NSIDRC Journal Article Alert — April 25, 2008
Prepared by the National Sudden Infant Death Resource Center
at Georgetown University.
This journal article alert provides selected items added to
the National Library of Medicine’s PubMed database in
the last week.
Past issues of NSIDRC journal alerts are available at http://www.sidscenter.org.
Availability of full-text journal articles is often limited to
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Sudden Infant Death Syndrome
1: Minozzi S, Amato L, Vecchi S, Davoli M.
Maintenance agonist treatments for opiate dependent pregnant
women.
Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006318.
BACKGROUND: The prevalence of opiate use among pregnant women
ranges from 1% to 2% to as much as 21%. Heroin crosses the
placenta and pregnant opiate dependent women experience a six
fold increase in maternal obstetric complications such as low
birth weight, toxaemia, 3rd trimester bleeding, malpresentation,
puerperal morbidity, fetal distress and meconium aspiration.
Neonatal complications include narcotic withdrawal, postnatal
growth deficiency, microcephaly, neurobehavioral problems,
increased neonatal mortality and a 74-fold increase in sudden
infant death syndrome. OBJECTIVES: To assess the effectiveness
of any maintenance treatment alone or in combination with psychosocial
intervention compared to no intervention, other pharmacological
intervention or psychosocial interventions on child health
status, neonatal mortality, retaining pregnant women in treatment,
and reducing use of substances SEARCH STRATEGY: We searched
Cochrane Drugs and Alcohol Group' Register of Trials (June
2007), PubMed (1966 - June 2007), CINAHL (1982- June 2007),
reference lists of relevant papers, sources of ongoing trials,
conference proceedings, National focal points for drug research.
Authors of included studies and experts in the field were contacted.
SELECTION CRITERIA: Randomised controlled trials enrolling
opiate dependent pregnant women DATA COLLECTION AND ANALYSIS:
The authors assessed independently the studies for inclusion
and methodological quality. Doubts were solved by discussion.
MAIN RESULTS: We found three trials with 96 pregnant women.
Two compared methadone with buprenorphine and one methadone
with oral slow morphine. For the women there was no difference
in drop out rate RR 1.00 (95% CI 0.41 to 2.44) and use of primary
substance RR 2.50 (95% CI 0.11 to 54.87) between methadone
and buprenorphine, whereas oral slow morphine seemed superior
to methadone in abstaining women from the use of heroin RR
2.40 (95% CI 1.00 to 5.77)For the newborns in one trial buprenorphine
performed better than methadone for birth weight WMD -530 gr
(95% CI -662 to -397), this result is not confirmed in the
other trial. For the APGAR score both studies didn't find significant
differences. No differences for NAS measures used. Comparing
methadone with oral slow morphine no differences for birth
weight and mean duration of NAS. The APGAR score wasn't considered.
AUTHORS' CONCLUSIONS: We didn't find any significant difference
betewen the drugs compared both for mother and for child outcomes;
the trials retrieved were too few and the sample size too small
to make firm conclusion about the superiority of one treatment
over another. There is an urgent need of big randomized controlled
trials.
2: Woida FM, Saggioro FP, Ferro MA, Peres LC.
Sudden infant death syndrome in Brazil: fact or fancy?
Sao Paulo Med J. 2008 Jan;126(1):48-51.
Department of Pathology, Faculdade de Medicina de Ribeirão
Preto, Universidade de São Paulo, Ribeirão
Preto, São Paulo, Brazil.
CONTEXT AND OBJECTIVE: The true incidence of sudden infant
death syndrome (SIDS) in Brazil is unknown. The aim here was
to identify SIDS cases in the city of Ribeirão Preto,
State of São Paulo, between 2000 and 2005, in order
to estimate its incidence. DESIGN AND SETTING: Retrospective
analysis of data on live births and infant deaths in Ribeirão
Preto and from autopsies of infants performed at the Death
Verification Service of the Interior (SVOI) between 2000 and
2005. RESULTS: There were 47,356 live births and 537 deaths,
with infant mortality rates ranging from 12.9 to 10.9 of live
births. Among the 24 infants who died possibly due to SIDS
and who were autopsied at the SVOI, six were from families
living in the municipality (0.13 of live births): three (50%)
were diagnosed as SIDS, and one each (16.66%) as indeterminate
cause, bronchoaspiration and cerebral edema. Two deaths occurred
in the first month of life (33.33%) and one each (16.66%) at
two, four, six and eight months. Two deaths each (33.33%) occurred
in the months of February and December, one each in August
and October (16.66%). Four cases (66.7%) occurred in the summer
and one each (16.66%) in winter and spring. There was 5:1 predominance
of males over females. CONCLUSIONS: The frequency of SIDS was
lower than what has been reported worldwide and in the Brazilian
literature, thus suggesting underdiagnosis, indicating the
lack of any specific postmortem protocol for SIDS identification
and showing the need to implement this.
