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High-velocity penetrating wounds of the gravid uterus: Review of 16 years of civil war
Ciiations from the Literature/M.
heavily pretreated patient population. Only 2% of the cycles were associated with neutropenic sepsis or required platelet transfusions. Nonhematologic toxicity was modest. Among 16 women who received chemotherapy alone, there were I I (69%) complete and three (19%) partial responses. When adjuvant therapies are included, the overall complete and partial response rates were 77 and 14%. respectively. Six (35%) of I7 complete responders developed recurrences. Five patients with partial response or relapse were salvaged with additional therapy. Fifteen of the 22 patients (68%) have sustained remissions. Conclusions: The regimen of alternating weekly etoposidemethotrexate-dactinomycin/cyclophosphamide-vincristine is effective and well-tolerated chemotherapy for patients with high-risk gestational trophoblastic disease. Reduced transfer of tetanus antibodies with placental malaria
Brair M.-E.; Brabin B.J.; Milligan P.; Maxwell S.; Hart C.A. GBR
LANCET 1994 34318891(208-209) Placental malaria may limit antibody transfer to the fetus. We compared concentrations of tetanus antibody in paired maternal-cord sera from 224 women living in a malarious area of Papua New Guinea. With heavy placental infection (>35 parasites per 200 white cells) the average cold tetanus antibody corresponding to a maternal level of I IU/ml was 0.18 (95% CI 0.12-0.26); corresponding figures after light (< 35 parasites per 200 white cells) or no infection were 0.23 (0.14-0.34) and 0.82 (0.57-l.21), respectively. About 10% of babies born to mothers with a placenta heavily infected with Plasmodium falciparum may fail to acquire protective levels of tetanus antibody despite adequate maternal antibody.
J. Gynecol. Obstet. 47 (1994) 83-91
91
High-velocity penetrating wounds of the gravid uterus: Review of 16 years of civil war
Awwad J.T.; Azar G.B.; Seoud M.A.; Mrouh A.M.; Karam K.S. LBN
OBSTET GYNECOL 1994 83/2 (259-264) Objective: To evaluate the value of selective laparotomy in pregnant women with penetrating abdominal injuries. Methods: A retrospective survey was carried out at our center over 16 years of civil war, extending from 1975 to 1991. Fourteen pregnant women had uterine injuries secondary to highvelocity abdominal penetrating trauma. The corresponding management was evaluated carefully with respect to maternal and fetal outcomes. Results: Two maternal deaths occurred, neither resulting solely from intra-abdominal injuries. Visceral injuries were present when the entrance of the missile was in either the upper abdomen or the back. When the entry site was anterior and below the uterine fundus, visceral injuries were absent in all six women upon surgical exploration. Perinatal deaths occurred in half of the cases and were due to maternal shock or uteroplacental or direct fetal injury. immediate cesarean delivery was performed because of either limited surgical field exposure, fetal injury, or distress. Three patients explored were managed by delaying delivery. All later delivered vaginally with successful fetal outcomes in all three. Conclusions: Selective laparotomy may be considered in pregnant women with anterior penetrating abdominal trauma, as the likelihood of intra-abdominal injuries may be predicted based on the location of the penetrating wound.
heavily pretreated patient population. Only 2% of the cycles were associated with neutropenic sepsis or required platelet transfusions. Nonhematologic toxicity was modest. Among 16 women who received chemotherapy alone, there were I I (69%) complete and three (19%) partial responses. When adjuvant therapies are included, the overall complete and partial response rates were 77 and 14%. respectively. Six (35%) of I7 complete responders developed recurrences. Five patients with partial response or relapse were salvaged with additional therapy. Fifteen of the 22 patients (68%) have sustained remissions. Conclusions: The regimen of alternating weekly etoposidemethotrexate-dactinomycin/cyclophosphamide-vincristine is effective and well-tolerated chemotherapy for patients with high-risk gestational trophoblastic disease. Reduced transfer of tetanus antibodies with placental malaria
Brair M.-E.; Brabin B.J.; Milligan P.; Maxwell S.; Hart C.A. GBR
LANCET 1994 34318891(208-209) Placental malaria may limit antibody transfer to the fetus. We compared concentrations of tetanus antibody in paired maternal-cord sera from 224 women living in a malarious area of Papua New Guinea. With heavy placental infection (>35 parasites per 200 white cells) the average cold tetanus antibody corresponding to a maternal level of I IU/ml was 0.18 (95% CI 0.12-0.26); corresponding figures after light (< 35 parasites per 200 white cells) or no infection were 0.23 (0.14-0.34) and 0.82 (0.57-l.21), respectively. About 10% of babies born to mothers with a placenta heavily infected with Plasmodium falciparum may fail to acquire protective levels of tetanus antibody despite adequate maternal antibody.
J. Gynecol. Obstet. 47 (1994) 83-91
91
High-velocity penetrating wounds of the gravid uterus: Review of 16 years of civil war
Awwad J.T.; Azar G.B.; Seoud M.A.; Mrouh A.M.; Karam K.S. LBN
OBSTET GYNECOL 1994 83/2 (259-264) Objective: To evaluate the value of selective laparotomy in pregnant women with penetrating abdominal injuries. Methods: A retrospective survey was carried out at our center over 16 years of civil war, extending from 1975 to 1991. Fourteen pregnant women had uterine injuries secondary to highvelocity abdominal penetrating trauma. The corresponding management was evaluated carefully with respect to maternal and fetal outcomes. Results: Two maternal deaths occurred, neither resulting solely from intra-abdominal injuries. Visceral injuries were present when the entrance of the missile was in either the upper abdomen or the back. When the entry site was anterior and below the uterine fundus, visceral injuries were absent in all six women upon surgical exploration. Perinatal deaths occurred in half of the cases and were due to maternal shock or uteroplacental or direct fetal injury. immediate cesarean delivery was performed because of either limited surgical field exposure, fetal injury, or distress. Three patients explored were managed by delaying delivery. All later delivered vaginally with successful fetal outcomes in all three. Conclusions: Selective laparotomy may be considered in pregnant women with anterior penetrating abdominal trauma, as the likelihood of intra-abdominal injuries may be predicted based on the location of the penetrating wound.