Outcome of Pregnancy in an Oxford-Cardiff Cohort of Women with Previous Bacteriuria

To investigate the influence of asymptomatic bacteriuria inchildhood on subsequent pregnancy, we reviewed the outcome of139 pregnancies in 88 women who were first identified duringa programme of screening schoolgirls for asymptomatic bacteriuriacarried out between 1970–1972 [1]. Data were analysedfor the following groups: 50 pregnancies in 28 women with knownrenal scars (group 1); 16 pregnancies in 14 women with normalkidneys and reflux (group 2); 73 pregnancies in 46 women withnormal urinary tracts (group 3); 139 healthy controls. Women in group 1 had a 3.3-fold increased relative risk of hypertension(p < 0.01) and a 7.6-fold increased risk of pre-eclampsia(p< 0.05) compared to controls, and a higher rate of obstetricinterventions, including emergency caesarean section. Womenin groups 2 and 3 appeared to carry a slightly increased riskof hypertension during the last trimester (RR = 1.8) but therewere no significant differences in this or the incidence ofpre-eclampsia or mode of delivery. Bacteriuria was more prevalentin all index groups compared to controls (37 per cent vs. 8per cent, p < 0.01) and included four cases of acute pyelonephritisin the study group. Fetal outcome was satisfactory in all cases.These results suggest that women with renal scars are at riskof hypertension and pre-eclampsia during pregnancy but thatmodern obstetric care minimizes these risks.     

The XXXXY Sex Chromosome Abnormality

The most common sex chromosome complex in sex chromatin-positive males with Klinefelter's syndrome is XXY. When the complex is XXYY or XXXY, the clinical findings do not seem to differ materially from those seen in XXY subjects, although more patients with these intersexual chromosome complements need to be studied to establish possible phenotypical expressions of the chromosomal variants.

Two male children with an XXXXY sex chromosome abnormality are described. The data obtained from the study of these cases and five others described in the literature suggest that the XXXXY patient is likely to have congenital defects not usually seen in the common form of the Klinefelter syndrome. These include a triad of (1) skeletal anomalies (including radioulnar synostosis), (2) hypogenitalism (hypoplasia of penis and scrotum, incomplete descent of testes and defective prepubertal development of seminiferous tubules), and (3) greater risk of severe mental deficiency.

That the conclusions are based on data from a small number of patients is emphasized, together with the need for a cytogenetic survey of a large control or unselected population.