Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).

The inevitable and incidental caesarian myomectomy

The management of fibroid encountered during caesarean remains controversial. The traditional approach has always been, not to perform myomectomy, because of the fear of haemorrhage due to increased vascularity and uterine atonicity of pregnant uterus and increased morbidity. Caesarean section was performed in 27-year G2P1 in view of previous LSCS, short inter-conception period, frank leaking and poor bishop score. After delivery of baby a fibroid of 6 cm by 5 cm was seen jutting out of left side of incision line. Myomectomy was performed, without any complication, as it was not possible to approximate the incision line without that. No excessive hemorrhage or postoperative complications were encountered.

Retained placenta accreta: An unusual cause of abnormal uterine bleeding in a non-gravid woman

@#Placenta accreta is one of the most feared complications among gravid women, as it is associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage. Due to its natural history, placenta accreta is only naturally seen or expected as a cause of bleeding only among obstetric patients. This case report describes a rare manifestation of profuse abnormal uterine bleeding secondary to a placenta accreta in a non-gravid patient. The non-pregnant state was evidenced by the absence of history of amenorrhea and pregnancy signs and symptoms, a negative urine pregnancy test and normal serum bhcg results. A diagnosis of placenta accreta was mainly based on a post-hysterectomy histopathological examination. Theoretical explanations to explain this phenomenon is discussed in this case report.

Human ocular thelaziasis caused by gravid Thelazia callipaeda � A unique and rare case report

An 80-year-old male reported to the clinic with complaints of diminished vision, foreign body sensation, and occasionally some black object moving in front of the right eye. Detailed ocular examination revealed three slender creamy white live worms in the conjunctival sac of the right eye. Total three worms were retrieved and sent to the pathology department for detailed examination. The worm was identified as gravid Thelazia callipaeda. As per the search results in PubMed and Cochrane search engine, this is the first report of human case of gravid Thelazia infestation with simultaneous existence of embryonated or ensheathed eggs and primary-stage larvae in the same worm.

Rupture of Gravid Bicornuate Uterus as a Rare Cause of Acute Abdomen: A Case Report.

Pregnancy in rudimentary horn of uterus is a rare and fatal complication of mullerian duct anomaly. We report one such female presenting with acute abdomen and amenorrhea to highlight the importance of keeping this in differential diagnosis of acute abdomen of women of child bearing age.

Maternal - Fetal Interaction: An Insight through the Stable Isotope Fractionation Prism.

Aims: To compare carbon and nitrogen isotopic composition of maternal and fetal organs. Study Design: Cross-sectional study. Place and Duration of Study: Biology Department of Lomonosov Moscow State University; Institute of Geochemistry and Analytical Chemistry, Russian Academy of Sciences; 2008 – 2011. Methodology: Mass spectrometric measurements of carbon and nitrogen isotopic ratios of corresponding maternal and fetal organs of gravid mice fed a monotonous diet. Results: Both the maternal and fetal organs (kidney, muscles, liver, myocardium, brain) of mice at the last term of gestation are enriched in 13C and 15N relative to food consumed. Isotopic composition of organs strongly depends on the number of bearing fetuses. The increase of fetuses’ number results in coordinated 13C depletion and 15N enrichment in both the maternal and fetal organs. Conclusion: The alteration of the δ13C and δ15N values reflects solely the metabolic restructuring during a pregnancy, since mice were fed the monotonous diet prior to conception and during gestation. Isotopic alterations develop as a reaction to the nutritional stress of the maternal organism under the trophic demands of fetuses. The protein replenishment is the most probable cause of isotope ratio changes. Under the controlled experimental condition the stable Isotope composition of biogenic elements can be used as integral indicators of metabolic efforts of the particular organismic structures. The predictive role of such integral indicators consists at least in limitation of possible biochemical conversions underlying the metabolism change.

Knowledge of breast feeding among primigravida mothers.