3: Alvarez-Lafuente R, Aguilera B, Suárez-Mier MA,
Morentin B, Vallejo G, Gómez J, Fernández-Rodríguez
A.
Detection of human herpesvirus-6, Epstein-Barr virus and cytomegalovirus
in formalin-fixed tissues from sudden infant death: A study
with quantitative real-time PCR.
Forensic Sci Int. 2008 Apr 16 [Epub ahead of print]
Neurology Service, Hospital Clínico San Carlos, C/
Profesor Martín Lagos s/n, Madrid 28040, Spain.
BACKGROUND: The role of viruses in the context of sudden
infant death in early childhood is still unclear, although
there are many findings pointing to a viral infection possibly
leading to death. OBJECTIVES: To analyse the prevalence and
viral loads of human herpesvirus-6 (HHV-6), Epstein-Barr virus
(EBV), and cytomegalovirus (CMV), three viruses that have been
previously detected in some cases of sudden death in infants,
in tissues from sudden infant death syndrome (SIDS) patients
and controls. MATERIALS AND METHODS: Thirty-nine formalin-fixed
paraffin-embedded tissue sections of eleven consecutive cases
of SIDS, and thirty-nine formalin-fixed paraffin-embedded tissue
sections of nine control cases were analysed by a specific
quantitative real-time PCR for the detection of HHV-6, EBV,
and CMV. RESULTS: The comparison of the whole viral DNA prevalence
in cases and tissue sections between SIDS and controls showed
a statistical significance (72.7% vs. 22.2%, p=0.025; 41.1%
vs. 10.3%, p=0.001, respectively); in particular, we found
a statistical significant difference for the EBV DNA prevalence
among cases (p=0.042) and tissues (p=0.048), and a statistical
significant difference for the HHV-6 DNA prevalence among cases
(p=0.017). CONCLUSIONS: This is one of the first studies using
quantitative real-time PCR for virus detection in cases of
SIDS, and the results suggest that some herpesvirus infections,
and particularly those caused by EBV and HHV-6 could be related
with some cases of SIDS. Further studies will be necessary
to understand the real significance of these findings in the
context of SIDS.
4: Thach BT.
Some Aspects of Clinical Relevance in the Maturation of Respiratory
Control in Infants.
J Appl Physiol. 2008 Apr 17 [Epub ahead of print]
Pediatrics, Washington University School of Medicine, St.
Louis, Missouri, United States.
Two reflex mechanisms important for survival are discussed.
Brainstem and cardiovascular mechanisms that are responsible
for recovery from severe hypoxia (autoresuscitation) are important
for survival in acutely hypoxic infants and adults. Failure
of this mechanism may be important in Sudden Infant Death Syndrome,
since brainstem mediated hypoxic gasping is essential for successful
autoresuscitation and since SIDS infants appear to attempt
to autoresuscitate just prior to death. The major function
of another mechanism is to protect the airway from fluid aspiration.
The various components of the laryngeal chemoreflex (LCR) change
during maturation. The LCR is an important cause of prolonged
apneic spells in infants. Consequently it also may have a role
in causing SIDS. Maturational changes and/or inadequacy of
this reflex may be responsible for pulmonary aspiration and
infectious pneumonia in both children and adults. Key words:
Sudden Infant Death Syndrome, apnea, autoresuscitation, hypoxic
gasping, laryngeal chemo-receptor.
5: Goldwater PN.
Intrathoracic Petechial Hemorrhages in sudden infant death
syndrome and other infant deaths: Time for re-examination?
