[Hepatitis and pregnancy in Tunis. 103 cases compared with 100 cases who were not pregnant (author's transl)]. / Hépatite et grossesse à Tunis. A propos de 103 cas comparés à 100 cas en dehors de la grossesse.

The authors have reviewed the notes of 103 pregnant women who contracted hepatitis during pregnancy and compared it with a controlled series of hepatitis occurring in 100 women who were not pregnant but were of reproductive age. The mortality rate in the pregnant group was considerably higher than in those who were not pregnant--27 deaths out of 103 cases as against 4 deaths in the control series of 100 cases. The fetal prognosis was very bad in the group of women who died. 3 out of 4 pregnancies resulted in loss of the fetus. It was less bad in those who had mild hepatitis--39.3% lost the fetus and one out of two pregnancies had a premature labour. Loss of consciousness was a very bad prognostic sign. The prognostic value of marked drop in prothrombin and raised white blood counts is emphasized in the cases who died. When the series of women who were pregnant and who survived is compared with those who survived in the control group, the authors found that judgment had to be used carefully in evaluating the prodromal signs in the pregnant women. They found in the two groups that the haemoglobin level and the serial levels of protein and albumen are comparable to those found in developed countries. They conclude that their maternal mortality due to hepatitis was comparable to that reported in underprivileged countries but that "malnutrition" in the broader sense of the term does not explain the serious state of affairs.

[Gastro-duodenal ulcers with pregnancy. Condition of shock in labour due to intestinal haemorrhage from an ulcer (author's transl)]. / Ulcère gastro-duodénal et grossesse. Etat de choc en cours de travail, par hémorragie digestive d'origine ulcéreuse.

We present the case of a multiparous woman of 32 years of age who, at term after a more or less normal pregnancy, went into severe shock in labour. The patient in this case was very difficult to diagnose. Her life was only saved after massive blood transfusions and after delivering a fresh stillborn infant. It was not a case of uterine rupture nor of retro-placental haemorrhage. The site of origin of the hypovolaemic shock was intestinal. The patient had an ulcer of the pylorus which was diagnosed after fibroscopy. Some authors state that it appears that the few ulcers that have been diagnosed before pregnancy go into remission during pregnancy. All the same it would appear that sometimes very serious complicated ulcers which have to be treated with great respect do occur, especially in toxaemic patients at the end of pregnancy, and these carry with them a significant mortality both for the mother and the fetus. Although medical treatment (resuscitation) is essential, surgery should be resorted to if necessary because it may save the mother and sometimes the infant and so improve the prognosis of complicated ulcers occurring in pregnancy.