Background : Breast feeding, the most natural way of infant feeding to satisfy nutritional, metabolic and psychological needs of the baby. Objectives : To assess the knowledge of breast feeding among primi- gravida mothers attending ante-natal clinic and to determine the association between socio-demographic variables with their knowledge. Materials and Methods : Hospital based cross sectional study was conducted at Ante-natal clinic of Krishna Hospital and Medical Research Center, Karad district Satara. Pre-tested structured proforma used to collect information from 590 married primi gravid mothers attending anti-natal clinic during study period by utilizing personal interview method. Statistical Analysis : socio-demographic frequency percentage distribution, knowledge scoreing and statistical association was analysed by using chi-square test. Results: Out of 590 primi gravida mothers,59.66% showed fair quality of knowledge about breast feeding. knowledge about rooming in, family support for breast feeding & burping after breast feeding was 97.7%, 95.4% , 93.5% however weaning, colostrums feed, hazards of bottle feeding and prelactal food was 84%, 82.7%,75.5% and 54% respectively. Statistical association was existed between age, education, religion, socio-economic status & occupation of respondents with their knowledge about breast feeding (?2=151.52, p < 0.0001*; ?2=211.27,p<0.0001*; ?2=133.91,p < 0.0001*; ?2=35.59,p < 0.0001* and ?2=131.04,p<0.0001*) respectively. Conclusion: knowledge of breast feeding among primi gravida mothers attending ANC clinic was of fair in quality.

Caesarean myomectomy: Prospective study.

Introduction: Contrary to previous belief many studies published now have shown that myomectomy during cesarean section (CS) is a safe procedure with no significant increased risk of intra and postoperative complications. Methods: This prospective study was carried out in antennal mothers from May09 to Sep 10 in a tertiary care hospital of Uttar Pradesh after taking institutional ethical committee approval. Diagnosis of myoma was confirmed by ultrsonography. Only those mothers were included in the study who gave the informed consent to participate in study. Cesarean myomectomy was planned in all mothers having myoma. Operative time, intraoperative haemorrhage and length of hospital stay of mothers having myoma were compared to matched pregnant women with CS alone (28cases). Data were collected on a questionnaire and analyzed by appropriate test of significance. Results: Out of 966 antenatal mothers registered during the study period myoma was detected in 14(1.18%) cases. Mean age mothers of having myoma were 27.08 years and 61.54% were primigravida and only 23.08 % were third gravida. In 61.54% mother’s parity was zero and only 15.39 % mothers were having parity two. Mean haemoglobin was 10.56 gm%. In all cases presentation of foetus was vertex. In 92.3% mothers location of myoma was at anterior wall and subserous and in 7.7% cases it was fundal . Size of myoma was less than 3.0 Cm in 38.50 cases , 3.1 Cm to 5.0 Cm in 23.1% cases and more than 5.1 Cm in 38.4% cases. There was no significant difference in operative time, intraoperative haemorrhage and length of hospital stay in comparison to matched pregnant women with CS alone. Postnatal period was uneventful and complication like PPH was nil in all in cesarean myomectomy cases. Conclusion: caesarean myomectomy can be safely performed in majority of patients with myomas without any serious or life threatening complication.

In vivo effects of Buthus occitanus tunetanus and Androctonus australis garzoni scorpion venoms on pregnant and non-pregnant rats

Scorpion envenomation in pregnant victims has been scarcely studied. Accidents with venomous animals can induce serious injuries for both mothers and embryos. In the current work, the lethality of Buthus occitanus tunetanus (Bot) and Androctonus australis garzoni (Aag) venoms was assessed in pregnant and non-pregnant murine rat models. The median lethal dose (LD50) was determined following the Spearman-Karber method. Our results showed great similarities of envenomation symptoms between term-pregnant and nonmated rats. An unusual vaginal bleeding was also seen in pregnant rats envenomed with Bot and Aag venoms. Our findings suggest that gestation may increase the venoms toxicity in rats.(AU)

