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RhD prophylaxis failure in Rio de Janeiro, Brazil
276
BRIEF COMMUNICATIONS
Table 1 Treatment of external genital warts in pregnant women with imiquimod 5% cream Type of response
Patients (n = 17)
Complete Partial None Recurrence
13 (76.6) 1 (5.8) a 3 (17.6) b 0 (0)
Values are given as numbers (percentage). a Before patient lost to follow-up. b Includes 1 patient who discontinued therapy because of uterine contractions.
In this retrospective case series of 17 pregnant women, selftreatment of both baseline and new external anogenital warts with imiquimod 5% cream provided a complete response in 13 (76.4%) women. One patient experienced a partial response, giving a total response rate of 82.3%. In this small series, a complete response was achieved more rapidly during pregnancy (mean 5.1 weeks) than in non-pregnant women (12 weeks) [1]. External anogenital warts did not reoccur in patients with a complete response, although the follow-up time was short (9 weeks).
This report of topical imiquimod 5% cream should be considered as a preliminary study because the relatively small number of subjects treated and short follow-up preclude generalization. Larger comparative clinical trials are needed to determine the therapeutic value and safety of topical imiquimod 5% cream for treating external anogenital warts in pregnancy.
References [1] Moore RA, Edwards J, Hopwood J, Hicks D. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis 2001:1–3. [2] Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines. MMWR 2006;55(No RR-11):64. [3] Einarson A, Costei A, Kalra S, Rouleau M, Koren G. The use of topical 5% imiquimod during pregnancy: a case series. Reprod Toxicol 2006;21:1–2. [4] Maw RD. Treatment of external genital warts with 5% imiquimod cream during pregnancy: a case report. Br J Obstet Gynaecol 2004;111:1475.
RhD prophylaxis failure in Rio de Janeiro, Brazil Gustavo Lobato ⁎, Christina S. Soncini Fetal Medicine Unit, Department of Obstetrics, Fernandes Figueira Institute, Oswaldo Cruz Foundation (IFF-FIOCRUZ), Rio de Janeiro, Brazil Received 4 July 2007; received in revised form 10 August 2007; accepted 13 August 2007
KEYWORDS Alloimmunization; Fetal anemia; Prophylaxis; Immunoglobulin
Despite the availability of the immunoglobulins, RhD alloimmunization remains a significant problem in several countries [1,2]. In Brazil, reliable data concerning its ⁎ Corresponding author. Fetal Medicine Unit, Department of Obstetrics, Fernandes Figueira Institute, Oswaldo Cruz Foundation (FIOCRUZ), Avenida Rui Barbosa, 716, Terceiro Andar, Flamengo - Rio de Janeiro (RJ), Brazil. Tel.: +55 21 2554 1893; fax: +55 21 2553 6730. E-mail address: [email protected] (G. Lobato). doi:10.1016/j.ijgo.2007.08.008
magnitude is lacking, and the major causes of maternal sensitization are not known. Between July 1996 and June 2006, the obstetric histories of 85 severely RhD-alloimmunized pregnant women who received care at the Fernandes Figueira Institute (FIOCRUZ) were examined for potential causes of RhD alloimmunization. The median maternal age was 29.4 years (range, 18– 42 years) and the total number of previous pregnancies was 292 (mean 3.43; range, 1–8), with 56 abortions and 236 births. Only 6 (7.1%) women received prophylaxis after all births and/or abortions, while 65 (76.5%) did not receive prophylaxis at least once following birth or abortion. A total of 14 (16.4%) women did not provide information regarding immunoglobulin administration in previous pregnancies. Table 1 provides details of RhD prophylaxis administration in the study group.
BRIEF COMMUNICATIONS
277
Table 1 RhD immunoglobulin administration after previous births and abortions in 85 severely RhD-alloimmunized pregnant women in Rio de Janeiro, Brazil Immunoglobulin administration
Number (%)
Previous births Prophylaxis administrated Prophylaxis not administrated Information unavailable Previous abortions Prophylaxis administrated Prophylaxis not administrated Information unavailable
236 17 (7.2) 184 (78) 35 (14.8) 56 1 (1.8) 45 (80.4) 10 (17.8)
The high rate of births and abortions in which RhD prophylaxis was not given differed from similar studies conducted in developed countries [3,4], where failure to administer postnatal prophylaxis is rare, and antenatal alloimmunization seems to be the most important reason for new cases of maternal sensitization. However, the inherent limitations of retrospective studies make it difficult to assess with certainty the proper cause and precise time that sensitization occurred. In some of the births and abortions in which immunoglobulin was reportedly not administered, both parents may have been RhD-negative, or the women could already have been alloimmunized. In addition, 14 women did not provide any information on administration in previous pregnancies, which could be interpreted as unawareness of its importance.
