Emergency cervical cerclage: A review of 15 cases.

BACKGROUND: This report describes our experience with 15 consecutive emergency cervical cerclages performed at Al Yamamah Hospital. PATIENTS AND METHODS: Between February 1994 and February 1997, 15 women with singleton pregnancies between 18 and 26 weeksâ gestation, with a cervical dilatation between 3 and 10 cm and with membrane prolapse, underwent emergency cerclage after excluding labor, placental abruption and intrauterine infection. The membranes were replaced using the technique of overfilling the urinary bladder and then performing McDonaldâs cerclage. All the patients received prophylactic antibiotics and tocolytics. RESULTS: Of the 15 pregnancies, two aborted and 13 ended in live births. Nine of the live births survived, giving a survival rate of 60%. The mean extension of pregnancy in the survivors was 11.5 weeks (range 7.6-15.2 weeks), and the gestational age at delivery ranged from 30-38+ weeks. In six of the patients, suture failed to prolong the pregnancy long enough to produce a âtake-home baby.â All the failures were due to subclinical intrauterine infection. There was no maternal morbidity. CONCLUSION: Emergency cerclage should be considered as a management option in women with painless cervical dilatation and membrane prolapse in the midtrimester.

Early oral intake after caesarean section performed under general anaesthesia.

This study assesses the outcome and benefits of initiation of oral intake 4 hours after caesarean section done under general anaesthesia. After uncomplicated sections, 207 healthy women were alternately assigned either to start oral intake 4 hours after operation, with concurrent stoppage of infusions (n = 106) or to receive 'standard'postoperative care (n = 101). Early oral intake was not associated with increase in gastrointestinal morbidity. Compared with the control group the early intake group had a shorter mean time to first flatus and to first bowel evacuation; initiated breast feeding earlier; ambulated more and were more satisfied. Both groups had similar urine output in the first 24 hours. The nurse's work load decreased when they looked after the early intake group. It is concluded that post-caesarean mothers could be adequately hydrated orally after discontinuing infusions in the early postoperative period without apparent harm and with benefit.

Selective tracheal suctioning to prevent meconium aspiration syndrome.

OBJECTIVE: To analyze the incidence and outcome of meconium aspiration syndrome (MAS) at Al-Yamamah Hospital, Riyadh, Saudi Arabia, where meconium-stained babies have intrapartum obstetrical cleansing of the upper airways, following which depressed/asphyxiated babies are intubated and vigorous babies are observed for 24 h. METHOD: The total live births, records of meconium-stained neonates who had intubations and of those observed, during a 6-year period were reviewed. RESULTS: During this period, there were 85562 live births. One in 325 births (0.27%) was complicated by MAS and the mortality rate was 7%. These figures concur with the reported incidence and mortality of MAS following routine combined obstetric-pediatric suction of airways at birth. Of the 265 cases of MAS that occurred during this period, 237 were in the intubated group and 28 in the observed group. The babies of the former group had severe disease compared with that of the latter. All mortality was from the intubated group. CONCLUSION: Adequate obstetrical cleansing of the upper airway in vigorous babies may obviate the need for endotracheal intubation; intubation of depressed babies following this treatment may be useful.

Trichomoniasis as sexually transmitted disease in sex partners.

Study of 30 male consorts of 30 cases of vaginal trichomoniasis with high levels of parasitic infection was undertaken to evaluate the sexually transmitted role of trichomoniasis in sex partners. There were 20 symptomatic and 10 asymptomatic male partners, who revealed T. vaginalis in 80.0% and 60.0 of the cases respectively and the overall prevalence was 73.3% (22 Of 30). T. vaginalis was detected in 83.3% male with urethritis and 50.0% males with prostatitis. Detection of trichomonas in urethral discharge, morning drop secretion, urine deposit and prostatic fluid was 80.0%, 50.0% 35.7% and 21.4% in that order. It is evident from these results that the sex consorts of all cases of trichomoniasis should be considered as harbouring T. vaginalis in their genito-urinary tract as carriers and be treated to break the chain of transmission. Fontanna smear was superior to culture and wet mount in the detection of T. vaginalis, the success rates being 73.3%, 63.3% and 53.3%. A good correlation was observed between smear and culture at high levels of parasitic infection.