SOME ASPECTS OF THE BIOLOGY OF Macrobrachium dux (LENZ, 1910) (CRUSTACEA:DECAPODA:NATANTIA) IN RIVER OROGODO, NIGER DELTA, NIGERIA / Algunos aspectos de la biología de Macrobrachium dux (Lenz, 1910) (Crustacea:Decapoda:Natantia) en el río Orogodo, delta del Niger, Nigeria

Preliminary investigation into some aspects of the biology of the palaemonid prawn, Macrobrachium dux (Lenz, 1910) in River Orogodo at Abavo, southern Nigeria was carried out between March and August 1995. The freshwater prawns were collected with properly baited cage traps and scooping with hand basket. The study revealed that the prawn species were widespread and abundant in the river. Abundance in terms of number and biomass was more during the wet season with a peak in August. Both adults and juveniles showed a progressive increase from late dry season to midrainy season (August). The malefemale ratio was 1:1.2. The fluctuation in the number and percentage of ovigerous females indicated that the prawn spawned during the midrainy season (JuneAugust). Ovigerous females ranged from 4.6 to 7.5 cm and egg size varied from 1.5 to 1.7 mm. The prawn attained a maximum total length and weight of 7.5 cm and 7.0 g respectively. Its growth pattern was allometric. The mean monthly condition factor (k) ranged from 1.43 to 2.37 and generally showed a monthly fluctuation with a peak in July.

Una investigación preliminar de algunos aspectos de la biología del langostino Macrobrachium dux (Lenz, 1910) fue realizada en el río Orogota en Abavo, sur de Nigeria entre marzo y agosto de 1995. Los langostinos de agua dulce fueron recolectados con trampas y removidos con una canasta de mano. Este estudio reveló que las especies de langostinos se encontraban distribuídas ampliamente y en abundancia en este río. La abundancia en términos de número y biomasa fue mayor en la estación lluviosa con un pico en agosto. Tanto adultos como juveniles mostraron un crecimiento progresivo desde el final de la estación seca hasta la mitad de la estación luuviosa (agosto). La relación machoshembras fue de 1:1,2. La fluctuación entre el número y porcentaje de hembras ovígeras que los langostinos depositan sus huevos durante la mitad de la estación lluviosa. Hembras ovígeras oscilaron entre 4,6 y 7,5 cm y el tamaño de los huevos varió entre 1,5 y 1,7 cm. Los langostinos alcanzaron longitudes y pesos totales de 7,5 cm y 7 g respectivamente. Su patrón de crecimiento fue alométrico. El promedio mensual del factor de condición osciló entre 1,43 y 2,37 y mostró fluctuación mensual con el pico en julio.

Incarceration of the Gravid Uterus with Myoma: Report of One Patient Managed with Uterine Reduction / 대한산부인과학회잡지

Incarceration of the gravid uterus is a rare but serious complication of pregnancy. Reported is the case of a gravid 2, para 0, abortus 1 with known uterine subserosal myoma(5.3 x5.5cm sized) 26-year-old woman presented with acute dysuria and urinary retention. The patient was 14 weeks and 3 days pregnant and presented several week history of urinary frequency and sensation of incomplete bladder emptying. Examination revealed a retroflexed uterus with cervical opening pointing toward the anterior abdominal wall. An ultrasound revealed a thin, elongated maternal bladder and a uterus incarcerated between the sacral promontary and the pubis. The incarceration was successfully reduced by tenaculum traction of the cervical posterior lip without surgical intervention and had a normal infant of appropriate weight at term.

