RESUMO
OBJECTIVE: To compare the obstetric performance, perinatal outcome and risk of neonatal infection in labour following spontaneous (SROM) and artificial (AROM) rupture of membranes. DESIGN: Prospective, non-randomised, comparative study during a one-month period in 1995. The study was approved by the ethics committee of the Faculty of Medicine, University of Colombo. SETTING: University Obstetrics Unit at De Soysa Hospital for Women, Colombo. PATIENTS: 324 women who were in early established labour after 37 weeks of gestation. 151 of these had SROM and 173 AROM. The AROM and SROM groups among primigravidae and multigravidae were considered separately. RESULTS: Oxytocin use in multigravidae was significantly higher in the AROM group than in the SROM group (p < 0.001). The emergency caesarean section (LSCS) rate in primigravidae was significantly higher in the AROM group than the SROM group (p < 0.001). A significantly larger number of primigravid AROM women had abnormal fetal heart rate changes on auscultation (p < 0.05) and cardiotopographic (CTG) patterns (p < 0.001) when compared with primigravid SROM women. Choreoamnionitis and funisitis were commoner in the AROM group although the difference was not statistically significant. CONCLUSIONS: AROM appears to be associated with a higher chance of fetal distress particularly in primigravidae. Both AROM and SROM are associated with a potential risk of infection at intrauterine sites.
Assuntos
Adulto , Âmnio/cirurgia , Infecções Bacterianas/epidemiologia , Membranas Extraembrionárias , Feminino , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Trabalho de Parto Induzido , Trabalho de Parto , Obstetrícia/métodos , Ocitocina/administração & dosagem , Paridade , Assistência Perinatal , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de Risco , Sri LankaRESUMO
Myocardial infarction in an infant due to anomalous origin of the left coronary artery from the pulmonary trunk is reported. The pathological features, haemodynamics related to morphology and differential diagnosis are discussed.
Assuntos
Anomalias dos Vasos Coronários/complicações , Países em Desenvolvimento , Diagnóstico Diferencial , Feminino , Hemodinâmica/fisiologia , Humanos , Recém-Nascido , Infarto do Miocárdio/diagnóstico , Sri LankaRESUMO
We describe two cases of children who were victims of illness fabricated by their mothers. Such clinical situations are identified as Munchausen syndrome by proxy (MSP). Although considered a form of child abuse, MSP often goes unrecognised in paediatric practice. The two children involved were unnecessarily investigated, and the underlying problems in the mothers were identified only after several hospital admissions. One mother had a major psychiatric disorder, and the other had serious marital problems. Maintaining a high degree of suspicion regarding inexplicable illness in a child with inappropriate or incongruous symptoms and signs, even when parents behave in an exemplary manner, would help in early diagnosis and management.