Pediatr Dev Pathol. 2008 Apr 16;:1 [Epub ahead of print]
Abstract Objective: To provide a predictive tool to assist
forensic and pediatric pathologists in diagnosis of sudden
unexpected infant death and to discuss the pathogenesis of
intrathoracic petechial hemorrhages. Design: retrospective
autopsy report review of 174 SIDS cases (2004 definition) and
67 age-matched comparison deaths. Setting: Qualitative assessment
(presence or absence) of macroscopic intrathoracic petechiae
in SIDS and age-matched comparison sudden unexpected deaths
that occurred in the late 1980s and early 1990s. Main outcome
measures: Sensitivity, specificity and positive and negative
predictive values for thymic, pleural and epicardial petechial
hemorrhages were developed. Results: 89.5%, 80% and 79.9% SIDS
(<12 months of age) had thymic, pleural and epicardial petechiae
respectively compared with 47.6%, 47.5% and 43.6% in non-SIDS
deaths respectively. Respective ORs: 9.4 (4.5-19.9), 4.6 (2.3-9.1),
5.3 (2.6-10.8). When all three intrathoracic organ sites contain
macroscopic petechiae, this is 84.9% predictive of SIDS and
when all 3 sites have no detectable petechiae this is 93.1%
predictive of a non-SIDS diagnosis. Conclusions: Careful assessment
of intrathoracic petechiae at autopsy is likely to be diagnostically
useful in assessment of sudden unexplained infant death.
Other Infant Death
1: Hong R.
Association of maternal HIV infection with increase of infant
mortality in Malawi.
J Paediatr Child Health. 2008 May;44(5):291-6.
Department of Global Health, School of Public Health and
Health Services, George Washington University, Washington,
DC 20037, USA. rhong@gwu.edu
AIM: To determine the association between maternal HIV infection
and infant mortality in Malawi. METHODS: A synthetic cohort
life table based on the birth history of 2618 childbirths during
1999 and 2004, from the subsample of 2020 mothers who completed
interview and were tested for HIV virus in the 2004 Malawi
Demographic and Health Survey was used. The survey collected
socio-demographic and health data of a natural representative
sample of women aged 15 to 49; and obtained voluntary counselling
tests for HIV infection from one-third of the representatives
of the sample. Associations of maternal HIV status and other
factors with infant mortality were estimated using survival
regression analysis and the results are presented as hazard
ratios (HR) with level of statistical significance (P-value).
RESULTS: Children born to HIV-infected mothers were more than
two times as likely to die during infancy as those born to
uninfected mothers (HR = 2.21; P < 0.01). Controlling for
other risk factors and confounding factors for infant mortality
further sharpened this relationship (HR = 2.70; P < 0.01).
Boys are more likely to die in infancy than girls. Young mothers
and mothers not receiving prenatal care, and low-birthweight
children and children living in rural areas, particular so
in the northern region, were associated with a higher risk
of infant mortality. CONCLUSION: Maternal HIV infection is
strongly associated with infant mortality in Malawi independent
of many other factors. Results from this study suggest that
the HIV/AIDS epidemic has had an enormous impact on child well-being,
child survival and infant mortality. The impact increases as
the HIV/AIDS epidemic matures and infection in mothers and
adults increases.
Miscarriage/Stillbirth/Prenatal Issues
1: Haas DM, Ramsey PS.
Progestogen for preventing miscarriage.
Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003511.
Indiana University School of Medicine, Wishard Memorial Hospital,
1001 West 10th Street, F-5, Indianapolis, USA, IN 46202.
BACKGROUND: Progesterone, a female sex hormone, is known
to induce secretory changes in the lining of the uterus essential
for successful implantation of a fertilised egg. It has been
suggested that a causative factor in many cases of miscarriage
may be inadequate secretion of progesterone. Therefore, progestogens
have been used, beginning in the first trimester of pregnancy,
in an attempt to prevent spontaneous miscarriage. OBJECTIVES:
To determine the efficacy and safety of progestogens as a preventative
therapy against miscarriage. SEARCH STRATEGY: We searched the
Cochrane Pregnancy and Childbirth Group's Trials Register (January
2008), CENTRAL (The Cochrane Library 2006, Issue 4), MEDLINE
(1966 to June 2006), EMBASE (1980 to June 2006), CINAHL (1982
to June 2006), NHMRC Clinical Trials Register (June 2006) and
Meta-Register (June 2006). We searched references from relevant
articles, attempting to contact authors where necessary, and
contacted experts in the field for unpublished works. SELECTION
CRITERIA: Randomised or quasi-randomized controlled trials
comparing progestogens with placebo or no treatment given in
an effort to prevent miscarriage. DATA COLLECTION AND ANALYSIS:
Two review authors assessed trial quality and extracted data.
