Efficacy of chloroquine plus chlorpheniramine in chloroquine-resistant falciparum malaria during pregnancy in Nigerian women: a preliminary study.

The efficacy of chloroquine plus chlorpheniramine, a histamine H receptor antagonist, which reverses chloroquine 1 insensitivity in Plasmodium falciparum in vitro and in vivo , was evaluated in 30 pregnant women with recrudescent chloroquine-resistant Plasmodium falciparum malaria. All patients had at least one or more treatment failures with one or more courses of chloroquine or pyrimethamine-sulphadoxine. There was a prompt response to treatment with parasitaemia and fever clearing in all patients within 48 and 96 hours respectively of commencement of therapy with the combination. The cure rate on day 14 was 77%. Parasitaemia recurred in seven patients after day 14 and was successfully treated with oral mefloquine. The combination was well tolerated; pruritus and drowsiness were the only noticeable adverse effects. The progress of pregnancy and its outcome were not adversely affected by treatment with the combination. When fully developed, the combination of chloroquine plus chlorpheniramine may be an alternative in the treatment of chloroquine-resistant malaria during pregnancy in Nigerian women.     

Abnormal menstruation in malaria: a short review

Malarial infection is an important tropical mosquito borne infectious disease. An important unusual manifestation of malaria is the abnormal menstruation. In this brief review, the author will focus on the abnormal menstruation in malarial infection.     

Measles in pregnancy: a review

Although measles is usually considered a benign viral disease of childhood, people may be affected whatever their age with severe pneumologic or neurologic consequences are more frequent before 5 years old and after 20 years old. The consequences of a congenital measles, defined as a newborn eruption within 10 days after birth, can be dramatic. The incidence of measles has significantly decreased since first vaccines were introduced in the late 1960s. In France, active immunization for measles is proposed since 1983. Since the beginning of 2008, France has been experiencing a measles outbreak with more than 17,000 notified cases. The current measles outbreak affects more particularly very young children and young adults and, among these, pregnant women. Measles during pregnancy may be severe mainly due to pneumonia. Measles is associated with a risk of miscarriage and prematurity, but congenital anomalies have not been described. If rash occurs near term, the consequences of congenital measles could be severe. Prevention of measles in pregnant women is based on improving immunization coverage, currently insufficient to eradicate virus circulation. The aim of this review is to state on the latest data concerning measles virus, give latest vaccine recommendations, and also to suggest management of measles contact or measles infection during pregnancy.     

Ectopic pregnancy: a review

Purpose

Ectopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2–1.4 % of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment.

Results

It was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP.     

Diabetic retinopathy in pregnancy: a review

Diabetic retinopathy is the leading cause of blindness between the ages of 24-64 years. The first half of this period corresponds to peak fertility and the childbearing years. The effects of pregnancy on diabetic retinopathy are unclear, but recent studies suggest that pregnancy may be less harmful to the retina of the diabetic subject than was thought previously. Nevertheless, there is reason to believe that at least some women experience a worsening of their retinopathy as a result of pregnancy. Thus, careful ophthalmic evaluation and follow-up are essential for the pregnant woman with diabetes. This should include a minimum of one complete eye examination every trimester and within 3 months postpartum. Color fundus photography and laser treatment are safe, whereas fluorescein angiography, although commonly used to evaluate retinal vascular disease, can usually be avoided during pregnancy.     

Gynaecological malignancies in pregnancy: a review

Gynaecological malignancies frequently occur in women of reproductive age and are estimated to complicate approximately one in 1000 pregnancies. The incidence of gynaecological malignancies during pregnancy is expected to rise as more women delay childbearing into their later reproductive years, and maternal age is the most powerful predictor of cancer risk. Pregnancy-associated malignancies present significant challenges as a result of the conflict between optimal maternal therapy and fetal well-being. The lack of prospective randomised treatment studies has prevented the development of clinical guidelines for most of the issues complicating the management. In the present review, recent diagnostic and treatment strategies for cervical, ovarian, vulvar and endometrial carcinomas during pregnancy are presented.     

Malaria in pregnancy: a literature review

Pregnant women are more likely than nonpregnant women to become infected with malaria and to have severe infection. The effects of malaria during pregnancy include spontaneous abortion, preterm delivery, low birth weight, stillbirth, congenital infection, and maternal death. Malaria is caused by the four species of the protozoa of the genus Plasmodium, which is transmitted by the bite of the female Anopheline mosquito, congenitally, or through exposure to infected blood products. This article reviews the epidemiology, pathology, clinical symptoms, diagnosis, and treatment of malaria in pregnant women. Interventions to prevent malaria include intermittent preventive treatment, insecticide-treated nets, and case management of malaria infection and anemia.     

