Obsetrical outcome of pregnancy in patients with systemic lupus erythematosus

To assess the impact of systemic lupus erythematous [SLE] on the outcome of pregnancy and the course of disease during pregnancy. During a period of three years we prospectively followed thirty pregnancies in thirty SLE patients in a tertiary care centre, for each case two age and parity-matched healthy control [60] were chosen. The management protocol included: * Planning of conception when disease was inactive. * Frequent follow-up visits by an internist-obstetrician team. * Use of sequential ultrasonographic, Doppler and fetal echo cardiographic examination. * Serial evaluation of maternal immunological condition. * The same dose of steroids or immunosuppressives as before pregnancy was continued. In the study group the mean age of patients was 27.1 +/- 3.8 years and mean previous duration of SLE at booking was [4.2 +/- 2.5]. SLE was active at conception in four cases [13.3%]; at that time all patients were taking prednisolone. In control group the mean age of patients was 25.3 +/- 3.2 years. In the study group there were 23 live birth [88.6%] with 15 full term and 8 premature deliveries, 4 [13.3] spontaneous abortion, 3 [10%] intra uterine foetal death. In the control group the were 54 live birth [98.1%] with 39 full term and 15 premature deliveries, 5 [8.3%] spontaneous abortion one [1.0%] intra uterine foetal death. The mean gestational age of live births were 35.8 weeks and 37.5 weeks respectively p<0.05. The mean birth weight of live births were 2108gm and 2750gm respectively p<0.05. Flares up of disease activity occur in 4 of 26 pregnancies. We conclude from our study that pregnancy induce SLE flare-up is uncommon but SLE is associated with increased incidence of intrauterine growth retardation. All of our patients were on corticosteroid therapy during pregnancy and it is possible that steroid therapy may have contributed to the low flare-up rate

Treatment of unruptured ectopic pregnancy with single-dose of methotrexate

The purpose of this study was to determine success rate with single-dose intramuscular methotrexate therapy for the treatment ectopic pregnancy. This was a retrospective review of patient who were treated with methotrxate from may 2003 to April 2006. Successful treatment was defined as resolution of ectopic pregnancy without surgical intervention. Tertiary centre. Our overall success rate was 90% [90/100 patient]. The median pre treatment serum beta-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure [3158 Vs 9249mIU/ml, p<0.0001]. The median time till resolution of ectopic was 30.7 days. A positive correlation was found between pre treatment beta hCG level and time to resolution [r=0.844]. Eight patients with positive ectopic cardiac activity were treated with an 75% success rate. This large series indicates that single-dose methotrexate for treatment of ectopic pregnancy is associated with an excellent rate

Preoperative vaginal preparation with povidone-iodine and post-cesarean infectious morbidity

Objective: to determine whether vaginal preparation with povidone-iodine before cesarean section decrease the incidence of postpartum infectious morbidity

Methods: a randomized, controlled study was performed on 304 women undergoing non-emergency cesarean delivery. The subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotics at the time of umbilical cord clamping. Each subject's postoperative course was reviewed for development of febrile morbidity [temperature >38.0 degree C], endometritis [temperature >38.4 degree C accompanied by fundal tenderness occurring beyond the first postoperative day, in absence of evidence of other infection], and wound infection

Results: post-cesarean endometritis occurs in 4.7% of subjects who received a preoperative vaginal preparation and 14.1% of controls [p=0.0097]. There was no measurable effect of a vaginal scrub on development of postoperative fever or wound infection. The adjusted odd ratio [OR] for developing endometritis after a vaginal preparation was 0.33 [95% confidence interval [CI] 0.287-0.831]. Multivariate analysis showed an increased risk of developing endometritis in association with severe anaemla [adjusted OR 1.22, 95% CI 0.755- 1.975]. Use of intraparturn internal monitors [adjusted OR 1.03, 95% CI 0.601 -1.756], or history of antenatal genitourinary infection [adjusted OR 0.988, 95% CI 0.612-1.596]

Conclusion: preoperative vaginal scrub with povidoneiodine decreases incidence of post-cesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection