and recently postpartum women, adolescents, and those with serious mental illness. Overall, voucher-based incentives hold promise as an innovative treatment intervention that has efficacy across a wide range of substance abuse problems and populations.

Publication Types:

Review
Review, Tutorial

PMID: 12369474 [PubMed - indexed for MEDLINE]

: [Fatal complications in pre-eclampsia and eclampsia]

[Article in Czech]

Srp B, Velebil P, Kvasnicka J.

Gynekologicko-porodnicka klinika UK, 1. LF a VFN v Praze.

OBJECTIVE: Analysis of preeclampsia and eclampsia--one of the major contributor to life-threatening maternal morbidity frequently leading to maternal mortality in the Czech Republic till late 70's. Our goal was to mention major causal links in clinical courses of individual maternal death and to highlight main mistakes and faults, and to provide frequencies and basic characteristics of risk groups. DESIGN: Retrospective epidemiological study. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague. Institute for the Care of Mother and Child, Prague-Podoli; 1st Intern Department of the 1st Medical School of Charles University and General University Hospital, Prague. METHODS: Analysis of 31 cases of maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic during 1978-2000, using a database of 470 maternal deaths during the observed period. We analyzed clinical course with special attention to obstetrical surgery and clinical management. We considered timelines of life-threatening events, age of mother, parity, and place of death. RESULTS: There were 36 maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic in 1978-2000, contributing 7.7% to total maternal mortality. Group A1 was 5th most frequent cause of maternal death. We analyzed 31 cases closely related to severe preeclampsia and eclampsia. During 1978-1990 there was 1 death per 74,263 live-born babies in this category, while during 1991-2000 we observed only 1 death per 171,137 live-born babies. Clinical management was not adequate in 15 cases of death (48%) and content of care did not reflect possibilities of prevention, diagnosis and therapy. Severe preeclampsia and eclampsia was more frequent among older women and multiparae. First group (61%) is composed of women with manifest convulsions, 25% of them experienced convulsion after delivery, and only few cases had mild preeclampsia ante partum. Eclampsia with convulsions leading to coma were in 10 cases complicated with DIC, two cases in this group had premature separation of placenta. Besides classic symptoms of preeclampsia there were within this group 5 cases of multiple pregnancy, history of unstable hypertension, hepatopathy in previous pregnancy and chronic nephrosis. The second group (39%) were cases without convulsions. These cases were complicated with severe liver disorders and renal failure, and 5 cases of intra-cranial hemorrhage. Several cases had combination of symptoms. DIC was present in 6 cases. In both groups there were 5 cases with hemorrhagic skin symptoms, thrombopenia, symptoms of DIC and liver and renal failure, which would fall into HELLP syndrome according to current classification. The most of women died during the postpartum period (87%) mostly after emergency operative deliveries. The fact that no women died during pregnancy indicates the effort to perform life-saving operative delivery. Forty two percent of women were in term. Especially at the beginning of observed period we noticed tendency to prolong gestation in order to save the baby. The mortality of fetuses or newborns was 71%. Operative deliveries accounted for 71%, the majority of them were caesarean sections. More than 50% of cases were operated in coma. We indicate major mistakes and failures in organization of care, primary prevention, diagnosis, and consequent care. CONCLUSION: Positive results in area of maternal deaths in association with severe preeclampsia and eclampsia during last 10 years are due to improved diagnostic and therapeutic measures in our field, especially in neonatology, because obstetricians currently terminate pregnancies early than before while symptoms of preeclampsia get worse. We focus on early recognition of symptoms of coagulopathy in combination with symptoms of preeclampsia, especially on early detection and treatment of HELLP syndrome.

PMID: 12661377 [PubMed - indexed for MEDLINE]

: Computer-assisted self-interview and nutrition education in pregnant teens.

Bechtel-Blackwell DA.

Carolinas College of Health Sciences School of Nursing, Charlotte, North Carolina, USA.

The purpose of this study was to conduct computer-assisted self-interview (CASI) nutrition assessment in a pregnant, adolescent African American population to compare the effect of a nutrition education intervention with the standard dietitian consult on gestational weight gain patterns and postpartum weight retention. Control group (n = 24) and experimental group (n = 22) data obtained from the nutritional assessment and measurement of gestational weight gain/postpartum weight retention patterns were compared during the second trimester, third trimester, and 6 weeks postpartum to evaluate the effectiveness of the program. The experimental group gained signficantly less weight during the first and second trimesters than the control group. During the third trimester gestational weight gain was significantly higher for the experimental group. Postpartum weight retention was signifcantly higher for the control group. There were no significant differences between maternal characteristics of the two groups. Fat content and daily caloric content of participants in the control group were significantly higher than the experimental group.

