Mycosis fungoides in pregnancy: remission after treatment with alpha-interferon in a case refractory to conventional therapy: a case report.

Mycosis fungoides complicating pregnancy is rarely encountered. As it is a form of cutaneous T-cell lymphoma, some of the treatment options are contraindicated in pregnancy, and the disease may become unresponsive to safer conventional therapies. We report a patient who, in her third trimester of pregnancy, failed to respond to the treatment options available. Left with little choice, a trial of alpha-interferon was undertaken. The patient responded with remission, and prolongation of pregnancy was achieved.

Singleton term breech deliveries in nulliparous and multiparous women: a 5-year experience at the University of Miami/Jackson Memorial Hospital.

OBJECTIVE: The purpose of this retrospective study was to evaluate the feasibility of planned vaginal delivery, the maternal morbidity and mortality, and the short-term perinatal outcome in selected multiethnic women at term with singleton breech presentations. STUDY DESIGN: Singleton breech deliveries were identified from the delivery database between January 1, 1989, and December 31, 1993. A retrospective chart review identified 310 nulliparous and 711 multiparous women at term (37-42 weeks) for a total of 1021. Parameters studied included the success rate of planned vaginal deliveries and the incidences of maternal morbidity, perinatal morbidity, and mortality as a whole stratified by parity and mode of delivery. The Student t test, chi(2) test, and Fisher exact test were used for statistical analysis. RESULTS: Among 1021 women with singleton fetuses in a breech position at term, 191 were candidates for vaginal delivery, and 135 (70.7%) of these deliveries were successful. By parity, 12.3% of 310 nulliparous women and 21.5% of 711 multiparous women were candidates for vaginal delivery; 50% of the former and 75.8% of the latter underwent vaginal delivery. Maternal morbidity was more commonly associated with multiparity and cesarean delivery. Newborn intensive care admissions were equally distributed by parity, and significantly more were for vaginal than cesarean deliveries (17.4% vs 10.8%, P =.036). Premature rupture of the membranes complicated deliveries in 23.9% of the nulliparous women and only 6.5% of the multiparous women (P =.000). CONCLUSION: In this multiethnic population 70.7% of candidates selected for attempted vaginal breech delivery at term were successful. The remaining 29.3% underwent cesarean delivery for labor disorders or nonreassuring fetal heart rate patterns.

A double-blind randomized trial of two dose regimens of misoprostol for cervical ripening and labor induction.

OBJECTIVES: The objective of this study was to compare the efficacy and safety of two dosing regimens of misoprostol for cervical ripening and labor induction. METHODS: Patients who fulfilled the study criteria were randomized to received misoprostol 25 microg or 50 microg intravaginally every 3 h for a total of eight doses for cervical ripening or until labor was established. Endpoints for successful cervical ripening was achievement of Bishop score of nine or greater, and for labor induction reaching the active phase of labor in the first 24 h. The rates of success, duration of first and second stages of labor, type of delivery, significant side effects, and neonatal outcome were measured and compared between the two study groups. Two hundred and fifty-one patients were randomized in two groups--126 received 50 microg and 125 received 25 microg misoprostol. Demographics of the two study groups were similar. RESULTS: Patients in the 50 microg group had a shorter first stage (848 min vs. 1,122 min, P < 0.007), shorter induction-to-vaginal delivery interval (933 min vs. 1,194 min, P < 0.013), decreased incidence of oxytocin augmentation (53.9% vs. 68%, P < 0.015), and decreased total units of oxytocin (2,763 mU vs. 5,236 mU, P < 0.023), but there was a higher hyperstimulation rate (19% vs. 7.2%, P < 0.005). CONCLUSIONS: Successful induction rate, delivery types, and fetal outcome were similar in both groups. Although the rate of vaginal delivery and neonatal outcome were similar in both groups, the 50 microg regimen had shorter first and second stages of labor, and a higher hyperstimulation rate that was easily manageable, allowing for flexibility in using the higher dose in low-risk pregnancies.

Segmental epidural analgesia in labor: a matched control study.

The effects of epidural analgesia, given during the first stage of labor, on the course of labor, mode of delivery, and fetal outcome were evaluated in 43 matched controlled patients. Both stages of labor were prolonged, more forceps were applied, and more patients needed oxytocin augmentation for a longer period in the epidural group. Cesarean section was associated also with the use of epidural analgesia, owing to failure to progress. Fetal outcome was similar in both groups as judged by Apgar scores. Patients who elect this mode of pain relief in labor should be made aware that these side effects can be expected.

Fetal supraventricular tachycardia: a case of (intermittent) atrial flutter.

Fetal tachycardia of "supraventricular" origin is uncommon. The authors present a patient with fetal ascites and atrial flutter. A review of the pertinent literature is included.

Successful pregnancy in a woman with a left ventricular cardiac aneurysm. A case report.

Ventricular cardiac aneurysms associated with pregnancy are extremely rare. The effects of one on the other are not known. The pathophysiology of cardiac aneurysms as known in the nonpregnant state combined with the physiologic cardiovascular adjustments of pregnancy can be suspected of compromising the welfare of the pregnant patient. We recently treated a 21-year-old pregnant patient with a post-myocardial-infarction left ventricular cardiac aneurysm. The outcome was successful.

Malaria in pregnancy.

Recent evidence suggests an increasing incidence of malaria among the civilian population of the United States. The effects of malaria in pregnancy can be serious to both mother and fetus. We present four patients with malaria during pregnancy and review the charts of 18 additional patients with malaria (two of whom were pregnant) in order to familiarize the reader with the general clinical picture. The currently recommended chemoprophylaxis and treatment are outlined.