Thrombolysis in pregnancy: a literature review

Background: Changes in the coagulation system during pregnancy and puerperium produce a physiological hypercoagulable state. These changes are thought to be the cause of the higher rates of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and mechanical prosthetic valve thrombosis (PVT) during pregnancy. Thrombolysis can be a treatment option in this case. However, there are no available data from randomized controlled trials in pregnant patients and information about the security of thrombolytics in pregnancy is missing.

Objective: The aim of this review is to summarize the available data regarding the use of thrombolytic agents in pregnancy, describing maternal and fetal outcomes.

Methods: A systematic review was performed, searching the electronic database MEDLINE for relevant studies published up to April 2017. The search included MeSH terms “thrombolytic therapy” OR “fibrinolysis” OR “streptokinase” OR “tissue plasminogen activator” AND “pregnancy”. All publications that reported the use of a thrombolytic agent for DVT, PE, stroke or PVT in pregnancy were included in the review. Data on the type and total dose of the thrombolytic agent, gestational week, outcome of mothers and children, preterm delivery and bleeding complications were described.

Results: Sixty-five articles have been published describing outcomes in 141 pregnant women with serious thrombotic events. There have been no randomized trials involving the use of thrombolytics in pregnancy. Only one prospective study was found. Four maternal deaths (2.8%), 12 major bleeding episodes (8.5%), 13 mild/moderate bleeding episodes (9.2%), two fetal death (1.4%), one child death (0.7%), nine miscarriages (6.4%), and 14 preterm delivery (9.9%) were described.

Conclusions: The risk of using thrombolytics in pregnancy seems reasonable taking into account the risk of death in a life-threatening event, with the majority of cases presented in this article resulting in encouraging outcomes. The complication rate of thrombolytic treatment does not seem higher in pregnant women than in the nonpregnant. Poor fetal outcome occurred in mothers with poor prognosis. Specific consensus recommendations are needed in the use of thrombolytics in pregnancy.     

Electric shock in pregnancy: a review

Objective: The effect of gestational age and other factors that could influence the outcome of an electric shock in pregnancy have not been defined yet. Objective of this study is to provide reliable data on medical issues linked to electric shock in pregnancy.

Methods: Authors consulted the most important scientific databases investigating reactions to electric shock in pregnancy, analyzing mechanism of electric shock, gestational age at the time of injury, the post-shock complications, interval from injury to delivery and fetal and maternal outcome.

Results: The spectrum of electrical injuries in pregnancy ranges from transient unpleasant sensation with no effect on the fetus to sudden maternal and fetal death. The clinical presentation of the fetal injury may manifest immediately or even postnataly. Reported outcomes include spontaneous abortion, placental abruption, cardiac arrhythmias, fetal burn and intrauterine fetal death. If the pregnancy is continued, decreased fetal movements and asphyxia, pathological fetal heart patterns, intrauterine fetal growth retardation, damage to the fetal central nervous system and oligoamnios can occur.

Conclusions: More large prospective observational studies are necessary for a proper insight into the expected outcomes of the electric shock in pregnancy as well as for a final definition of monitoring procedures of such pregnancies.     

Yoga during pregnancy: a review

The purpose of this review article is to evaluate the peripartum outcomes of yoga during pregnancy, including the postpartum period and lactation. The PubMed database was analyzed from January 1970 to January 2011. We identified five prospective observational studies (n = 575) and three randomized clinical trials (RCTs; n = 298), which were analyzed separately. The nonrandomized trials indicated a significant reduction in rates of preterm labor (p < 0.0006), intrauterine growth retardation (p <0.003), low birth weight (p < 0.01), pregnancy discomforts (p = 0.01), and perceived sleep disturbances (p = 0.03) in those who practiced yoga during pregnancy. Results of the RCTs indicated that doing yoga during pregnancy can significantly lower pain and discomfort (p < 0.05) and perceived stress (p = 0.001) and improve quality of life in physical domains (p = 0.001). All three RCTs were poorly compliant with the Consolidated Standard of Reporting Trials statement. While awaiting an appropriately designed RCT to determine the benefits of yoga during pregnancy, it remains a viable exercise option.