MAIN RESULTS: Fifteen trials (2118 women) are included. The
meta-analysis of all women, regardless of gravidity and number
of previous miscarriages, showed no statistically significant
difference in the risk of miscarriage between progestogen and
placebo or no treatment groups (Peto odds ratio (Peto OR) 0.98;
95% confidence interval (CI) 0.78 to 1.24) and no statistically
significant difference in the incidence of adverse effect in
either mother or baby.In a subgroup analysis of three trials
involving women who had recurrent miscarriages (three or more
consecutive miscarriages), progestogen treatment showed a statistically
significant decrease in miscarriage rate compared to placebo
or no treatment (Peto OR 0.38; 95% CI 0.20 to 0.70). No statistically
significant differences were found between the route of administration
of progestogen (oral, intramuscular, vaginal) versus placebo
or no treatment. AUTHORS' CONCLUSIONS: There is no evidence
to support the routine use of progestogen to prevent miscarriage
in early to mid-pregnancy. However, there seems to be evidence
of benefit in women with a history of recurrent miscarriage.
Treatment for these women may be warranted given the reduced
rates of miscarriage in the treatment group and the finding
of no statistically significant difference between treatment
and control groups in rates of adverse effects suffered by
either mother or baby in the available evidence. Larger trials
are currently underway to inform treatment for this group of
women.
2: Ota H, Goto T, Yoshioka T, Ohyama N.
Successful pregnancies treated with pioglitazone in infertile
patients with polycystic ovary syndrome.
Fertil Steril. 2008 Apr 16 [Epub ahead of print]
Departments of Obstetrics and Gynecology.
OBJECTIVE: To investigate the efficacy of pioglitazone on
fecundity in infertile patients with polycystic ovary syndrome
(PCOS) who are resistant to conventional ovulation induction
such as clomiphene, dexamethasone, or metformin. DESIGN: A
retrospective pilot study. SETTING: Department of Obstetrics
and Gynecology in a general hospital. PATIENT(S): Nine infertile
women with PCOS. INTERVENTION(S): Pioglitazone, 15-30 mg/day,
up to 32 weeks. MAIN OUTCOME MEASURE(S): Pregnancy rate. RESULT(S):
Seven of nine women became pregnant at an average of 11.3 weeks
of initiation of pioglitazone. Four of seven pregnant cases
conceived after the first successful induction of ovulation
with the initiation of pioglitazone, and two cases conceived
after the second cycle. Three women have already delivered,
and there is one ongoing pregnancy. The other three cases ended
in miscarriage during the sixth or eighth week of pregnancy.
CONCLUSION(S): Pioglitazone may be effective in infertile patients
with resistant PCOS.
3: Winger EE, Reed JL.
Treatment with Tumor Necrosis Factor Inhibitors and Intravenous
Immunoglobulin Improves Live Birth Rates in Women with Recurrent
Spontaneous Abortion.
Am J Reprod Immunol. 2008 Apr 17 [Epub ahead of print]
Alan E. Beer Center for Reproductive Immunology & Genetics,
San Francisco, CA, USA.
Problem The purpose of this study was to investigate whether
treatment with tumor necrosis factor (TNF) inhibitors combined
with intravenous immunoglobulin (IVIG) increases live birth
rates among women with recurrent spontaneous abortion (RSA)
concurrently treated with anticoagulants (AC). Method of study
Seventy-five pregnancies in patients with a history of RSA
were retrospectively evaluated. The population was divided
into three groups: group I: 21 patients treated with AC (anticoagulants),
group II: 37 patients treated with AC and IVIG, and group III:
17 patients treated with AC, IVIG and the TNF inhibitor Etanercept
(Enbrel((R))) or Adalimumab (Humira((R))). In groups II and
III, IVIG was administered at least once during the cycle of
conception and/or at least once after a positive pregnancy
test. In group III, either Adalimumab or Etanercept was administered
by subcutaneous injection according to standard protocols.
