Falciparum Malaria in Pregnancy

EDITORIAL COMMENT We accepted this paper to remind readers to warn their patients about the problems of malaria prophylaxis, especially during pregnancy. The final sentence is repeated as a summary Women who are pregnant or planning pregnancy are advised to avoid travel to high-risk areas, since prophylaxis is inadequate. See also 'Failure of chloroquine malaria prophylaxis in pregnancy' Mola G L, Wanganapi A. Aust NZ J Obstet Gynaecol 1987; 27: 24–26.     

Malaria and Pregnancy: A Global Health Perspective

Malaria, a parasitic infection transmitted by mosquitoes, is one of the most devastating infectious diseases, killing more than 1 million people annually. Pregnant women, children, and immunocompromised individuals have the highest morbidity and mortality, and Africa bears the heaviest burden. The World Health Organization defines malaria as a disease of poverty caused by poverty. Pregnant women infected with malaria usually have more severe symptoms and outcomes, with higher rates of miscarriage, intrauterine demise, premature delivery, low-birth-weight neonates, and neonatal death. They are also at a higher risk for severe anemia and maternal death. Malaria can be prevented with appropriate drugs, bed nets treated with insecticide, and effective educational outreach programs.Key words: Plasmodium falciparum, Malaria, pregnancy, Malaria, immunocompromised host, Malaria, neonatesMalaria is the second most common cause of infectious disease-related death in the world, after tuberculosis. It is estimated to affect between 350 to 500 million people annually and accounts for 1 to 3 million deaths per year.^1,2 Sub-Saharan Africa has the largest burden of malarial disease, with over 90% of the world’s malaria-related deaths occurring in this region. Twenty-five million pregnant women are currently at risk for malaria, and, according to the World Health Organization (WHO), malaria accounts for over 10,000 maternal and 200,000 neonatal deaths per year.³These figures may underestimate the impact malaria has in maternal morbidity and mortality. A recent study from Mozambique that assigned cause of maternal death via autopsy examination found that up to 10% of maternal deaths were directly attributed to malarial infection and 13% were secondary to human immunodeficiency virus (HIV)/AIDS, which can be exacerbated by coexisting malarial infection.⁴ This suggests that in parts of the world where malaria is endemic, it may directly contribute to almost 25% of all maternal deaths.Malaria in pregnancy also contributes to significant perinatal morbidity and mortality. Infection is known to cause higher rates of miscarriage, intrauterine demise, premature delivery, low-birth-weight neonates, and neonatal death. As funding increases to combat both malaria and maternal mortality, understanding how malaria specifically affects pregnant women is crucial in our efforts to improve maternal and perinatal health and curb the spread of this preventable infectious disease.     

甲氨蝶呤预防腹腔镜手术后持续性异位妊娠的研究

目的:探讨异位妊娠腹腔镜保守性手术后预防持续性异位妊娠(PEP)的方法。方法:对86例输卵管妊娠患者行腹腔镜保守性手术后随机分成两组:A组采用甲氨蝶呤(MTX)注入患侧输卵管近端残腔;B组除用MTX外,并于术后口服米非司酮。所有患者均于术前及术后24小时、72小时、7天、12天检测血-βHCG值并观察其毒副反应的发生。结果:A组PEP发生1例(2.27%),B组2例(4.76%),差异无显著性(P>0.05);术后24小时血-βHCG值较术前明显下降(P<0.01),但两组间差异无显著性(P>0.05);术后72小时、7天血-βHCG值两组间差异无显著性(P>0.05),但12天两组间差异有非常显著性,B组明显高于A组(P<0.01);且B组出现的毒副反应明显多于A组。结论:单用MTX对异位妊娠腹腔镜保守性手术后预防PEP发生,可能要优于MTX加米非司酮。     

紧急避孕失败后继续妊娠95例初步临床观察

目的:了解左炔诺孕酮紧急避孕失败而又自愿生育者,其所用药物对妊娠及胎儿有否不良影响。方法:连续3次随访观察95例对象和她们的对照组。随访分别在孕13-15周、孕24周左右和分娩后,用B超作胎儿生长发育监测和胎儿畸形筛查。结果:妊娠15周内研究组自然流产18例(18.95%),对照组11例(11.58%)。第2次随访时2组均发现畸形胎儿1例。最后研究组分娩正常新生儿74例,新生儿畸形和重度窒息各1例。对照组分娩正常新生儿83例,新生儿湿肺症1例。2组在上述各方面的差异均无统计学意义。结论:除自然流产率略高于正常人群外,胎儿和新生儿畸形发生率并未明显升高,所出现重度窒息者与服用左炔诺孕酮间未见因果关系。     

妊高征并发急性肾功能衰竭11例分析

目的 :了解妊高征并发急性肾功能衰竭 (ARF)的发病特点、探讨其发生规律及防治措施。方法 :对 30 5 2 0例产妇进行回顾性分析。结果 :30 5 2 0例产妇中 ,妊高征患者 5 14例 ,急性肾功能衰竭患者 11例 (占分娩总数的 0 .0 4 % ,占妊高征总数的 2 .1% )。诱因 :感染 (2 7.2 % )、心力衰竭 (18.2 % )、原有肾炎 (占 18.2 % )、妊娠肾病综合征、药物、胎盘早剥、DIC(各占 9.1% )。结论 :妊高征并急性肾功能衰竭的发病率为 2 .1% ,与原有肾损害、产时合并感染、心功能衰竭、DIC、胎盘早剥等有关。及时终止妊娠 ,控制高血压和各种诱因是关键 ,内科保守治疗加透析疗法 ,可减少母婴死亡 ,提高 ARF抢救成功率     

