Malaria in pregnancy--a master of masquerade.

One case of malaria in pregnancy at 23 weeks of gestation in a woman returning from Ghana is presented. The patient complained of diarrhea and abdominal pain and was admitted to the department of Gynecology and Obstetrics. Under suspicion of appendicitis an exploratory laparotomy was performed. Diagnosis was missed and treatment delayed five days. Outcome was favorable for both woman and fetus.

Low dose iron supplementation does not cover the need for iron during pregnancy.

OBJECTIVE: To determine: 1) if 18 mg iron daily is sufficient to cover the iron need during normal pregnancy, and 2) if women, who will not need iron supplementation during pregnancy, can be identified by early screening. DESIGN: In a prospective study the women were randomized to receive either 18 or 100 mg iron daily from the 16th week until delivery. Investigations were performed in the 16th, 30th, and 38th week. SUBJECTS: Healthy nulliparae (n = 43) experiencing a normal singleton pregnancy. Only women with a normal hemoglobin concentration and intact iron stores (S-Ferritin > 15 micrograms/1) in the 16th week were included. VARIABLES: These measurements were done consecutively: 1) the total hemoglobin mass (with carbon monoxide). 2) S-Ferritin, 3) S-Transferrin, 4) S-Iron, 5) red cell indices (hemoglobin concentration, hematocrit, MCV, MCHC). RESULTS: Changes in red cell indices and S-Transferrin were equal in the two groups. There was no significant difference in S-Ferritin in the 16th week. In the 30th week 3 women (14%) in the 100 mg group and 11 (52%) in the 18 mg group had empty iron stores (p < 0.05). The numbers were 1 (5%) and 15 (72%) in the 38th week (p < 0.0001). The increment in total hemoglobin mass was equal in the two groups from the 16th to the 30th week (13% in the 100 mg group and 12% in the 18 mg group). From the 30th to the 38th week the increment in total hemoglobin mass was largest in the 100 mg group (8.1% versus 2.7%, p < 0.05). CONCLUSION: Despite a normal hemoglobin concentration and intact iron stores in the 16th week, an iron supplementation of 18 mg daily is not sufficient to cover the iron need in many pregnant women in the 3rd trimester.

IUD (Nova-T) insertion following induced abortion.

In a prospective study, 86 women who had an IUD (Nova-T) inserted immediately after induced abortion were compared to 95 abortion patients who started another contraception (control I). Additionally, the rate of complications following IUD insertion in a Family Planning Clinic (control II) were studied in 83 non-pregnant women. The overall infection rate for post-abortion patients was 4.4% (5.8% in the study group, 3.2% in control I). No infections were observed in control group II. Confidence limits (95%) for the three groups were overlapping. Among the women in the study group, bleeding and pain were not more frequent, but if one of these complications occurred, it tended to be more serious and the duration was longer. The number of days before resumption of work after abortion was 3-4 days in both abortion groups. After three months, the continuation rate was 83% (71 of 86) in the study group, 76% (72 of 95) in control I and 93% (77 of 83) in control II. Sixty-nine of the 181 women admitted for legal abortion had been admitted for the same reason previously. In this study, the recurrence rate after 12 months was 0% in the study group and 4.2% (4 of 95) in control group I. The insertion of an IUD at the time of abortion seems to be an effective and acceptable solution to the problem of recurrent abortion.

[Myomectomy as treatment of infertility in women with uterine fibromyoma]. / Myomektomi som behandling af infertilitet hos kvinder med fibromyoma uteri.

During a period of ten years, 33 women were submitted to myomectomy with infertility as the only indication for operation. On an average, infertility had been present for five years. Primary infertility was found in 2/3 of the women. At operation, solitary fibromata were encountered in half of the women. After a period of observation of 5 1/2 years, a total of 15 pregnancies had occurred in nine of the women. These resulted in 13 normal deliveries at term, one spontaneous abortion and termination of pregnancy in one patient. The frequency of pregnancy was thus 27.2%. However, four women avoided pregnancy after operation, so the corrected frequency of pregnancy becomes 31%. No significant differences were observed between the group of women who became pregnant and the group who remained infertile when the following factors were taken into consideration: age, primary or secondary infertility, size of the uterus, opening into the uterine horn or cavity during operation or the situation of the fibromata.

[Prevalence of positive gonococcal and chlamydial findings in women applying for termination of pregnancy. A screening evaluation]. / Praevalensen af positive gonokok- og Chlamydia-fund hos abortsøgende kvinder. Vurdering af screening.

All 335 pregnant women referred for termination of pregnancy in the first trimester were examined preoperatively for infection with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and were questioned about symptoms of gynaecological infection. Only 0.6% had positive cultures for gonorrhoeae while CT infection was demonstrated in 7.8%. Half of the women with infection had one of the following symptoms: discharge, pain or dysuria. These same symptoms were, however, also found in half of the women without infection. All gynaecological special departments in Denmark and a few of the surgical departments which carry out termination of pregnancy replied to a questionnaire about routine examinations for NG and CT in cases of termination of pregnancy. Only 29.2% of the departments made routine preoperative examinations for CT, NG or both. It is concluded that there are no indications for routine examination for gonococcal infection whereas screening for CT infection appears to be indicated.