Statistical analysis of pregnancy outcome was performed using
Fisher's exact test. Results Patient populations in the three
treatment groups were similar in terms of age, past miscarriages,
inherited thrombophilia and autoimmunity. The live birth rate
was 19% (4/21) in group I, 54% (20/37) in group II, and 71%
(12/17) in group III. There was significant improvement in
pregnancy outcome in group II versus group I (P = 0.0127) and
in group III versus group I (P = 0.0026). The live birth rate
in group III compared to group II was not significantly different
(P = 0.3723). Side effects of AC, IVIG and TNF inhibitor treatment
were minimal in these patients, and no birth defects were identified
in their offspring. Conclusion In women with RSA, addition
of either IVIG or a TNF inhibitor + IVIG to the AC regimen
appears to improve live birth rates compared to the treatment
with AC alone. The positive effect of IVIG and TNF inhibitor
therapy on pregnancy outcome merits further study in prospective
clinical trials.
4: Lash GE, Quenby S, Burton GJ, Nakashima A, Kamat BR, Ray
J, Bulmer JN.
Gestational Diseases - A Workshop Report.
Placenta. 2008 Mar;29S:92-94. Epub 2007 Nov 26.
Uterine Cell Signalling Group, Institute of Cellular Medicine,
3rd Floor, William Leech Building, Newcastle University, Newcastle
upon Tyne NE2 4HH, UK.
Between 11% and 20% of all clinically recognised pregnancies
are lost before the 20th week of gestation, with huge financial
and personal implications. Immune mechanisms have been proposed
to play a role in unexplained recurrent miscarriage. Considerable
attention has focused on endometrial leucocyte populations
in recurrent miscarriage, although the underlying pathogenesis
remains largely unexplained. The mechanisms underlying sporadic
miscarriage are even less well understood, although aneuploidy
is the commonest attributable cause of early (</=12 completed
weeks gestation) sporadic miscarriage. Hydatidiform mole is
a rare cause of early pregnancy loss with marked geographical
variation in incidence. Both complete and partial hydatidiform
mole are associated with excessive trophoblast proliferation
and hence provide an opportunity to study trophoblast growth
regulation.
5: Poespoprodjo JR, Fobia W, Kenangalem E, Lampah DA, Warikar
N, Seal A, McGready R, Sugiarto P, Tjitra E, Anstey NM, Price
RN.
Adverse pregnancy outcomes in an area where multidrug-resistant
plasmodium vivax and Plasmodium falciparum infections are endemic.
Clin Infect Dis. 2008 May 1;46(9):1374-81.
District Health Authority, School of Health Research-National
Institute of Health Research and Development Malaria Research
Program, Indonesia.
BACKGROUND: Plasmodium falciparum infection exerts a considerable
burden on pregnant women, but less is known about the adverse
consequences of Plasmodium vivax infection. METHODS: In Papua,
Indonesia, where multiple drug resistance to both species has
emerged, we conducted a cross-sectional hospital-based study
to quantify the risks and consequences of maternal malaria.
RESULTS: From April 2004 through December 2006, 3046 pregnant
women were enrolled in the study. The prevalence of parasitemia
at delivery was 16.8% (432 of 2570 women had infections), with
152 (35.2%) of these 432 infections being associated with fever.
The majority of infections were attributable to P. falciparum
(250 [57.9%]); 146 (33.8%) of the infections were attributable
to P. vivax, and 36 (8.3%) were coinfections with both species.
At delivery, P. falciparum infection was associated with severe
anemia (hemoglobin concentration, <7 g/dL; odds ratio [OR],
2.8; 95% confidence interval [95% CI], 2.0-4.0) and a 192 g
(95% CI, 119-265) reduction in mean birth weight (P<.001).
