Randomised trial of artemether versus artemether and mefloquine for the treatment of chloroquine/sufadoxine-pyrimethamine-resistant falciparum malaria during pregnancy.

The efficacy of artemether and artemether followed by mefloquine was evaluated in 45 pregnant women with drug resistant Plasmodium falciparum malaria during the second and third trimesters. There was prompt clinical response to both treatment regimens. The parasite and fever clearance times and the cure rate were similar in both groups. Except for the correlation between initial parasite density and fever clearance time in the artemether-mefloquine group, there was no correlation between initial parasite density and parasite or fever clearance times in the two groups. Similarly, there was no correlation between parasite and fever clearance. Both treatment regimens were well tolerated. All newborn babies of the participating women were normal at birth. Physical and neurodevelopmental assessment of the newborn babies followed up for a period varying between 6 and 36 months were within normal limits. Artemether alone or with mefloquine are effective and do not produce undue deleterious effects in pregnant patients with drug-resistant falciparum malaria during the second and third trimesters.

Outcome of 441 breech singleton deliveries at the Catholic Hospital, Oluyoro, Ibadan.

Breech presentation at delivery occurred in 441 of 21,243 deliveries giving an incidence of 2.1% in Oluyoro Catholic Hospital, Ibadan. The fresh stillbirth rate was 7.8% and this was six times the cephalic (1.2%) fresh stillbirth rate for the same period. The incidence of breech presentation was lowest between parity 1 and 3, and rose above parity 5. Majority of the stillbirths occurred in primigravidae and grandmultiparous patients. Caesarean section was performed in 15.7% of breech singleton, while 79% were delivered by assisted breech delivery. The commonest indication for caesarean section was fetal distress. Low birth weight (2.5 kg) or less breech singleton occurred in 22% cases, and accounted for 45% of all breech stillbirths. The lowest risk to the fetus was between 3kg and 4kg birth weights. Congenital abnormalities of the Central Nervous System occurred in 2.7% of breech babies as compared to 0.2% in cephalic presentation. Low birth weight, prematurity, primigravidity and grandmultiparity were the identified factors associated with stillbirths. Early identification and management of these factors will reduce the high incidence of perinatal deaths in breech deliveries. We advocate the use of symphysiotomy in the management of the entrapped aftercoming head of the breech.