Coombs-negative haemolytic anaemia in pregnancy: A case report.

We present a rare case of Coombs-negative autoimmune haemolytic anaemia in a multiparous woman in secondary care. There were no known underlying medical or obstetric risk factors for haemolytic anaemia. Following extensive investigation and a therapeutic trial of oral corticosteroids, a diagnosis was made. Autoimmune haemolytic anaemia is potentially fatal, and prompt diagnosis with haematology input is essential to ensure maternal and fetal safety in pregnancy and the puerperium. With only a small number of cases of Coombs-negative autoimmune haemolytic anaemia reported in the literature, we present this rare case for discussion. We highlight the importance of thorough investigation of refractory anaemia in pregnancy and consider the associated challenges.

Obstetric management of a patient with narcolepsy and cataplexy: a case report.

We report the management of a patient who suffers from narcolepsy and cataplexy and presented to the clinic at 14 weeks of gestation. Her symptoms were resistant to modafinil but controlled with clomipramine and amphetamine. Discussion concerning mode of delivery for these patients is scarce in the literature. We discuss some issues surrounding the antenatal management and counselling regarding mode of delivery and postpartum care.

Management of splenic artery aneurysm rupture during trial of scar with epidural analgesia.

We report a case of ruptured splenic artery aneurysm during labor in which the clinical signs were masked by epidural analgesia. A high index of clinical suspicion must be maintained in cases of atypical epidural breakthrough pain, and attending clinicians must be prepared for the unexpected when faced with a maternal collapse.

Laminaria digitata in saline abortions.

PIP: Laminaria tents were used in addition to the technique of saline abortion in an attempt to shorten the injection-abortion interval. 142 second trimester therapeutic abortion patients, aged 13 to 40 years, agreed to participate in the study and were assigned to 1 of 4 groups. 72.2% were single, 27.8% were married, and the gestational age was from 13 to 20 weeks. Group 1 (26 primigravid patients) served as the control group (no oxytocin or laminaria tent used). Group 2 (25 primigravid patients) received an intravenous infusion of 20 units oxytocin/500 ml of 5% dextrose in water (beginning 12 hours after saline injection). Group 3 (50 primigravid patients) likewise received an infusion of 20 units oxytocin/500 ml of 5% dextrose in water (beginning 12 hours after saline injection), and in addition, a single medium, sterile laminaria tent was inserted at the time of the saline injection and removed 12 hours after insertion. Group 4 (41 multigravid patients) received treatment identical to that of Group 3. The mean interval time from injection to delivery in Group 1 was 41.26 hours. The mean injection-abortion time was 30.67 hours for Group 2, 26.84 hours for Group 3, and 22.96 hours for Group 4. The complication rate was significantly higher for both the oxytocin plus saline group (Group 2) as well as the laminaria plus saline groups (Groups 3 and 4). Group 3 experienced a 22% febrile rate, and 18% of patients required uterine curettage, while the figures for Group 4 were 12.2% and 24.4%, respectively. The laminaria tents did result in an 11% to 15% increase in complications in Groups 3 and 4, respectively, as compared with Group 2.^ieng

Oxytocin augmentation of saline abortion.

PIP: 53 patients undergoing second trimester saline abortion were given either 20 units or 100 units of oxytocin per 500 ml of 5% dextrose solution 12 hours after saline instillation. Mean abortion time (30.67 hours, 20 units; 27.66 hours, 100 units) was 11-14 hours less than a control group of 26 patients who did not receive oxytocin (41.26 hours). The smaller dose is as effective as the larger dose and should prove safer for patients undergoing saline abortion.^ieng