P. vivax infection was associated with an increased risk of
moderate anemia (hemoglobin concentration, 7-11 g/dL; OR, 1.8;
95% CI, 1.2-2.9; P=.01) and a 108 g (95% CI, 17.5-199) reduction
in mean birth weight (P<.019). Parasitemia was associated
with preterm delivery (OR, 1.5; 95% CI, 1.1-2.0; P=.02) and
stillbirth (OR, 2.3; 95% CI, 1.3-4.1; P=.007) but was not associated
with these outcomes after controlling for the presence of fever
and severe anemia, suggesting that malaria increases the risk
of preterm delivery and stillbirth through fever and contribution
to severe anemia rather than through parasitemia per se. CONCLUSIONS:
These observations highlight the need for novel, safe, and
effective treatment and prevention strategies against both
multidrug-resistant P. falciparum and multidrug-resistant P.
vivax infections in pregnant women in areas of mixed endemicity.
6: Chen LJ, Zhou H, Zou L.
Defect in lipid rafts results in failed tolerance induction
at the maternal-fetal interface: A possible cause for the
recurrent spontaneous abortion.
Med Hypotheses. 2008 Apr 14 [Epub ahead of print]
Department of Obstetrics and Gynecology, Union Hospital,
Tongji Medical College, Huazhong University of Science and
Technology, 1277 Jiefang Road, Wuhan 430022, China.
The pregnancy is the successful induction and maintenance
of maternal tolerance to semi-allogeneic fetus. As a failure
result, recurrent spontaneous abortion occurs in about 1-2%
of women of reproductive age, defined as the loss of three
or more consecutive pregnancies. The mechanism of recurrent
spontaneous abortion is often elusive. Recently, mounting evidence
suggests that HLA-G induced suppressive uterine natural killer
(uNK) cells play an important role in the maternal-fetal tolerance
and their abnormalities are responsible for recurrent spontaneous
abortion. However, there are some clinical cases of recurrent
spontaneous abortion could not be detected of the HLA-G alterations,
while their uNK cells showed considerable cytolytic activities
against fetus. Thus we hypothesize that lipid rafts, specialized
micro-domains in plasma membrane, is of vital importance in
the HLA-G-NK cells interactions and the accompanied suppressive
induction process. We further hypothesize that the defect in
lipid rafts may result in failed tolerance induction at the
maternal-fetal interface, which would be a novel explanation
for the occurrence of recurrent spontaneous abortion. The hypothesis
can be practically evaluated by in vitro experiments and clinical
tests. To sum up, this hypothesis proposes a new mechanism
in the NK cells suppressive induction. Also the hypothesis
may provide new vision in the drug development and disease
control of recurrent spontaneous abortion.
7: Sugiura-Ogasawara M, Aoki K, Fujii T, Fujita T, Kawaguchi
R, Maruyama T, Ozawa N, Sugi T, Takeshita T, Saito S.
Subsequent pregnancy outcomes in recurrent miscarriage patients
with a paternal or maternal carrier of a structural chromosome
rearrangement.
J Hum Genet. 2008 Apr 15 [Epub ahead of print]
Department of Obstetrics and Gynecology, Nagoya City University
Medical School, Mizuho-ku, Nagoya, 467, Japan, og.mym@med.nagoya-cu.ac.jp.
Information concerning the prognosis of subsequent pregnancies
in patients with reciprocal translocations is limited. This
study was performed to determine the percentage success rate
with first pregnancies after ascertainment of a carrier status.
A total of 2,382 couples with a history of two or more consecutive
miscarriages were studied in multicenters. The prevalence of
an abnormal chromosome in either partner was examined, and
subsequent success rates were compared between cases with and
without an abnormal karyotype in either partner. A total of
129 couples (5.4%) had an abnormal karyotype in one partner
excluding inversion 9 in 44 men and in 85 women. Thus, 2,253
couples had a normal karyotype in both partner. Eighty-five
(3.6%) had translocations, 13 being Robertsonian translocations.
Twenty-nine of the 46 cases (63.0%) who became pregnant with
reciprocal translocations in either partner experienced a live
birth with natural conception. In contrast, 950 of 1,207 cases
(78.7%) with normal chromosomes had successful live births,
the difference being significant (P = 0.019). No infant with
an unbalanced translocation was found in 29 cases of successful
pregnancy following recurrent miscarriage. Pregnancy prognosis
was worsened with either maternal or paternal reciprocal translocations.
