ABSTRACT
This study was designed to determine the ability of a hemoglobinopathy screening protocol involving sickle solubility testing and red blood cell (RBC) indices to identify at-risk pregnancies. Retrospective chart review of all patients registering for prenatal care at the New York Hospital/Cornell Medical Center prenatal clinic in 1996 was the study design. All patients had RBC indices as well as hemoglobin electrophoresis. RBC indices of those with normal and abnormal electrophoreses were compared. Comparison of protocols involving universal hemoglobin electrophoresis and selective use of hemoglobin electrophoresis were compared. Student's t-test was used for statistical analysis. There were 36 carriers of hemoglobinopathy traits in 631 patients screened (5.7%). Four (three with hemoglobin C trait and one with hemoglobin D trait) had normal RBC indices and presumably would have had negative sickle solubility testing. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a protocol with selective use of hemoglobin electrophoresis would have been 88.9, 79.4, 20.8, and 99.2%, respectively. Cost analysis reveals a difference of $11,384 or $18/patient less in a protocol with selective use of hemoglobin electrophoresis. Although a protocol involving solubility testing with RBC indices will not identify every carrier of a hemoglobinopathy trait, it may be appropriate in some populations.
Subject(s)
Genetic Testing , Hemoglobinopathies/diagnosis , Pregnancy Complications, Hematologic/diagnosis , Clinical Protocols , Costs and Cost Analysis , Electrophoresis/economics , Erythrocytes, Abnormal , Female , Genetic Testing/economics , Hemoglobinopathies/blood , Hemoglobins/analysis , Heterozygote , Humans , Pregnancy , Pregnancy Complications, Hematologic/blood , Prenatal Diagnosis/economics , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Sickle Cell Trait/blood , Sickle Cell Trait/diagnosisSubject(s)
Aortic Aneurysm/complications , Aortic Dissection/complications , Myocardial Infarction/complications , Pregnancy Complications , Turner Syndrome/complications , Adult , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Aortic Valve Insufficiency/complications , Female , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/surgerySubject(s)
Amniotic Fluid/enzymology , Chorionic Villi/enzymology , Fibroblasts/enzymology , Lysosomes/enzymology , Amniotic Fluid/cytology , Cells, Cultured , Cerebroside-Sulfatase/metabolism , Female , Galactosylceramidase/metabolism , Glucuronidase/metabolism , Humans , Pregnancy , Sphingomyelin Phosphodiesterase/metabolism , beta-Galactosidase/metabolismABSTRACT
Although varicella is a common infection in the United States, pregnant women are infrequently infected. Varicella pneumonia is an even rarer though potentially fatal complication during pregnancy. Fulminant respiratory collapse often ensues and is associated with greater than 40% mortality. We successfully treated three patients for varicella pneumonia in pregnancy. Critical points of management include prompt diagnosis of the disease and recognition of the complications, rapid transfer to a facility capable of providing intensive care (including ventilatory support) and early initiation of aggressive antiviral chemotherapy.
Subject(s)
Chickenpox/drug therapy , Pneumonia/drug therapy , Pregnancy Complications, Infectious/drug therapy , Adult , Chickenpox/complications , Chickenpox/therapy , Female , Humans , Pneumonia/etiology , Pneumonia/therapy , Pregnancy , Pregnancy Complications, Infectious/therapy , Vidarabine/therapeutic useABSTRACT
Multiple peripheral pulmonic stenosis is a rare congenital cardiac disorder. The clinical course of this disease in pregnancy is not established. We report the benign obstetric course of a patient whose pregnancy was complicated by peripheral pulmonic stenosis and pulmonary hypertension.