A Comparison of Early Pregnancy Failure and Ongoing Pregnancy Rates Between Fresh and Frozen Embryo Transfer Following In Vitro Fertilization

Summary: In order to compare pregnancy outcomes following fresh and frozen embryo transfer after invitro fertilization (IVF), a retrospective analysis of data from the Royal North Shore IVF Programme was performed. Six hundred and sixty seven embryo transfers following routine IVF were performed during 1991 and 1992. Four hundred and twenty fresh embryo transfers were performed during that period, resulting in a clinical pregnancy rate of 21%. In comparison, 247 frozen transfers, where the initial procedure was routine IVF, were performed, resulting in a clinical pregnancy rate of 16.6%. This difference was not significant. When varying numbers of transferred embryos in the 2 groups were taken into account, there was a significant difference in the proportion of ongoing viable fetuses per embryo returned for 1991, but not for 1992. Although there were a greater number of abortions and ectopic pregnancies in the fresh transfer group, these differences did not achieve statistical significance. The implications of improving results from frozen embryo transfer are discussed.     

Malaria in pregnancy

Recently, there has been a resurgence of malaria in densely populated areas of the United States secondary to human migration from endemic areas where factors such as cessation of vector control, vector resistance to insecticides, disease resistance to drugs, environmental changes, political instability, and indifference, have played a role for malaria becoming an overwhelming infection of these tropical underdeveloped countries. It is important for health care providers of gravida to be alert of the disease and its effects on pregnancy.     

Malaria in pregnancy

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

Malaria in pregnancy

Malaria in pregnancy is one of the major causes of maternal morbidity worldwide, and leads to poor birth outcomes. There is a complex interaction between pregnancy and parasite-all favour the parasite and disadvantage the pregnant woman. Women who are semi-immune lose much of that immunity. They may present with placental malaria but with no parasites in their peripheral blood. A non-immune pregnant women and her fetus are at serious risk from falciparum malaria. The diagnosis and management of malaria in pregnancy, including the safety of antimalarial drugs and interactions of malaria with HIV in pregnancy are reviewed.     

Prophylaxis against thromboembolism in gynecologic patients

Deep venous thrombosis and pulmonary emboli remain a significant cause of postoperative morbidity and mortality in gynecologic patients. While numerous reports indicate the benefits of different prophylactic measures, no clear "best" method of prophylaxis has emerged. This review is intended to familiarize the practicing gynecologist with risk factors, methods of detection and risks and benefits associated with prophylactic regimens.     

Single Dose Tinidazole Prophylaxis in Hysterectomy

The results of this randomized double blind, placebo controlled trial of a single oral dose of 2 g tinidazole or placebo approximately 12 hours before hysterectomy showed the incidence of infective morbidity in patients who received placebo was 12.2% compared with 1.9% in patients who received tinidazole, (p = 0.045). The mean serum concentration of tinidazole at the time of surgery was 35 mcg/ml, which was well in excess of the minimum concentration required to inhibit all of the 95 anaerobes isolated in this study. Serum tinidazole concentration remained adequately inhibitory for at least 24 hours after surgery. The ability of tinidazole prophylaxis to reduce further our already low rate of febrile morbidity was considered a worthwhile gain. It is now Unit policy to give this agent prophylactically to all patients if the integrity of the vagina is likely to be breached at the time of surgery.     

Evaluating Chronic Endometritis in Women with Recurrent Implantation Failure and Recurrent Pregnancy Loss by Hysteroscopy and Immunohistochemistry

Study ObjectiveThe identification of less invasive methods with acceptable diagnostic value for evaluating intrauterine abnormalities can improve the satisfaction of patients and physicians. Although hysteroscopy plus biopsy has favorable predictive and diagnostic values, limited studies have evaluated its value, and the exact value of this method is not completely understood. The aim of this study was to evaluate the prevalence of chronic endometritis in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) by hysteroscopy and immunohistochemistry.DesignA cross-sectional study.SettingAn infertility clinic at Jundishapur University Hospital, Ahvaz, Iran.PatientsWomen with RIF after IVF and RPL.InterventionsHysteroscopy on the third to fifth day after finishing the menstruation cycle and then a biopsy for immunohistochemistry by a specific monoclonal antibody against the CD138 marker.Measurements and Main ResultsIn total, 85 patients with a mean age of 36.08 ± 5.76 years underwent hysteroscopy on the third to fifth day after finishing the menstruation cycle. At the end of hysteroscopy, a biopsy was taken and assessed using immunohistochemistry by a specific monoclonal antibody against the CD138 marker. Immunohistochemical staining findings of >5 plasma cells per 20 high-power fields were considered the gold standard. The prevalence of chronic endometritis (CE) in both groups and the diagnostic value of hysteroscopy were evaluated. All data were analyzed using the Fisher exact test and analysis of variance. The prevalence of RIF-related CE was 23.4% (11); 21.3% (10) of the cases were diagnosed by hysteroscopy. The prevalence of RPL-related CE was 36.8% (14) and 31.6% (12) based on hysteroscopy and immunohistochemistry staining, respectively. Subsequently, 10 patients (RIF/RPL-related CE with a positive hysteroscopic outcome) were selected randomly for in vitro fertilization therapy, and 3 (30%) of them eventually became pregnant. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy in diagnosing CE were 86.36%, 87.30%, 70.37%, and 94.82%, respectively.ConclusionHysteroscopy is a reliable diagnostic technique in patients with RIF after in vitro fertilization and RPL that can reliably diagnose chronic endometritis.