ABSTRACT
BACKGROUND: Anaphylaxis associated with breast-feeding is a rare but potentially life-threatening event. CASE: This woman reported anaphylaxis with three previous pregnancies while breast-feeding. With her fourth pregnancy she was treated with corticosteroids and antihistamines after delivery. Despite treatment, she developed urticaria, facial edema, and throat tightening, less severe than prior episodes. Her symptoms resolved with epinephrine and antihistamine but recurred with subsequent breast-feeding. On postpartum day 4 she had no symptoms while breast-feeding. CONCLUSION: Three cases of postpartum breast-feeding anaphylaxis have been reported. Although the pathophysiology is unclear, it may involve the decrease in progesterone and rise of prolactin causing mast cell degranulation. Avoidance of nonsteroidal antiinflammatories and prophylaxis with corticosteroids and antihistamines may offer the best protection.
Subject(s)
Anaphylaxis/etiology , Breast Feeding/adverse effects , Puerperal Disorders/etiology , Adult , Anaphylaxis/diagnosis , Anaphylaxis/therapy , Female , Humans , Puerperal Disorders/diagnosis , Puerperal Disorders/therapy , RecurrenceABSTRACT
OBJECTIVE: To compare neonatal outcomes when dosing betamethasone every 12 hours compared to the standard 24-hour dosing regimen when premature deliveries occur within 48 hours of presentation. METHODS: A retrospective chart review was performed on preterm deliveries from January 1, 1996 to July 1, 2000. Deliveries that occurred less than 48 hours after initiation of antenatal steroids were analyzed for neonatal outcomes. RESULTS: Betamethasone was given to 562 women, of whom 166 delivered less than 48 hours after beginning therapy. There were no statistically significant differences in the rates of respiratory distress syndrome, surfactant use, chronic lung disease, intraventricular hemorrhage, neonatal death, or other outcomes between the two groups. The only statistically significant difference between the two groups was for venous cord blood pH (7.27 vs. 7.32, p = 0.01). Separating the results into delivery from 0-24 and 24-48 hour groups, there were no significant differences between the 12-hour and 24-hour dosing groups, although small sample size limited conclusions. CONCLUSION: Dosing betamethasone in 12-hour intervals may result in similar neonatal outcomes compared to the standard 24-hour regimen when delivery occurs within 48 hours of therapy initiation.
Subject(s)
Betamethasone/administration & dosage , Fetal Organ Maturity , Glucocorticoids/administration & dosage , Lung/embryology , Obstetric Labor, Premature , Adult , Drug Administration Schedule , Female , Gestational Age , Humans , Infant, Newborn , Medical Records , Pregnancy , Pregnancy Outcome , Retrospective StudiesABSTRACT
OBJECTIVE: To determine any differences in neonatal outcomes when dosing betamethasone every 12 hours vs. 24 hoursfor anticipated preterm delivery. STUDY DESIGN: A retrospective review of births at <36 weeks' gestation from January 1, 1996, to July 1, January 1, 1996, to July 1, 2000. Maternal and neonatal charts were reviewed. The deliveries were separated into 3 groups: those not receiving antenatal corticosteroids, those who received betamethasone 12 hours apart and those who received 24-hour dosing. Demographic, obstetric and neonatal variables were compared between the groups. RESULTS: There were 909 deliveries analyzed. With the 2 betamethasone groups, a significant difference was found for more maternal antibiotic use (90.4% vs. 83.6%, p=0.03), venous cord blood gas pH (7.31 vs. 7.32, p=0.04) and neonatal surfactant use (39.8% vs. 25.5%, p = 0.001) in the 12-hour group as compared to the 24-hour group. For all other outcomes there was no difference. CONCLUSION: Outcomes using a 12-hour dosing schedule of betamethasone were similar to those using a 24-hour regimen in this retrospective review. Twelvehour dosing could be considered an alternative way to deliver antenatal corticosteroids.
Subject(s)
Betamethasone/administration & dosage , Glucocorticoids/administration & dosage , Pregnancy Outcome , Adult , Apgar Score , Birth Weight , Brain Hemorrhage, Traumatic/prevention & control , Drug Administration Schedule , Female , Fetal Blood/chemistry , Gestational Age , Humans , Hydrogen-Ion Concentration , Infant Mortality , Infant, Newborn , Pregnancy , Pulmonary Surfactants/administration & dosage , Respiratory Distress Syndrome, Newborn/prevention & control , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the maternal mortality ratio (MMR) in Department of Defense medical facilities from 1993 to 1998. STUDY DESIGN: We conducted a retrospective review of birth data from military medical facilities using the Standard Inpatient Data Records from 1993 through 1998. The total number of live births and dispositions due to maternal death were obtained. RESULTS: Twenty-two maternal deaths occurred in the study time out of 398,107 live births, for an MMR of 5.5 per 100,000 live births. The ratiosfor the service branches were: Army 7.0, Navy 5.3 and Air Force 3.6. The leading cause of death was embolic disease. CONCLUSION: The military MMR is closer to the Healthy People 2010 goal of 3.3 than is the national ratio, 13.2. Improved reporting of cases, patient education and treating high-risk conditions may help further decrease pregnancy-related mortality.
