Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia.

BACKGROUND: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery. METHODS: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded. RESULTS: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality. CONCLUSIONS: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Placental and oral delivery of Schistosoma mansoni antigen from infected mothers to their newborns and children.

A 63-kD Schistosoma mansoni antigen was detected in 149 (86%) of 174 umbilical cord blood sera from infected women at delivery. Specific IgG antibodies to this antigen were also detected in 80% of cord blood sera. The 63-kD antigen showed the same molecular mass by Western blotting when isolated from cord blood, maternal blood, breast milk, and urine from women infected with S. mansoni. This antigen was detected in the urine of 25 infants born to infected mothers and followed for 18-24 months after delivery. It was also detected in some infants up to 21 days after parturition and then disappeared at 28 days, demonstrating the influence of breast-feeding on persistence of antigen in infants born to infected women. Thus, exposure to Schistosoma antigens and maternal antibodies to this organism may influence the developing immune responses to natural infection or vaccination of children born in endemic areas.