Evaluation of the Use of Intravenous Iron Supplements in an Obstetrics and Gynecology Department.

Background: The use of intravenous (IV) iron sucrose was approved for the obstetric and gynecologic (OBGYN) population at our mother-child teaching hospital in 2006 for intolerance or nonresponse to oral iron supplements, contraindication to intramuscular (IM) iron, and rapid increase of the hemoglobin desired in iron-deficient patients. Objectives: (a) To describe the indications and doses of IV iron sucrose used in OBGYN, (b) to assess monitoring, and (c) to describe the adverse effect profile. Methods: A retrospective study of patients admitted to the OBGYN wards with at least one prescription of IV iron from January 1, 2006, to March 31, 2010, was conducted. A standardized data collection sheet was used to record data. Results: A total of 164 prescriptions of IV iron were reviewed in 128 women. The indications for IV iron were anemia before delivery (n = 76), intolerance or no response to oral iron (n = 61), or intolerance or contraindication to IM iron (n = 27). Fourteen doses (9%) were appropriate, and the others were too low. Prior to prescription, ferritin or serum iron levels were assessed in 31% of women and hemoglobin electrophoresis in nearly all of Black or Asian women. One-week follow-up hemoglobin levels were measured after 66 prescriptions (40.2%). Adverse effects, mostly pain at the injection site, were reported in 18 (11%) occasions. Conclusions: IV iron is prescribed in OBGYN patients to obtain a rapid hemoglobin increase or when oral iron is not tolerated or inefficacious. The dose prescribed is generally too low, baseline essential testing often omitted, and appropriate follow-up monitoring incomplete. IV iron is well tolerated.

Low-dose ASA response using the PFA-100 in women with high-risk pregnancy.

OBJECTIVES: To study the platelet function response to low-dose ASA with the Platelet Function Analyzer (PFA-100) in pregnant women and to identify maternal characteristics associated with non-responsiveness. METHODS: We conducted a prospective cohort study involving 87 pregnant women on ASA. The platelet function response to ASA was measured as the closure time obtained with epinephrine cartridges (CT-EPI) by the PFA-100. Non-response to ASA was defined as a CT-EPI < or =150 seconds after four weeks of therapy. Non-responders were given an escalating dose of ASA and their CT-EPI was tested again. RESULTS: After four weeks of enteric-coated ASA 81 mg daily, 25/87 women (28.7%) were non-responders (95% CI 16.1 to 41.4). Among these women, a CT-EPI < or =150 seconds was found in 8/24 women (33.3%) after another four weeks of alternating ASA 81 mg and 162 mg daily. After a further four-week course of ASA 162 mg daily, a CT-EPI < or =150 seconds was found in 3/6 women (50.0%). Among the women who initially responded and who were reassessed at 24-32 weeks of pregnancy, the CT-EPI was < or =150 seconds in 9/36 (25.0%). There was no statistical difference in maternal characteristics between ASA responders and non-responders. CONCLUSION: A significant number of pregnant women showed a lack of platelet function response to ASA 81 mg that was in most cases overcome with higher dosing. Furthermore, the prevalence of non-responsiveness increased with advancing pregnancy.

Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness.

OBJECTIVE: To compare the performance in screening for gestational carbohydrate intolerance of the 1-h 50-g glucose challenge test (GCT), fasting plasma glucose (FPG) and fasting capillary glucose (FCG). DESIGN AND METHODS: FPG and FCG were measured at the same time as the GCT in 188 women. Gestational carbohydrate intolerance was diagnosed according to the Canadian Diabetes Association criteria. We constructed receiver operator characteristic (ROC) curves and compared the sensitivity and specificity of the FPG, FCG and GCT. RESULTS: Gestational diabetes was diagnosed in 11.2% women and gestational impaired glucose tolerance in 8.4%. The areas under the ROC curves for the FPG, the GCT and the FCG were not statistically different (P = 0.26). The GCT yielded a better specificity than the FPG and the FCG for a comparable level of sensitivity. CONCLUSIONS: The GCT is better than the FPG in our population and is cost effective.

Preeclampsia as a cause of pancreatitis: a case report.

BACKGROUND: Pancreatitis is an uncommon but well-described entity in pregnancy and labour, with most cases attributable to biliary disease. Preeclampsia is not an established cause of pancreatitis. CASE: A 29-year-old woman with preeclampsia and adverse features at 33 weeks' gestation developed pancreatitis during her labour induction. Investigations ruled out known etiologies of pancreatitis. The woman was monitored clinically, biochemically, and radiologically, and underwent a Caesarean delivery of a healthy infant. Both the pancreatitis and preeclampsia resolved rapidly postpartum. Given her benign clinical picture, no specific therapeutic intervention was deemed necessary for the pancreatitis, and she was discharged 5 days postpartum. CONCLUSION: The clinical course and investigations of this woman suggest that preeclampsia should be considered as a cause of pancreatitis.