PMID: 12413116 [PubMed - indexed for MEDLINE]

42: Int J Obes Relat Metab Disord. 2002 Nov;26(11):1494-502.

Related Articles, Links

Randomized controlled trial to prevent excessive weight gain in pregnant women.

Polley BA, Wing RR, Sims CJ.

University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

BACKGROUND: The Institute of Medicine (IOM) recommends that normal-weight women (BMI (body mass index) of 19.8-26.0) gain 25-35 lb (11.4-15.9 kg) during pregnancy, and that overweight women (BMI of 26.1-29.0) gain 15-25 lbs (6.8-11.4 kg). A significant number of normal-weight women and an even greater proportion of overweight women exceed these guidelines, which increases postpartum weight retention and may contribute to the development of obesity. OBJECTIVE: To determine whether a stepped care, behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation. DESIGN: Randomized controlled trial comparing a stepped-care behavioral intervention with usual care. Women (n=120) who had a BMI>19.8, age>18 and <20 weeks gestation were recruited from a hospital-based clinic serving low-income women and randomized by race and BMI category to the intervention or control group. The intervention group received education about weight gain, healthy eating, and exercise and individual graphs of their weight gain. Those exceeding weight gain goals were given more intensive intervention. Women were followed through pregnancy to their first postpartum clinic visit. The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations. RESULTS: The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations (33 vs 58%, P<0.05). There was a non-significant (P=0.09) effect in the opposite direction among overweight women (59% of intervention and 32% of control gained more than recommended). Postpartum weight retention was strongly related to weight gain during pregnancy (r=0.89). CONCLUSIONS: The intervention reduced excessive weight gain during pregnancy among normal weight women.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 12439652 [PubMed - indexed for MEDLINE]

43: J Midwifery Womens Health. 2002 Nov-Dec;47(6):409-21.

Related Articles, Links

Comment in:

J Midwifery Womens Health. 2003 Mar-Apr;48(2):162.

Safe prescribing practices in pregnancy and lactation.

Hansen WF, Peacock AE, Yankowitz J.

University of Iowa Hospitals and Clinics, USA.

Midwives and other health care providers face a dilemma when a pregnant woman develops a condition that usually is treated with a pharmacologic agent. Understanding of basic teratology associated with drugs as well as the FDA categorization of agents can assist professionals in recognizing which pharmaceuticals should be used or avoided. In addition to reviewing teratology, this article addresses the use of common drugs for the treatment of upper respiratory conditions, minor pain, gastrointestinal problems, psychiatric illnesses, and neurologic disorders. In each category, current evidence is presented pertaining to which agents should be recommended for pregnant women.

Publication Types:

Review
Review Literature

PMID: 12484662 [PubMed - indexed for MEDLINE]

44: J Vet Intern Med. 2002 Nov-Dec;16(6):732-5.

Related Articles, Links

Erratum in:

J Vet Intern Med. 2003 Mar-Apr;17(2):245.

Efficacy of sodium borate in the prevention of fatty liver in dairy cows.

Basoglu A, Sevinc M, Birdane FM, Boydak M.

Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey. abasoglu@selcuk.edu.tr

The effects of sodium borate (100 mg/kg body weight, p.o., 15 days) from a month before expected calving until a month after calving were evaluated in dairy cows susceptible to fatty liver. Cows received either sodium borate (n = 13) or no treatment (n = 10). All cows had mild fatty livers and increased plasma triglycerides and very low density lipoprotein (VLDL) concentrations at the beginning of the experiment. The control group of cows developed significant fatty liver after calving, and 2 of them had severe fatty liver associated with clinical and biochemical abnormalities. There were no clinicopathological signs related to sodium borate administration. Serum triglycerides and VLDL concentrations before calving decreased significantly at calving and after calving in controls, and they were within the normal range only after calving. There were significant alterations during the experiment in some hematological and chemical variables between groups, within period, but they were within the normal range. Unlike treated cows, serum triglycerides and VLDL concentrations correlated with liver fat content after calving in untreated cows. Our results document that sodium borate decreases the degree of fatty liver in dairy cows during early lactation.

Publication Types:

Clinical Trial

PMID: 12465773 [PubMed - indexed for MEDLINE]

: [Management of tuberculosis during pregnancy and puerperium]

[Article in Japanese]

Toyota E, Minoura S, Miyazawa H.