Plasma ferritin in the assessment of iron status of Indian infants.

In order to assess the iron nutritional status of infants, plasma ferritin levels were measured in the infants and children at different time intervals till two years of age from two different socio economic groups. While ferritin levels at 3-4 months age were significantly higher in upper income group infants, levels were almost similar in the subsequent infancy between the two income groups. A close correlation was seen between ferritin levels of mothers and infants at 1-3 months of age (p less than 0.001). Prenatal iron supplements (oral or parenteral) resulted in higher ferritin levels at 4-6 months age as compared to placebo group. While the infants born to mothers receiving parenteral iron did not show any evidence of iron deficiency (serum ferritin levels less than 12 ng/ml), 23.5 and 25.0% of infants in oral iron and placebo group had evidence of iron deficiency between 6-12 months. Thus it would appear that improving the iron status of mothers during pregnancy will have significant impact on the iron status of breast fed infants till 6 months.

Use of body mass index for assessing the growth status of infants.

Growth status of infants measured by weight and height was assessed from birth to 12 months in a randomly selected community from the urban slums of Hyderabad City. Mean birth weight was 2.82 kg. Weight/height indicator of body mass index (BMI) showed a progressive increase till 4th month, followed by more or less a constant figure with a mean value of 1.50 in longitudinal, semi-longitudinal and cross sectional data till one year. Critical limit for BMI at birth for given weight of 2.5 kg was 1.20 and subsequently increased to 1.35. BMI was well correlated with weight and weight for height (%) and least correlated with height. Children with height of 90% or above and birth weight of above 2.5 kg were observed with better growth and better maintenance of weight for height (%) and BMI till 6 months.

Bacillemia and Its Relationship with Bacteriological Index in Leprosy.

Detection of bacillemia in 40 untreated cases of leprosy was carried out by buffy coat. haemolysis and Petroff's concentration method. Bacillemiawas detected in 17 (42.5%) cases by Petroff's method. Out of 20 LL-BL cases, it was positive in 16 (80%) patients. Petroff's and haemolysis methods revealed bacillemia in 100% and 90% of LL cases respectively. The Petroff's method of concentration was found superior over the other techniques for better detection and quantitatioxi of bacffemia. A significant relationship between the bacillary load (BI) in the skin and the degree of bacillemia was observed especially in the lepromatous part of the spectrum of the dise4se.

Skin Tests for Evaluation of Cell Mediated Immunity in Leprosy.

Cell-meate,d immune (CMI) response to lepromin and dinitrochloro benzene (DNCB) was evaluatt-d in 60 freshly detected leprosy cases. It was observed that 70%, ( 28 of 40 ) of the pa across tie leprosy spectrum except LL cases revealed delayed hypersensitivity to DNCB as -against 42.5% (1-7 of 40) to lepromin. DNCB test was found superior to lepromin test to measure CMI because of its simplicity and easy interpretation of skin reactivity. It detected CMI in 40% of BL cases who were lepromin negative. Grading of skin reactivity showed a program decrease in delayed hypersensitivity across the spectrum of leprosy from TT to LL. It can be concluded that there is no gross impairment of non-specific CMI in leprosy patients other than LL cases and this non-specific CMI depression correlates well with Ridley-Jopling clinical scale of leprosy.

Effect of cyproheptadine on feeding behaviour in albino rats.

The effect of cyproheptadine on feeding behaviour was investigated in fasted albino rats with the help of a Skinner box. Cyproheptadine decreased the rate of bar-pressing under continuous reinforcement although it has been reported to be an appetite promoting drug.