Explanation of the success rate with natural conception should
be provided before the subsequent pregnancy after ascertainment
of carrier status.
8: Hanprasertpong J, Hanprasertpong T.
Abruptio placentae and fetal death following a Malayan pit
viper bite.
J Obstet Gynaecol Res. 2008 Apr;34(2):258-61.
Department of Obstetrics and Gynecology, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Reports of venomous snakebites during pregnancy are uncommon.
Little is known about maternal and fetal outcome following
the venomous snakebite of a pregnant woman, and there is no
consensus for proper management. In southern Thailand, Malayan
pit viper (Calloselasma rhodostoma) bites are quite common,
and we have some experience with bites of pregnant women. With
these victims, the toxicity is most severely expressed in a
bleeding disorder that is a significant cause of both morbidity
and mortality in both the gravid woman and the fetus. Herein,
because there are few such published reports, we report the
case of a 43-year-old woman, gravida 5 para 4, 32 weeks pregnant
who was bitten by a Malayan pit viper and, as a result, developed
abruptio placentae, coagulopathy, and death of fetus in utero.
She otherwise responded well to antivenom and blood components.
A hysterotomy was performed and the postoperative course was
unremarkable.
9: Sengupta A, Kohli JK.
Antibiotic prophylaxis in cesarean section causing anaphylaxis
and intrauterine fetal death.
J Obstet Gynaecol Res. 2008 Apr;34(2):252-4.
Department of Obstetrics and Anesthesiology, Indira Gandhi
Hospital, Kavaratti, Lakshadweep, India.
Intrauterine fetal death and maternal shock occurred as a
result of a type-1 hypersensitivity reaction following antibiotic
prophylaxis in a cesarean section. Amniotic fluid embolism
may mimic the condition. The ability to diagnose and treat
such an event as early as possible is necessary in all maternity
centers. The selection of antibiotic regimen and the type of
anesthesia should be individualized depending upon the existing
facilities and the patient's profile, especially in a resource-scarce
developing country.
10: Mei S, Gu H, Wang Q, Zhang S, Zeng Y.
Pre-eclampsia outcomes in different hemodynamic models.
J Obstet Gynaecol Res. 2008 Apr;34(2):179-88.
Department of Pathology, Shanghai Medical College of Fudan
University, Shanghai, China.
Aim: To evaluate whether there is a significant relationship
between hemodynamic models and pre-eclampsia outcomes. Method:
A controlled experimental study was performed. We analyzed
2910 hemodynamic series systematically sampled from 970 pregnant
women three times every 2 weeks from the definite diagnosis
of pre-eclampsia until delivery. Women were divided into three
groups based on total peripheral resistance (TPR): a low-TPR
group, a normal-TPR group and a high-TPR group. Every group
was divided into three subgroups based on cardiac index (CI):
a low-CI subgroup, a normal-CI group and high-CI group. Common
lab tests, electrocardiographic examination, fundus examination,
cardiac function, liver function and kidney function were measured
after every hemodynamic monitoring. Primary outcomes included
various maternal and neonatal morbidity and neonatal and infant
mortality. Results: In our study we found seven hemodynamic
models in pre-eclampsia during the third trimester of pregnancy.
No significant differences in maternal age, weight, and height
were observed between the three groups. The low-TPR and normal-TPR
groups showed better disease results than the high-TPR group
in respect of HELLP (P < 0.01), lung edema (P < 0.01),
acute renal failure (P < 0.01), heart failure (P < 0.01),
neonatal intensive care unit admission (P < 0.01), infant
weight (P < 0.01), neonatal mortality (P < 0.01) and
infant mortality (P < 0.01). The low-TPR group had better
results than the normal-TPR group in respect of eclampsia (P < 0.01),
liver hemorrhage (P < 0.01), birthweight (P < 0.01) and
gestational week at birth (P < 0.05). Conclusion: Among
all the subgroups, the highest maternal and neonatal morbidity
was in the high-TPR-high-CI subgroup. There is clear relationship
between hemodynamic and disease outcomes during the third trimester.
Prepared by the
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