Department of Respiratory Disease, International Medical Center of Japan, 1-21-1, Toyama-cho, Shinjuku-ku, Tokyo 162-8655, Japan. etoyota@imcj.hosp.go.jp

We reported 22 cases with tuberculosis in pregnancy and puerperium, who were treated in our hospital from 1993 to 2001. Nine out of 22 cases were foreign women and the onset of tuberculosis was not clear and the diagnosis tended to be delayed in most cases. In the reports from industrial countries, most of those patients are foreign bone and the delay in diagnosis is common because symptoms are apt to be mixed up those for pregnancy and puerperium. In 10 of 22 cases, extrapulmonary lesions were noted. Most of our cases were treated with INH, RFP and EB, and in some severer cases PZA was added. WHO and BTS recommend standard therapy with PZA but ATS recommends INH, RFP and EB without PZA. Generally SM is contraindicated because of adverse effect of hearing loss for all pregnant periods, and the data for PZA and other second line drugs are insufficient. Our cases and their neonates showed normal course and no malformation nor congenital tuberculosis. 2 cases could not keep adherence for drugs and 2 babies got active tuberculosis. Precaution for infection is one of most important problem to deal with cases with tuberculosis during pregnancy and postpartum in the hospital. If she is still infectious on delivery, we should consider prevention for transmission and manage her in isolated manner. CDC recommends not to treat for latent tuberculosis during pregnancy because of high frequency of hepatic damage due to INH. It is the best way to check and treat latent tuberculosis before gestation if she is at high risk with tuberculosis.

PMID: 12494507 [PubMed - indexed for MEDLINE]

46: Clin Infect Dis. 2002 Oct 15;35(8):950-9. Epub 2002 Sep 26.

Related Articles, Links

Erratum in:

Clin Infect Dis. 2003 Jan 15;36(2):243..

Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention.

Prevention of Invasive Group A Streptococcal Infections Workshop Participants.

The Centers for Disease Control and Prevention hosted a workshop to formulate recommendations for the control of invasive group A streptococcal (GAS) disease among household contacts of persons with invasive GAS infections and for responding to postpartum and postsurgical invasive GAS infections. Experts reviewed data on the risk of subsequent invasive GAS infection among household contacts of case patients, the effectiveness of chemoprophylactic regimens for eradicating GAS carriage, and the epidemiology of postpartum and postsurgical GAS infection clusters. For household contacts of index patients, routine screening for and chemoprophylaxis against GAS are not recommended. Providers and public health officials may choose to offer chemoprophylaxis to household contacts who are at an increased risk of sporadic disease or mortality due to GAS. One nosocomial postpartum or postsurgical invasive GAS infection should prompt enhanced surveillance and isolate storage, whereas > or =2 cases caused by the same strain should prompt an epidemiological investigation that includes the culture of specimens from epidemiologically linked health care workers.

PMID: 12355382 [PubMed - indexed for MEDLINE]

: To screen or not to screen--that is the question in perinatal depression.

Buist AE, Barnett BE, Milgrom J, Pope S, Condon JT, Ellwood DA, Boyce PM, Austin MP, Hayes BA.

Austin & Repatriation Hospital, University of Melbourne, Building 129A, Repatriation Campus, Locked Bag 1, West Heidelberg, VIC 3081, Australia. a.buist@medicine.unimelb.edu.au

Significant perinatal distress and depression affects 14% of women, producing short and long term consequences for the family. This suggests that measures for early detection are important, and non-identification of these women may exacerbate difficulties. Screening provides an opportunity to access large numbers of women and facilitate pathways to best-practice care. A valid, reliable, economical screening tool (the Edinburgh Postnatal Depression Scale, EPDS) is available. Arguments against screening pertain largely to lack of evidence about the acceptability of routine use of the EPDS during pregnancy and the postnatal period, and inadequate evidence regarding outcomes and cost-effectiveness. To address these concerns, the National Postnatal Depression Prevention and Early Intervention Program will evaluate outcomes of screening in terms of acceptability, cost-effectiveness, access and satisfaction with management in up to 100 000 women.

PMID: 12358566 [PubMed - indexed for MEDLINE]

: Increasing trend of illicit drug abuse in Thai parturient at Siriraj Hospital.

Inthawiwat S, Rattanachaiyanont M, Leerasiri P, Manoch D, Titapant V.

