Iron and folate status of pregnant black women in Gazankulu

A limited nutritional survey was carried out in 229 first attenders at an antenatal clinic in Gazankulu during the winter of 1984. Haemoglobin concentrations equal to or less than 11 g/dl were found in 33% of these women, the prime reason being folate deficiency. Serum folate concentrations were less than a 3.5 ng/ml in 60% of subjects and less than 3.0 ng/ml in 48%. A mean corpuscular volume of 100 fl or more, which reflects a defect in red cell DNA synthesis, was present in 35%. Iron related measurements indicated that only 17% were also iron deficient but the figure is certainly an underestimate, since the presence of folate deficiency tends to mask concomitant iron deficiency. The findings underline the need for folate and iron supplementation in pregnancy; the very high prevalence of significant folate deficiency also indicates that serious consideration should be given to the fortification of maize meal with folic acid.     

Syphilis in the 'unbooked' pregnant woman.

To determine the prevalence of syphilis in the 'unbooked' pregnant woman attending King Edward VIII Hospital, Durban, mothers who had no previous history or record of antenatal care were studied over a 3-month period. One hundred and fourteen mothers were recruited, 35 (30.7%) of whom had reactive syphilis serology. None had clinical evidence of primary or secondary syphilis. Clinical evidence of congenital syphilis was found in 4 of the 35 (11.5%) babies born to mothers with reactive syphilis serology. While the fluorescent treponemal antibody absorption (FTA-ABS) IgG test was positive in umbilical cord and neonatal venous blood of all 35 babies, the FTA-ABS IgM test was negative in all specimens, including the sera from the 4 babies with clinical signs of syphilis. The FTA-ABS IgM test is therefore of little value for the laboratory confirmation of congenital syphilis. It also has limitations when it comes to screening asymptomatic neonates born to mothers with reactive syphilis serology.     

Serological markers of sexually transmitted diseases associated with HIV-1 infection in pregnant black women

While the prevalence of HIV-1 is increased in women attending sexually transmitted diseases (STD) clinics, in South Africa little is known about STD risk factors in women infected with HIV-1 in the general population. Serological markers of STDs were investigated in a cohort of 21 pregnant women, who were found to be carriers of HIV-1, and in 42 age- and residentially matched uninfected pregnant women. The rapid plasma reagin test (RPR) was positive in 33% of the HIV-1- infected women (P less than 0.05 compared with controls). The specific treponemal fluorescent antibody absorbed test (FTA-abs) was positive in 43% of the HIV-1-infected women (P less than 0.05 compared with controls). Similarly the prevalence of chlamydial IgG antibodies as measured by enzyme-linked immunosorbent assay was 95% (P = 0.026 compared with controls). Markers of hepatitis B infection were similar to both groups. Pregnant women with HIV-1 infection in the Johannesburg area have an increased seroprevalence of markers of STDs and more data are required on the attitudes and sexual activity of these women in order to target AIDS and education information.     

Epilepsy in pregnant women

Opinion statement  

Kidney function in pregnant women

In pregnancy, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) increase to levels approximately 50% to 80% above nonpregnant levels. The increments occur shortly after conception and persist throughout the second trimester, with some reduction in late pregnancy. There is no accelerated growth akin to compensatory hypertrophy. The increased excretion of glucose and other nutrients in as well uric acid and protein is related in part to altered tubular function. These changes in renal physiology are so marked that nonpregnant norms cannot be used for the management of pregnant women. Cognizance of all these alterations is essential if kidney problems in pregnancy are to be suspected, detected, and managed correctly.     

Intracardiac surgery in pregnant women

A survey of members of The Society of Thoracic Surgeons was undertaken to obtain information on experiences with cardiac operations in pregnant women. The experiences reported were highly successful, with only 1 maternal death in 68 procedures utilizing cardiopulmonary bypass and more than 80% survival of fetuses. Cardiac operations in pregnant patients probably can be made safer by avoidance of perfusion hypothermia and by use of fetal heart and uterine monitoring. When valve replacement is necessary, use of biological valves is recommended to avoid the necessity for anticoagulation.     

