Thermal injury in pregnancy--the neglected tragedy.

Thermal injury sustained during pregnancy presents special management problems for the gravid woman and her unborn child. Because of the reported high morbidity and mortality and lack of available data in South Africa, a multicentre retrospective review was undertaken by five burn centres. Thirty-three patients (average age 25,7 years) with mean 30% (range 1-80%) total body surface area burn were assessed. A review of the clinical material led to the following observations and conclusions. Pregnancy does not influence maternal outcome after thermal injury and maternal survival is usually accompanied by fetal survival in the absence of significant maternal complications. Maternal survival is less likely if the burn wound exceeds 50% total body surface area. Thermal injury does increase the risk of spontaneous abortion and premature labour, and fetal survival depends on fetal maturity. Early obstetric intervention is only indicated in the gravely ill patient where complications (hypoxia, hypotension, sepsis) jeopardize the life of a viable fetus. The mode of delivery should be determined by obstetric considerations.

Maternal mortality in southern Africa, 1980-1982. Part I. Pregnancy can be lethal.

Statistics regarding the number of births and maternal deaths during the 3-year period 1980-1982, received from 267 hospitals in southern Africa, are presented. Although 812 maternal deaths were recorded, sufficient information for adequate analysis of epidemiological factors (age and parity), cause of death and avoidable factors was available in only 737. The maternal mortality rate was 8.3/10,000. Six hundred and sixty deaths (89.6%) were classified as direct obstetric death. Two hundred and twenty-nine deaths (31%) occurred in women experiencing their first pregnancy. Avoidable factors could be shown to operate in 407 deaths. Important factors identified were that the patient presented very late for antenatal or intrapartum care, that inadequate therapy was administered and that therapy deviated from the accepted norm. Fetal and neonatal loss was high: only 271 infants survived.

Maternal mortality in southern Africa, 1980-1982. Part II. Causes of maternal deaths.

Of 737 maternal deaths studied in southern Africa between January 1980 and December 1982, 660 were classified as direct obstetric deaths. Hypertensive disorders of pregnancy were the most frequent cause of death (30%). Obstetric haemorrhage and infection were associated with 20% and 19% of maternal deaths respectively. Advancing age and increased parity were strongly associated with death from obstetric haemorrhage.

Genital prolapse in the neonate. A case report.

A case of genital prolapse in a newborn infant is described and possible aetiological factors briefly reviewed. The need for early reduction is stressed.

An echographic evaluation during the early puerperium of the uterine wound after caesarean section.

Serial echographic evaluation of the uterine wound after lower uterine segment caesarean section was performed on 48 puerperal patients. Similar examinations after vaginal delivery were carried out on 14 puerperal patients. The aim of this study was to determine whether evidence of abnormal healing could be detected by this method. Although three distinctive patterns were noted, no correlation with clinical findings could be made and no conclusions could be drawn.

Intermediate size papovavirus particles in pregnancy urine.

By electron microscopy of negatively stained urinary sediments, papovavirus particles of size intermediate between papillomavirus and polymavirus have been detected in the urine of a pregnant woman. The excretion of size variants of these viruses and the absence of detectable papillomas in any of the women who were found to excrete only papillomavirus represent new findings.

Missed abortion, hydatidiform mole and intra-uterine fetal death treated with 15-methyl-prostaglandin F 2-alpha.

The efficacy of (15S)-15-methyl-prostaglandin F2 alpha in terminating pregnancy in cases of known missed abortion, hydatidiform mole and intra-uterine fetal death was tested. There were 8 cases of missed abortion, 13 cases of intra-uterine death at or after 28 weeks' gestation, and 1 case of hydatidiform mole. No other oxytoxic preparation was required in 19 (86%) patients. The mean induction-to-delivery time was 17,2 hours in the group with missed abortions and 12,4 hours in the group with intra-uterine deaths, and the maximum blood loss was 350 ml. Gastro-intestinal side-effects, which were present in 21 (95%) patients, were severe in 5 (23%).

Urinary virus excretion in pregnancy.

In a series of 774 women with pregnancies ranging from 7 weeks to term, virus particles representing five different groups have been detected in urine specimens by negative staining electron microscopy. Of the virus-positive women, 0,39% excreted papillomavirus (in the absence of genital warts), 3,1% polyomavirus, 0,26% adenovirus type II, 0,65% an antibody-coated unidentified virus particle and 7,7% a membrane-associated virus-like particle. The implications of these findings are discussed in the light of the apparently increased susceptibility of pregnant women to virus infection.

Inhibition of puerperal lactation: A comparative study of bromocriptine and pyridoxine.

Ninety-seven patients requiring suppression of lactation in the postpartum period were treated on a double-blind basis with bromocriptine and pyridoxine--49 patients received bromocriptine and 48 pyridoxine. A statistically significant difference between the two groups was noted, beginning after 1 day of treatment. Bromocriptine was superior to pyridoxine in the parameters measured. At the end of therapy the clinician, the midwife and the patient assessed the therapeutic efficacy of the trial drug. There was a statistically significant difference in favour of bromocriptine. Two patients treated with bromocriptine reported mild side-effects, but medication was not discontinued. In 1 patient receiving pyridoxine side-effects were so severe that medication was discontinued--however, the patient was already receiving the inactive tablets at this stage.

Hypercalcaemia in pregnancy: a case report.

A case of hypercalcaemia in a pregnant patient on substitution therapy for hypoparathyroidism is reported. The clinical picture included transient cerebral disturbances, acute pancreatitis and persistent partial blindness. Calcium metabolism in pregnancy is discussed, and a possible mechanism for the sequence of events is postulated. The relevant literature is reviewed.