Department of Obstertrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

OBJECTIVE: To report the magnitude of the problem and to evaluate the outcome of maternal illicit drug use in Thai parturients. DESIGN: Retrospective case-control study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECT: The subjects were 44,640 parturients who had deliveries at Siriraj Hospital from January 1998 to December 2001 and were divided into two groups. The study group consisted of 66 parturients with a history of illicit drug use and the control group consisted of 44,574 parturients without a history of illicit drug use. INTERVENTION: Medical records of 66 parturients with a history of illicit drug use were reviewed. Obstetric statistics of the department were retrieved from the computerized database in the Division of Obstetric and Gynecologic Registry. The data were analyzed using descriptive statistics. MAIN OUTCOME MEASURE: Characteristics of parturients, pregnancy outcome, type and incidence of illicit drug. RESULTS: Within the study period, 66 cases of maternal illicit drug use were identifiable during the intrapartum period; 65 cases used amphetamine or derivatives and 1 case used an opioid derivative. The number had risen from 1 case in 1998 to 58 cases in 2001. Mean age of the patients was 23.30 +/- 6.04 years. Compared to the control group which included 44,574 parturients, the patients had a lower incidence of antenatal care (ANC rate = 21.21% vs 94.35%; RR = 0.23, 95% CI = 0.14-0.26), a higher incidence of HIV infection (10% vs 2%; RR = 6.09, 95% CI = 2.83-13.12), a higher incidence of birth before arrival (BBA rate = 9.09% vs 1.06%; RR = 8.59, 95% CI = 3.98-18.51), and a lower cesarean section rate (10.60% vs 26.36%; RR = 0.40, 95% CI = 0.20-0.81). There were no serious intrapartum, immediate postpartum and neonatal complication. Fetal outcome included a higher incidence of low birth weight infants (22.73% vs 10.23%; RR = 2.22, 95% CI = 1.42-3.46) and a smaller head circumference than the normal range of Thai fetal biometry (31.85 +/- 1.47 cm). CONCLUSION: There is an increasing trend of illicit drug use in Thai parturients. Although the present case series of drug abuse in Thai parturients cannot give the whole picture of maternal drug abuse in the Thai population, the dramatic increase in the identifiable cases during the past 4 years is very alarming. Currently, the outcome of pregnancy in case detected during intrapartum is not much different from that in the general population. However, there are potential risks for the patients and their babies. All medical staffs should be aware of this condition. Careful clinical data gathering and laboratory testing are suggested for prevention of complications and the potential hazards of this problem.

PMID: 12501899 [PubMed - indexed for MEDLINE]

: Epidemiology and prevention of thyroid disease in pregnancy.

Lazarus JH.

University of Wales College of Medicine, Cardiff, Wales, United Kingdom. Lazarus@cf.ac.uk

Pregnancy has variable effects on thyroid hormone concentrations throughout pregnancy as well as being associated with goiter. The latter is largely preventable by ensuring optimal iodine intake of at least 200 microg/d. Immunologic changes in pregnancy include a so-called T(H)2 shift that reverts to T(H)1 status around birth or early in the postpartum period. Hyperthyroidism during gestation, usually caused by Graves' disease, is rare (0.2%) and is best managed medically with propylthiouracil; thyroid-stimulating antibodies should be measured. Prevention of the deleterious effects of Graves' disease includes adequate preconception advice, adequate monitoring during pregnancy, and total avoidance of (131)I therapy during pregnancy. Hypothyroidism during pregnancy has an incidence of 2.5% although there is a 10% incidence of thyroid peroxidase (TPO)-antibody positivity in early gestation. There are convincing epidemiologic data to show that suboptimal thyroid function in pregnancy is associated with impaired neurointellectual development (e.g., 19% with IQ < 85 compared to 5% in one study). Therefore, there is a case for screening for thyroid function in early pregnancy with thyroxine (T(4)) intervention therapy. Maintenance of optimal iodine intake is critical to prevent nonautoimmune gestational maternal hypothyroxinaemia. Postpartum thyroid dysfunction (PPTD) occurs in 5%-9% of women and in up to 50% of TPO-antibody positive women (as ascertained in early pregnancy). Prevention of PPTD at this time could only be achieved by pregestational ablation of the thyroid. Another approach is to at least improve the prediction of postpartum thyroid disease (PPT) because the TPO antibody has a sensitivity of only 50%.

PMID: 12487768 [PubMed - indexed for MEDLINE]

: Variable response of Hermansky-Pudlak syndrome to prophylactic administration of 1-desamino 8D-arginine in subsequent pregnancies.

Zatik J, Poka R, Borsos A, Pfliegler G.

Department of Obstetrics and Gynecology, Medical Faculty, Center for Health and Medical Sciences, University of Debrecen, Debrecen, Hungary. jzatik@yahoo.com

Hermansky-Pudlak syndrome is characterised by oculocutaneous albinism and haemorrhagic diathesis. The bleeding tendency that is associated with this autosomal recessive disease is caused by storage-pool deficiency and has been reported to be controllable by prophylactic administration of 1-desamino 8D-arginine (desmopressin, DDAVP). The DDAVP prophylaxis at the first delivery of our patient did not prevent the severe haemorrhagic sequeal requiring transfusion of packed red cells and platelets, but the same preventive measure was successful at her second childbirth. Response to prophylactic DDAVP administration varies between as well as within patients with Hermansky-Pudlak syndrome. Copyright 2002 Elsevier Science Ireland Ltd.

PMID: 12206932 [PubMed - indexed for MEDLINE]