THE EFFECTS OF HEMODILUTION ON HEMODYNAMICS AND OXYGEN CARRYING CAPACITY IN GRAVID EWE AND FETAL LAMB / 대한마취과학회지

Massive bleeding during pregnancy has a significant effect on the mother and the fetus. To evaluate the safety of hemodilution as a therapy for hemorrhage during pregnancy, the author compared maternal and fetal hemodynamics and oxygen carrying capacity at varying conditions in gravid ewes. Six Corriedale-breed, near-term pregnant ewes (120-140 days gestation) were anesthetized with nitrous oxide, halothane and oxygen. After the vital signs became stable, the maternal and fetal parameters of hemodynamics and oxygen carrying capacity were measured as control values. After then, 15% of total estimated matemal blood volume (12.5 ml/kg) was removed over approximately 15 minutes and infusion of the same amount of a mixture of lactated Ringer's solution and 10% pentastarch was done simultaneously (15% bleeding). Twenty minutes later the same parameters were measured. After then, a second phlebotomy was performed to remove an additional 15% of the total estimated maternal blood volume and infusion of the same amount of a mixture of the same solutions was done simultaneously (30% bleeding). And the same parameters were measured. Data collections included matemal heart rate, systolic, diastolic and mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, hemoglobin, hematocrit, serum lactate, arterial and mixed venous pH, oxygen tension, carbon dioxide tension, oxygen saturation, and fetal heart rate, systolic, diastolic and mean arterial pressure, hemoglobin, hematocrit, serum lactate, and umbilical arterial and venous blood gas analysis. Matemal arterial blood pressure, heart rate, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and carfiac output revealed no significant changes, and there was neither hypoxemia nor acidosis in gravid ewes. Serum lactate concentration at 30% bleeding increased significantly but within normal range. Oxygen flux, oxygen consumption and oxygen extraction ratio revealed no significant differences. In fetal lamb blood pressure was not changed, but heart rate, serum lactate concentration and oxygen extraction ratio were revealed significant increases in 15% bleeding and 30% bleeding cases. In conclusion, gravid ewe was well tolerated to acute hemodilution, and.fetal lamb was well compensated.

The contractility of myometrial strips from the lower segment of human term gravid uterus in vitro.

Myometrial strips were taken from the lower segment of 20 parturients undergoing low transverse caesarean section. Nine were in latent phase and 11 were in active phase of labor. Each strip was divided into 2-8 small strips of equal size. The pattern of isotonic contraction in vitro was observed. Spontaneous contraction, showing viability of the strips, could be obtained in 83.70 percent of total of 49 strips from the latent phase parturients and in 90.40 percent of a total of 52 strips from the active phase parturients. The period of contraction was the only parameter analysed to demonstracte the active phase parturients. The period of contraction was 11.33+6.31 minutes in the latent phase group and 11.99+5.23 minutes in the active phase group. The data showed no statistically significant difference by the Wilcoxon rank-sun test (p=0.425). In conclusion, the pattern of contraction of the myometrial strips from the lower segment of human term pregnant uterus in vitro was the same in the latent phase as in the active phase. Further study is suggested to confirm and further investigate the aetiologies of this finding.

Rupture of the gravid uterus.

Rupture of the gravid uterus, the most tragic obstetric emergence, is said to occur infrequently nowadays due to efficient antenatal and intranatal intensive care. Forty-six incidents of uterine rupture were reviewed among 197, 254 deliveries during 1978-1987, that is 1 per 4288 deliveries. There were 20 cases of previous scarred rupture, 18 traumatic, and 8 cases of spontaneous ruptures. A rupture of a previously scarred uterus had an approximately equal number of classical and low transverse scars. Maternal and fetal prognoses were much better with low transverse scars. A rupture of the previously unscarred uterus was a more dramatic event. It tended to be longitudinal and complete, and fetal prognoses were relative poor. About 28% of the ruptures were diagnosed prior to delivery, 33% were noticed at operation, and 39% were observed only after delivery and diagnosed by manual uterine exploration. The majority of cases were managed by hysterectomy rather than repair. Under special circumstances, the uterus may be repaired for subsequent reproduction. Maternal mortality was 2.2% and fetal loss 42.6%, 37% suffering from asphyxia at birth. Preventative measures, early diagnosis, and prompt treatment are emphasized.