It is important to mention that the possibility of antenatal alloimmunization could not be evaluated in the present study. Although official Brazilian guidelines recommend administration of RhD immunoglobulin between 28 and 34 weeks of gestation, in Rio de Janeiro it is not routine at basic health facilities. Further population studies are needed to address the real prevalence of RhD alloimmunization in Brazil, its causes, and regional discrepancies. In order to determine the success rate of the RhD prophylaxis, assessment of the number of RhDnegative women who receive antenatal and postnatal prophylaxis is essential. Disparity in immunoglobulin availability should also be recognized, as well as gaps in the ability of health services to identify and administer RhD prophylaxis properly, and women's knowledge about its importance.
References [1] Mari G, Zimmermann R, Moise K, Deter RL. Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions. Am J Obstet Gynecol 2005;193:1117–20. [2] Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2001. Natl Vital Stat Rep 2002;18:1–102. [3] Hughes RG, Craig JI, Murphy WG, Greer IA. Causes and clinical consequences of Rhesus (D) haemolytic disease of the newborn: a study of a Scottish population, 1985–1990. Br J Obstet Gynecol 1994;101:297–300. [4] McSweeney E, Kirkham J, Vinall P, Flanagan P. An audit of anti-D sensitisation in Yorkshire. Br J Obstet Gynecol 1998;105:1091–4.
Detection of fetal structural abnormalities by early pregnancy ultrasound in China Qiuming Li, Buyun Guan, Dongzhi Li ⁎ Prenatal Diagnostic Center, Guangzhou Maternal and Neonatal Hospital, Guangzhou Medical College, Guangdong, China Received 3 August 2007; received in revised form 20 August 2007; accepted 24 August 2007
KEYWORDS Fetal abnormalities; First trimester; Ultrasound; Nuchal translucency
⁎ Corresponding author. Prenatal Diagnostic Center, Guangzhou Maternal and Neonatal Hospital, Renminzhong Road 402, Guangzhou, Guangdong 510180, China. Fax: +86 20 8185 4671. E-mail address: [email protected] (D. Li). doi:10.1016/j.ijgo.2007.08.015
In recent years nuchal translucency (NT) in the first trimester has been introduced as a screening test for Down syndrome. By using a combination of NT and maternal serum biochemistry, detection rate for fetal aneuploidy can be as high as 80% [1]. There is also increasing evidence that many fetal structural abnormalities can be detected by early ultrasound [2,3]. The first trimester NT scan can also be a good opportunity to identify structural abnormalities. The aim of this study was to evaluate the role of early ultrasound in the detection of fetal structural abnormalities in China. During a 3-year period a total of 2288 consecutive unselected pregnant women were evaluated during the
BRIEF COMMUNICATIONS
Table 1 Treatment of external genital warts in pregnant women with imiquimod 5% cream Type of response
Patients (n = 17)
Complete Partial None Recurrence
13 (76.6) 1 (5.8) a 3 (17.6) b 0 (0)
Values are given as numbers (percentage). a Before patient lost to follow-up. b Includes 1 patient who discontinued therapy because of uterine contractions.
In this retrospective case series of 17 pregnant women, selftreatment of both baseline and new external anogenital warts with imiquimod 5% cream provided a complete response in 13 (76.4%) women. One patient experienced a partial response, giving a total response rate of 82.3%. In this small series, a complete response was achieved more rapidly during pregnancy (mean 5.1 weeks) than in non-pregnant women (12 weeks) [1]. External anogenital warts did not reoccur in patients with a complete response, although the follow-up time was short (9 weeks).
This report of topical imiquimod 5% cream should be considered as a preliminary study because the relatively small number of subjects treated and short follow-up preclude generalization. Larger comparative clinical trials are needed to determine the therapeutic value and safety of topical imiquimod 5% cream for treating external anogenital warts in pregnancy.
References [1] Moore RA, Edwards J, Hopwood J, Hicks D. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis 2001:1–3. [2] Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines. MMWR 2006;55(No RR-11):64. [3] Einarson A, Costei A, Kalra S, Rouleau M, Koren G. The use of topical 5% imiquimod during pregnancy: a case series. Reprod Toxicol 2006;21:1–2. [4] Maw RD. Treatment of external genital warts with 5% imiquimod cream during pregnancy: a case report. Br J Obstet Gynaecol 2004;111:1475.
