Detecting fetomaternal hemorrhage after first-trimester abortion with the Kleihauer-Betke test and rise in maternal serum alpha-fetoprotein

OBJECTIVE: To compare the incidence and detect the volume of fetomaternal hemorrhage (FMH) during first-trimester abortion with the Kleihauer-Betke test (KBT) and rise in maternal serum alpha-fetoprotein (AFP). STUDY DESIGN: Blood samples were drawn immediately before and after first-trimester termination of pregnancy in 48 women. AFP was estimated using an enzyme-linked immunosorbent assay technique. Fetal cells were counted using the acid elution technique described by Kleihauer. Volume of FMH with both techniques was calculated using standard formulae. Significant FMH was reported when there was a > 40% rise in AFP or > 0.25 mL bleed detected by KBT. RESULTS: Of the 48 cases studied, 18 (37.5%) showed no indication of FMH by either AFP or KBT. In 30 (62.5%) cases there was evidence of FMH; in 7 (14.6%) this was shown by both AFP and KBT. Another 10 (21%) showed significant changes in AFP concentration only, and 13 (27%) showed abnormal KBT results with stable AFP levels. The incidence of detectable FMH after first-trimester abortion in this series was 35% when assessed by AFP and 42% when assessed by KBT (P > .05). The mean volume of FMH detected by KBT was 0.5+/-0.05 mL and by AFP was 0.01+/-0.02 mL. CONCLUSION: This study showed that AFP and KBT are equally sensitive methods of detecting the incidence of FMH in first-trimester abortion, but concordance between the 2 tests is poor. The volume of FMH detected by KBT and FMH is also significantly different.     

Daily versus intermittent iron supplementation in pregnant women: hematological and pregnancy outcome

AIM: To compare the hematological parameters and pregnancy outcome in women receiving daily versus weekly iron supplements during pregnancy. METHODS: A prospective randomized controlled study was carried out at the Department of Obstetrics and Gynaecology of the All India Institute of Medical Sciences, New Delhi, India, during which 111 women were randomized to receive either 100 mg elemental iron daily (n=55) or 200 mg elemental iron weekly (n=56). Hemogram and serum ferritin level estimation were carried out at the beginning of pregnancy and within the 32-34-week period of gestation. Side-effects, compliance and the number of tablets consumed were noted for each group. The mean birth weight, period of gestation at delivery and mode of delivery were also compared between the two intervention groups. RESULTS: There was no significant difference in the mean hemoglobin levels between the two intervention groups at the end of an average 17 weeks of iron supplementation. However, among anemic women who received daily supplementation, there was a greater rise in hemoglobin compared with those receiving supplementation weekly. The serum ferritin level was lower in the weekly supplemented group compared with that in the daily. There was no difference in the mean birth weight, period of gestation and mode of delivery between the two groups. Side-effects and non-compliance were significantly higher (P<0.001) in the daily supplemented group. CONCLUSIONS: Weekly iron supplementation is an effective option for prophylaxis in non-anemic pregnant women, but has less than optimal benefit in anemic women.     

Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort

BACKGROUND: A few studies have examined change in cognitive performance by diabetes status with disparate results. We examined the 4-year change in cognitive performance among older adults according to glucose tolerance status. METHODS: Three cognitive tests (Mini-Mental State Examination, Verbal Fluency [VF] test, and Trail-Making Test B) were measured 4 years apart in 999 white men and women aged 42 to 89 years, who were enrolled in the Rancho Bernardo Study. Participants were classified with normal (NGT), impaired (IGT) or diabetic glucose tolerance. Sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E epsilon4 allele, and current estrogen use. We checked for mediation by further adjusting for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; blood pressure; glycohemoglobin level; and microalbuminuria, retinopathy, stroke, or coronary heart disease. RESULTS: At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes mellitus had a 4-fold increased risk of a major cognitive decline on the VF test after 4 years compared with nondiabetic women. After multivariate adjustment, VF test scores at follow-up for women were 15.2 +/- 0.6 for those with diabetes, 16.7 +/- 0.4 for those with IGT, and 17.2 +/- 0.2 for those with NGT (P =.007). Glycohemoglobin attenuated this effect, but lipid levels, blood pressure, and microvascular or macrovascular disease did not. Performance on Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status. CONCLUSIONS: Elderly white women with diabetes had a more rapid decline in performance on the VF test compared with women with IGT or NGT. Better glucose control might ameliorate this decline.     

Implementing reproductive and child health services in rural Maharashtra,India: a pragmatic approach

The Government of India has been providing limited maternal and child health services through its Family Welfare programme, but this system is characterised by weaknesses that include inefficient work schedules; non-availability of functioning equipment; poor contraceptive and drug supplies; poor skills and knowledge of health workers; and poor access to services in villages without health centres. For the new Reproductive and Child Health programme to deliver an even wider range of services, the health system will need to be strengthened and the quality of service delivery improved. This paper describes a seven-year operations research project in Parner block, Ahmednagar district, Maharashtra, India, undertaken by the Foundation for Research in Health Systems in partnership with state and district health administrations. It shows the feasibility of establishing a more efficient system, with a minimum of affordable inputs, that increases the use of services by women. Four critical policy changes were implemented: service delivery in each village was changed from household visits to a clinic base, stringent monitoring mechanisms were put in place, in-service training for health workers was instituted and the range of services was gradually increased. This experience is now being applied more widely, with eventual phasing up to full district and state level.     

Forgotten needle--an unusual cause of chronic pelvic pain

Case report A case presented with chronic pelvic pain since a Fothergills repair 9 years back. Over the years she had received multiple courses of antibiotics and anti-inflammatory drugs to no avail.Results Thorough evaluation revealed the presence of a foreign body in the form of a surgical needle in the cervix.     

Wilms' tumor: transureteral intravesical extension and presentation as urinary retention

The authors report an unusual case of Wilms’ tumor. The tumor grew transureterally into the urinary bladder, became dislodged, and presented as recurrent urinary infection with retention of urine after the child underwent nephroureterectomy. Such a presentation has not been reported earlier.