Effect of passive smoking in pregnancy on neonatal nucleated red blood cells.

OBJECTIVE: We evaluated whether the absolute nucleated red blood cell (RBC) count is elevated in term, appropriate for gestational age (AGA) infants born to women exposed to passive smoking in pregnancy. PATIENTS AND METHODS: We compared absolute nucleated RBC counts taken during the first 12 hours of life in 2 groups of term, vaginally delivered infants, 1 group born to mothers who were routinely exposed to tobacco smoke during pregnancy (n = 55) either at home or at the workplace, and the other to mothers who were not routinely exposed to any tobacco smoke (n = 31). We excluded infants of women with conditions known to elevate nucleated RBC counts. RESULTS: There were no differences between groups in birth weight, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores. Gestational age was minimally higher in the control group (39.6 +/- 1.1 vs 39.2 +/-.8 weeks). The median absolute nucleated RBC count in the passive smoking group was 357 x 10(6)/L (range: 0-5091 x 10(6)/L) versus 237 x 10(6)/L (range: 0-1733 x 10(6)/L) in nonsmoking controls. Stepwise regression analysis that included Apgar scores, gestational age, and the passive smoking status (yes/no) as independent variables showed significant correlation of absolute nucleated RBC count only with the passive smoking status. CONCLUSION: At birth, term AGA infants born to mothers exposed to passive smoking have increased circulating absolute nucleated RBC counts compared with those of controls. We speculate that passive smoking in pregnancy should be avoided, because it may have subtle negative effects on fetal oxygenation.

Pemphigus vulgaris in pregnancy: a case report and review of literature.

Pemphigus vulgaris (PV) is an uncommon, immune-mediated bullous dermatosis, which, during its active phase, has been associated with infertility. Pemphigus vulgaris during pregnancy is exceedingly rare-only 26 cases with immunopathological confirmation have been reported. The disease may be associated with adverse neonatal outcome, including prematurity and fetal death. Transient skin lesions may occasionally appear in the neonate. We report a patient who conceived during the active phase of PV, required high doses of corticosteroids to control the disease, and was delivered of a pre-term, appropriate-for-gestational age newborn.

Can labor with breech presentation be induced?

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.

Intrauterine irrigation with prostaglandin F2-alpha for management of severe postpartum hemorrhage.

BACKGROUND: Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F2-alpha to control severe postpartum hemorrhage may avert surgery for the control of bleeding. METHODS: After ruling out the possibility of genital tract injuries, 18 patients with severe postpartum hemorrhage caused by uterine atony were enrolled in the study. None of the patients responded to treatment with oxytocin, methylergonovine, or uterine massage. A Foley catheter was introduced into the uterine cavity and the balloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12 24 hours. RESULTS: In 17 patients (94.4%) bleeding ceased within several minutes of initiation of intrauterine prostaglandin F2-alpha infusion, the uterus was firmly contracted and uterine bleeding did not recur. In one patient with placenta increta bleeding continued and hysterectomy was performed. None of the patients had any side effects. CONCLUSIONS: Intrauterine irrigation with low concentrations of prostaglandin F2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuous hemostasis. Moreover, the minute dosage used eludes potentially complicating side effects.

Plasma soluble endothelial selectin is elevated in women with pre-eclampsia.

The study was conducted to determine whether altered plasma concentrations of soluble selectins are involved in the pathogenesis of pre-eclampsia. Maternal plasma samples were collected from 20 patients with pre-eclampsia, and from 20 matched normotensive patients with uncomplicated pregnancies. Samples were assayed for soluble endothelial selectin (sES), platelet selectin (sPS) and leukocyte selectin (sLS) by specific enzyme-linked immunosorbent assay. The three soluble selectins were detectable in the plasma of all pre-eclamptic and control patients. The mean plasma concentrations of sPS and sLS were comparable between the groups. However, the mean plasma concentration of sES was significantly higher in the pre-eclamptic group compared with the control group (61 ng/ml +/- 30 ng/ml compared with 40 ng/ml +/- 17 ng/ml; P < 0.01). The selective increased plasma concentrations of sES in patients with pre-eclampsia provide specific evidence for endothelial activation and may reflect distinct pathways for neutrophil activation in pre-eclampsia.

Balloon catheter with extra-amniotic saline instillation: a method of induction in pregnancies at 41 or more gestational weeks.

One hundred five women with a documented pregnancy of 41 weeks' gestation or more, admitted for induction of labour by balloon catheter with extra-amniotic saline instillation, were retrospectively compared to 196 women admitted in spontaneous labour at the same gestational age, with regard to mode of delivery. The success rate of the induction group was 97.1%. The mode of delivery did not differ significantly between the 2 groups. The Caesarean section rates were 11.4% in the induction group versus 9.7% in the spontaneous group. The mode of delivery after induction of labour by balloon catheter with extra-amniotic saline instillation and simultaneously commenced intravenous oxytocin infusion, in pregnancies of 41 weeks or more, is similar to that of spontaneous deliveries at the same gestational age.

Postpartum surveillance of urinary retention by ultrasonography: the effect of epidural analgesia.

Our objective was to investigate by ultrasonography whether the risk for postpartum urinary retention is increased following administration of epidural analgesia during labor and delivery. In a prospective study, 106 healthy women who had undergone vaginal delivery were evaluated. Sixty-eight of the women had received epidural analgesia during labor and delivery. All subjects had an ultrasound examination at a mean of 42 h after delivery, and residual urine volume was estimated immediately after voiding. Correlations among obstetric parameters, epidural analgesia and residual urine volumes were evaluated. The mean accuracy rate of ultrasonography for estimation of bladder volumes was +/- 10.2%. No cases of clinically evident urinary retention were diagnosed in the total puerperal population. There were no significant differences between the groups in the average amounts of residual urine as measured by ultrasonography. With modern obstetric practice, epidural analgesia for labor is not associated with an increased risk for postpartum urinary retention. The non-invasive nature of ultrasound renders it especially attractive and useful for measuring residual urine volume in postpartum patients. The safety, simplicity and relative comfort of this method over-ride the slightly imperfect calculations that it currently yields, and makes it preferable to catheterization or cystometry for evaluation of residual urine volume.

Uterine rupture at 33 weeks' gestation subsequent to hysteroscopic uterine perforation.

A 40-year-old woman underwent operative hysteroscopy for suspected submucosal myoma, during which the uterine fundus was perforated. At laparotomy the perforation site was sutured. In a subsequent pregnancy she had a sudden onset of abdominal pain. Laparotomy revealed a uterine rupture with a partially protruding placenta. A healthy newborn was delivered by a low-segment cesarean section.