An association of pregnancy and autoimmune haemolytic anaemia.

14 cases of pregnancy-associated autoimmune haemolytic anaemia were analyzed. 4 cases were diagnosed during pregnancy; 10 cases became pregnant during the remission period of the disease. 6 cases were secondary to systemic lupus erythematosus. In the first group, the anaemia developed in the third trimester whereas in the second group the Hb fell slightly in the first trimester and rapidly between the third and fourth month of gestation. Only 1 case could withstand the hazard of pregnancy uneventfully; 4 needed corticosteroid and delivered normal infants; 2 developed toxaemia of pregnancy; in 5, either therapeutic or spontaneous abortion was noted and 1 death occurred due to renal complication. Abortion was induced in 1 case due to socio-economic indications.

Pregnancy in patients with autoimmune thrombocytopenic purpura.

The obstetric and hematologic problems in 21 pregnancies of 18 patients with ATP are analyzed: one maternal and one fetal death occurred. Urinary estriol and oxytocinase were measured. Eighteen infants were born by vaginal delivery and three by cesarean section. None of the 20 liveborn infants died, but they had NIP due to the passage of maternal antibodies to the fetus. These results are compared to those reported in previous publications. The obstetric management of these patients should be individualized and carefully planned; it should not be based on the platelet count.

Prognostic aspects of aplastic anemia in pregnancy. Experience on six cases and review of the literature.

Our resent experience on six cases of aplastic anemia complicated with pregnancy is described. In addition, 43 similar cases were collected from the literature and reviewed to analyze some prognostic aspects of this relatively rare but potentially serious complication. Clinical and hematological data were treated to extract some clinically meaningful factors in relation to the success and failure of pregnancy. Among initial hematological parameters, no significant difference was found between successful and unsuccessful cases with an exception of hemoglobin concentration. The patients diagnosed as aplastic anemia prior to conception demonstrated an better outcome of pregnancy as well as survival rate of mother when compared with those diagnosed during pregnancy. Mortality has apparently improved after the late 1950's. Success rate of pregnancy before 1958 was 21%, while it was 67% and 71% in the era of 1959-1969 and after 1970, respectively. However, hemorrhage and infection remained to be two major causes of maternal death in both eras. Based on these observations, the currently recommendable attitude to this complication is discussed.

Immunologic thrombocytopenic purpura and pregnancy: six new cases.

Six new cases of idiopathic thrombocytopenic purpura (ITP) associated with pregnancy are reported; one of these patients delivered triplets. In addition, 78 patients with 122 pregnancies and 124 fetuses have been reported previously. The maternal mortality rate was 4% and the fetal mortality rate was 18%. Prior recommendations for elective cesarean section in all mothers with a platelet count less than 100,000/cu mm at delivery is not supported by the data available. Treatment of pregnant women with ITP with adrenal corticosteroids has virtually eliminated maternal mortality, has replaced splenectomy as the therapy of choice during pregnancy, but has had little effect on fetal mortality.

Acute fatty liver of pregnancy with disseminated intravascular coagulation.

A patient with acute fatty liver of pregnancy associated with disseminated intravascular coagulation (DIC) is reported. The case lends support to the hypothesis that DIC may be of pathophysiologic significance in this disorder. Treatment principles are discussed and the importance of prompt Caesarean section as early as possible after the onset of symptoms is emphasized.

[Ultrasonic study of fetal dysmaturity: hypertension, diabetes and Rhesus-immunization (author's transl)]. / Ultraschallfetometrie bei intrauterinen Wachstummsstörungen: Gestose, Diabetes, Rhesusinkompatibilität

Using ultrasonic A- and B-scan equipment (Kretz-Technik), 80 pregnancies with chronic placental dysfunction were investigated: 34 cases with hypertension, 24 cases with diabetes and 22 cases with rhesus immunization. In addition to biparietal diameter (A-scan), the direct and transverse diameter, the circumference and the area were estimated on B-scan displays of the occipito-frontal plane and the largest cross-sectional plane of the abdomen. 15 parameters of fetal growth and body composition were compared with normal standards. The significance of the different methods in the diagnosis of fetal dysmaturity was demonstrated.

Cerebral lesions of mature newborn due to perinatal hypoxia. II. Mother's diseases.

The influence of chronic intrapregnancy hypoxia caused by mother's diseases (toxemia, gravidarum, hypochromic anemia, diabetes) on the brain of a mature newborn has been investigated. Besides the vast damages of the parieto-occipital cortex, Ammon's horn (entorhinal) motor and insula cortex there were also some damages of the cerebellum and the brain stem cells. The damages of the cells in the brain stem seem to be one of the causes of the abnormal perinatal adaption.

Pregnancy, pre-eclampsia and disseminated intravascular coagulation.

A prospective evaluation of the haemostatic mechanism was undertaken in 15 normal primigravidas and in 12 primigravidas with mild to moderately severe pre-eclampsia in order to further examine the possibility that disseminated intravascular coagulation may occur in this clinical syndrome. The only coagulation abnormality demonstrated was a prolongation of bleeding time. The data do not support the suggestion that significant disseminated intravascular coagulation is associated with pre-eclampsia. The addition of the heparinoid drug sodium pentosan polysulphate to the therapeutic regimen resulted in a significant fall in platelet factor 3 availability and in decreased aggregation against ADP but conferred no objective clinical improvement. We conclude that the drug has no place in the management of established pre-eclampsia.