Case report: post partum class 1 HELLP syndrome.

The objective of this case report is to highlight the lack of screening tests that is capable of predicting HELLP syndrome before its occurrence. The patient developed severe pre-eclamptic toxaemia at 34+ weeks gestation. The foetus was growth retarded. The patient received anti-hypertensive therapy and was delivered by an emergency caesarean section. The patient developed post partum HELLP syndrome that required supportive treatment and renal haemodialysis; nevertheless, the patient fully recovered.

Audit: women's perception and knowledge of the 20 weeks anomaly scan.

We surveyed 385 women attending two maternity units for an anomaly scan at 20 weeks' gestation. Ninety-five per cent of the women thought that the purpose of the anomaly scan was to check for structural abnormalities in the fetus, indicating good knowledge. Most women thought the anomaly scan would pick up spinal, limb and kidney abnormalities. There was high expectation of what structural abnormalities the anomaly scan could pick up; 22% and 51% of the women thought the scan would pick up 61-70% and 71-100% of the structural abnormalities, respectively. Only 8% of the women thought, realistically, that the anomaly scan would pick up 50% of the abnormalities. The women's knowledge of soft markers was poor; 92% of them never heard of it. The main source of information about the anomaly scan was the hospital.

Viral hepatitis in pregnancy.

Fifty pregnant women with viral hepatitis were compared with 31 non-pregnant women with viral hepatitis in a prospective case-control study. The two groups were matching except for the serum bilirubin level and area of residence. Seven pregnant women died while none of the control patients died and the difference between the two groups was significant. More than 80% of the deaths occurred in the third trimester and most of them were post-partum deaths. Except for a higher incidence of pre-term birth, the outcome of pregnancy in the case group was not affected. It is concluded that pregnancy is a risk factor which increases the mortality of viral hepatitis and that viral hepatitis does not affect the outcome of pregnancy except for pre-term birth.

PIP: 50 pregnant women and 31 nonpregnant women (age 15-40 years) with viral hepatitis admitted to Wad Medani Teaching Hospital, Sudan, during the period January 1987-January 1990 were compared in a prospective case control study. The mean serum bilirubin level was higher in the control group and the difference was statistically significant (p = 0.0084). Significantly more case came from rural settings (76%) compared with control patients (48%) (p 0.01). The criteria for admission were the presence of symptoms and signs of hepatitis and bilirubin in the urine. Almost all patients admitted to the study had viral hepatitis caused by type A virus, type B virus, or non-A, non-B viruses, however, a very small number of diseases of patients could be attributed to rare viruses like EB or cytomegalovirus. No specific medication was given and patients were managed by bed rest and parenteral multivitamins (Parentrovit). All patients were kept in the hospital until they became asymptomatic and serum bilirubin dropped to less than 2 mg/100 ml. All cases and controls were followed up for 6 weeks. All the control patients were discharged after recovery and none of them died or developed recurrence of disease. Out of the 50 pregnant women, 7 died, giving a maternal mortality rate of 14%; the rest recovered and none of them developed recurrence of disease during the follow-up period. The difference between the 2 groups was statistically significant (p = 0.04). The estimated relative risk of death in viral hepatitis with pregnancy was 9.93. Among 5 deaths that occurred after delivery during the 3rd trimester 1 was at term and the baby was normal; 4 were preterm deliveries. Out of the 50 pregnant women, 1 died before delivery and 1 delivered at home. The outcome of pregnancy in the remaining 48 was: 2 abortions (4.2%), 10 preterm (20.8%), and 36 (75%) term deliveries. There were 2 stillbirths (4.2%) one at term and one at 34 weeks.