RhD prophylaxis failure in Rio de Janeiro, Brazil Gustavo Lobato ⁎, Christina S. Soncini Fetal Medicine Unit, Department of Obstetrics, Fernandes Figueira Institute, Oswaldo Cruz Foundation (IFF-FIOCRUZ), Rio de Janeiro, Brazil Received 4 July 2007; received in revised form 10 August 2007; accepted 13 August 2007
KEYWORDS Alloimmunization; Fetal anemia; Prophylaxis; Immunoglobulin
Despite the availability of the immunoglobulins, RhD alloimmunization remains a significant problem in several countries [1,2]. In Brazil, reliable data concerning its ⁎ Corresponding author. Fetal Medicine Unit, Department of Obstetrics, Fernandes Figueira Institute, Oswaldo Cruz Foundation (FIOCRUZ), Avenida Rui Barbosa, 716, Terceiro Andar, Flamengo - Rio de Janeiro (RJ), Brazil. Tel.: +55 21 2554 1893; fax: +55 21 2553 6730. E-mail address: [email protected] (G. Lobato). doi:10.1016/j.ijgo.2007.08.008
magnitude is lacking, and the major causes of maternal sensitization are not known. Between July 1996 and June 2006, the obstetric histories of 85 severely RhD-alloimmunized pregnant women who received care at the Fernandes Figueira Institute (FIOCRUZ) were examined for potential causes of RhD alloimmunization. The median maternal age was 29.4 years (range, 18– 42 years) and the total number of previous pregnancies was 292 (mean 3.43; range, 1–8), with 56 abortions and 236 births. Only 6 (7.1%) women received prophylaxis after all births and/or abortions, while 65 (76.5%) did not receive prophylaxis at least once following birth or abortion. A total of 14 (16.4%) women did not provide information regarding immunoglobulin administration in previous pregnancies. Table 1 provides details of RhD prophylaxis administration in the study group.
BRIEF COMMUNICATIONS
277
Table 1 RhD immunoglobulin administration after previous births and abortions in 85 severely RhD-alloimmunized pregnant women in Rio de Janeiro, Brazil Immunoglobulin administration
Number (%)
Previous births Prophylaxis administrated Prophylaxis not administrated Information unavailable Previous abortions Prophylaxis administrated Prophylaxis not administrated Information unavailable
236 17 (7.2) 184 (78) 35 (14.8) 56 1 (1.8) 45 (80.4) 10 (17.8)
The high rate of births and abortions in which RhD prophylaxis was not given differed from similar studies conducted in developed countries [3,4], where failure to administer postnatal prophylaxis is rare, and antenatal alloimmunization seems to be the most important reason for new cases of maternal sensitization. However, the inherent limitations of retrospective studies make it difficult to assess with certainty the proper cause and precise time that sensitization occurred. In some of the births and abortions in which immunoglobulin was reportedly not administered, both parents may have been RhD-negative, or the women could already have been alloimmunized. In addition, 14 women did not provide any information on administration in previous pregnancies, which could be interpreted as unawareness of its importance.
It is important to mention that the possibility of antenatal alloimmunization could not be evaluated in the present study. Although official Brazilian guidelines recommend administration of RhD immunoglobulin between 28 and 34 weeks of gestation, in Rio de Janeiro it is not routine at basic health facilities. Further population studies are needed to address the real prevalence of RhD alloimmunization in Brazil, its causes, and regional discrepancies. In order to determine the success rate of the RhD prophylaxis, assessment of the number of RhDnegative women who receive antenatal and postnatal prophylaxis is essential. Disparity in immunoglobulin availability should also be recognized, as well as gaps in the ability of health services to identify and administer RhD prophylaxis properly, and women's knowledge about its importance.
References [1] Mari G, Zimmermann R, Moise K, Deter RL. Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions. Am J Obstet Gynecol 2005;193:1117–20. [2] Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2001. Natl Vital Stat Rep 2002;18:1–102. [3] Hughes RG, Craig JI, Murphy WG, Greer IA. Causes and clinical consequences of Rhesus (D) haemolytic disease of the newborn: a study of a Scottish population, 1985–1990. Br J Obstet Gynecol 1994;101:297–300. [4] McSweeney E, Kirkham J, Vinall P, Flanagan P. An audit of anti-D sensitisation in Yorkshire. Br J Obstet Gynecol 1998;105:1091–4.
Detection of fetal structural abnormalities by early pregnancy ultrasound in China Qiuming Li, Buyun Guan, Dongzhi Li ⁎ Prenatal Diagnostic Center, Guangzhou Maternal and Neonatal Hospital, Guangzhou Medical College, Guangdong, China Received 3 August 2007; received in revised form 20 August 2007; accepted 24 August 2007
KEYWORDS Fetal abnormalities; First trimester; Ultrasound; Nuchal translucency
⁎ Corresponding author. Prenatal Diagnostic Center, Guangzhou Maternal and Neonatal Hospital, Renminzhong Road 402, Guangzhou, Guangdong 510180, China. Fax: +86 20 8185 4671. E-mail address: [email protected] (D. Li). doi:10.1016/j.ijgo.2007.08.015
In recent years nuchal translucency (NT) in the first trimester has been introduced as a screening test for Down syndrome. By using a combination of NT and maternal serum biochemistry, detection rate for fetal aneuploidy can be as high as 80% [1]. There is also increasing evidence that many fetal structural abnormalities can be detected by early ultrasound [2,3]. The first trimester NT scan can also be a good opportunity to identify structural abnormalities. The aim of this study was to evaluate the role of early ultrasound in the detection of fetal structural abnormalities in China. During a 3-year period a total of 2288 consecutive unselected pregnant women were evaluated during the