Supplementary tests in pregnant women

Additional examinations of pregnant women (radiology...) are a real danger, but radiographies CT scans and ultrasound examinations must be carried out when necessary.     

Diagnostic laparoscopy in pregnant women

54 laparoscopic examinations were performed in 52 pregnant women when acute surgical diseases of the abdomen were suspected. When the suspicions of acute surgical diseases in pregnant women are substantiated, diagnostic laparoscopy has high diagnostic potential and is safe for the mother and fetus. This method permits to avoid unnecessary open operations, and also to perform simple operations through laparoscope.     

Breast lumps in pregnant women

Breast lumps detected during pregnancy are generally benign and reflect fibroadenoma, lactating adenoma, cysts, infarction of the breast or galactocele. Although rare, the possibility of breast cancer must also be considered to avoid any delays in diagnosis. After patient questioning and clinical examination, the first imaging modality to use is ultrasound. No further assessment is called for if lesions are categorized as BI-RADS 2 and no suspicious clinical signs are observed. Depending on the clinical setting, lesions classified BI-RADS 3 require monitoring and mammographic assessment (which can be helpful in diagnosing cancer and incurs no risk to the embryo or fetus). If the clinical signs are unclear and/or the lesion(s) are categorized as ≥ BI-RADS 4a, then mammography and often biopsy should be performed. Strict BI-RADS scoring (American College of Radiology) should be applied, bearing in mind that benign lesions can appear suspicious during pregnancy, and some cancers can exhibit what seem to be reassuring characteristics.     

Haemodynamics in obese pregnant women

BackgroundObesity in pregnant women is a serious health issue. Invasive monitoring devices are rarely used in pregnancy due to their risks; however, assessment of cardiac function is often required in these women. Transthoracic echocardiography offers advantages but may be technically difficult to perform. Our aim was to determine the feasibility of transthoracic echocardiography and to quantify left ventricular function and structure using transthoracic echocardiography in obese pregnant women.MethodFifteen obese but otherwise healthy pregnant women (body mass index >30 kg/m²), were compared with 40 healthy non-obese pregnant women. Echocardiography was performed according to American Society of Echocardiography recommendations.ResultsTest completion with key haemodynamic data were obtained in 100% of women. Gestational age (Mean ± SD) was similar between groups (36 ± 5 weeks). Compared with non-obese pregnant women, obese pregnant women had elevated mean arterial pressure (88 ± 6 vs. 81 ± 8 mmHg, P = 0.003), increased left ventricular mass (162.8 ± 35.4 vs. 130.8 ± 21.0 g, P = 0.008) but similar cardiac output (4417 ± 890 vs. 4109 ± 595 mL/min, P = 0.230) and diastolic changes (mitral valve E/se′ > 8 in 33% vs. 15% of patients, P = 0.26). Septal tissue Doppler indices in obese pregnant women were s′ 9.1 ± 1.9 cm/s, e′ 11.6 ± 2.6 cm/s, a′ 8.1 ± 2.7 cm/s. Tei index was reduced in both groups (0.49 ± 0.12 vs. 0.42 ± 0.09, P = 0.05).ConclusionsTransthoracic echocardiography was used to delineate haemodynamics in obese pregnant women. Mean arterial blood pressure and left ventricular mass were increased in obese pregnant woman. The incidence of diastolic impairment and reduced myocardial performance were similar between groups.     

Acute pancreatitis in pregnant women and women in childbirth

The result of treatment of 11 pregnant women with an acute pancreatitis in 1991-1998 period was analyzed. In all the patients biliary pancreatitis was diagnosed. The necessity of treatment of cholelithiasis in women before pregnancy as well as timely beginning of treatment of pregnant woman just from first signs of an acute pancreatitis occurrence were established.     

