A prospective study on the occurrence of autoantibodies in low-risk pregnancies.

OBJECTIVE: This investigation was done to study the prevalence of anti-nuclear antibodies (ANA), anti-cardiolipin antibodies (aCL), and rheumatoid factor (RF), in presumed healthy women during their pregnancies. STUDY DESIGN: During an 18 month period blood samples were taken in the first, second and third trimester from 1200 pregnant women, representing a low-risk population. Clinical data on the pregnancy outcome were obtained by birth statistics after their deliveries. The diagnoses of preeclampsia, intrauterine growth retardation, fetal death, or abruptio placentae were stated in 57 of these women. An age- and parity-matched control group of 207 women with normal pregnancy outcome was drawn from the same low-risk population (n= 1200). A nonpregnant control group consisted of 157 women. The prevalence of ANA (immunofluorescence microscopy on HEp-2 cells), aCL-immunoglobulin G (enzyme-linked immunosorbent assay), and RF (latex agglutination test) in preeclampsia, intrauterine growth retardation, fetal death, or abruptio placentae were compared to the normal pregnancies, and to the nonpregnant controls. RESULTS: ANA occurred significantly more often (P<0.05) in pregnancies complicated by preeclampsia when compared to normal pregnancies. aCL occurred sparsely in normal as well as complicated pregnancies. RF was infrequently seen among all women in this study. CONCLUSION: An association was noted between the occurrence of ANA and preeclampsia. However, this association was too insensitive to use as a clinical tool.

Clinical consequences of anal sphincter rupture during vaginal delivery.

BACKGROUND: Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to meet women with anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth. STUDY DESIGN: Fifty-one consecutive women with primarily sutured anal sphincter rupture and 31 women without anal sphincter rupture were prospectively studied after vaginal delivery. All were assessed clinically at 3 days, 6 weeks, and 6 months after delivery. After 6 months, all women underwent anorectal manometry and answered a questionnaire about incontinence, social function, and general health. RESULTS: The overall incidence of sphincter rupture was 2.4 percent. Significantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture. The resting pressures did not differ between groups. Approximately 40 percent of the women in both groups had noted some fecal incontinence by 6 months postpartum. Symptoms were significantly more severe in patients with sphincter rupture. CONCLUSIONS: Anal sphincter rupture was 2.4 times as common as reported in Swedish birth statistics. The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.