Cerebrospinal fluid progesterone in pregnant women

To assess the possible relationship between an increase in progesterone concentration in cerebrospinal fluid (CSF) and enhancement of spread of spinal anaesthesia, we have measured CSF progesterone concentrations in 134 patients undergoing spinal anaesthesia with hyperbaric amethocaine 8 mg. Patients were allocated to one of five groups according to the gestational period: non-pregnant group (n = 13), first trimester group (8-12 weeks, n = 16), second trimester group (13-24 weeks, n = 18), third trimester group (25-36 weeks, n = 38) and term group (37-41 weeks, n = 49). Progesterone concentration in CSF was higher in the third trimester and term groups than in the non-pregnant, first trimester and second trimester groups. Maximum cephalad spread of analgesia was higher in the second trimester, third trimester and term groups than in the non-pregnant and first trimester groups. Although an increase in CSF progesterone concentration in the second trimester group was similar in magnitude to that observed in the first trimester group, enhanced spread of spinal anaesthesia, comparable in magnitude with that observed in the term group, occurred in the second trimester group. There was no significant correlation between CSF progesterone concentration and spread of spinal anaesthesia in any of the groups. These data suggest that not only a minimum level of progesterone in CSF but also a certain duration of exposure to elevated CSF progesterone concentrations may be necessary for enhancement of spread of spinal anaesthesia, and that values of CSF progesterone concentration do not correlate directly with enhancement of spread of spinal anaesthesia.      

不同孕期妇女跟骨骨量检测结果分析

目的 探讨不同孕期妇女骨量的变化，指导孕妇合理补钙。方法 采用UBIS5000型超声成像骨量仪，测量300例不同孕期健康妇女跟骨超声振幅衰减（BUA）参数值，并与同年龄组非孕妇女结果进行比较。结果 中，晚期孕妇骨量均值均低于非孕及早孕期妇女，晚孕组与非孕组比较差异有显性（P＜0．05）。结论 孕期妇女存在不同程度骨量减少。骨量测定对孕期保健指导有重要意义。     

Acute aortic dissection in pregnant women

Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Management of parturient with acute aortic dissection is complex. We report our experience of two pregnancies with type A acute aortic dissection. One patient is a 31-year-old pregnant woman (33rd gestational week) with a bicuspid aortic valve and the other is a 32-year-old pregnant woman (30th gestational week) with the Marfan syndrome. In both cases, a combined emergency operation consisting of Cesarean section, total hysterectomy prior to corrective surgery for aortic dissection was successfully performed within a relatively short period of time after the onset. Both patients’ postoperative recovery was uneventful, and we achieved a favorable maternal and fetal outcome.     

Osteopathic manipulative treatment in pregnant women

Pregnant women experience extensive physiologic and structural changes during pregnancy that affect their daily functioning. The addition of osteopathic manipulative treatment (OMT) to the standard care of pregnant women has been hypothesized to enhance homeostasis and improve quality of life as the body adapts to these changes. Specifically, it has been postulated that OMT can ease pain in pregnant women by eliminating somatic dysfunction and maintaining proper structure. Also, through the viscerosomatic connection, the hemodynamic changes of the maternal body can be controlled, the duration of labor reduced, and the complications of labor avoided. The author reviews the available literature on the use and effectiveness of OMT during pregnancy.     

Acute pulmonary oedema in pregnant women

Acute pulmonary oedema in pregnant women is an uncommon but life-threatening event. The aims of this review are to address why pulmonary oedema occurs in pregnant women and to discuss immediate management. We performed a systematic literature search of electronic databases including MEDLINE, EMBASE and the Cochrane Library, using the key words obstetrics, pregnancy, acute pulmonary oedema, pregnancy complications, maternal, cardiac function and haemodynamics. We present a simple clinical classification of acute pulmonary oedema in pregnancy into pulmonary oedema occurring in normotensive or hypotensive women (i.e. without hypertension), and acute pulmonary oedema occurring in hypertensive women, which allows focused management. Pre-eclampsia remains an important cause of hypertensive acute pulmonary oedema in pregnancy and preventive strategies include close clinical monitoring and restricted fluid administration. Immediate management of acute pulmonary oedema includes oxygenation, ventilation and circulation control with venodilators. Pregnancy-specific issues include consideration of the physiological changes of pregnancy, the risk of aspiration and difficult airway, reduced respiratory and metabolic reserve, avoidance of aortocaval compression and delivery of the fetus.