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Sickle cell disease in pregnancy
Reproductive Problems in the DES-Exposed Woman Rosenfeld D, Bronson R: Reproductive problems in the DES-exposed female. Obstet Gynecol 55:453, 1980. This report documents the high infertility and pregnancy wastage among DESexposed women. Among 25 women seeking medical assistance for either primary or secondary infertility (12 patients and 13 patients respectively) 8 patients conceived 10 times during the 242 years of the study. There were five term deliveries, three early abortions, and two tubal pregnancies. This provided a 50% pregnancy wastage rate. Although a small study, this report does document some difficulties within this group of women: infertility, habitual abortion, premature birth and tubal pregnancy. These are suggested to result from oligo-ovulation, hostile cervical mucus, and abnormalities of the uterus and oviducts.
Berger M, Goldstein D: Impaired reproductive performance in DESexposed women. Obstet Gynecol 55125, 1980. This is a report on the reproductive performance of 69 patients in the authors’ private practice who were at risk for becoming pregnant. Forty-six patients achieved 80 pregnancies (fertility rate of 66.7%). Of the 32 patients electing to continue their pregnancies, there were 36 pregnancy failures (58.1%) and 26 live births (41.9%). The failures consisted of 19 spontaneous first-trimester losses (30.6%) 3 tubal pregnancies (4.8%) 11 spon40 0091-2182/80/060040+3$02.25
institution over a 19-year period in order to compare their approach with the approach of others. Neither the mere existence of sickle cell disease nor increased anemia without symptoms were used as an indication for transfusion. Patients were transfused for two indications: (1) because of clinical deterioration in the vaso-occlusive manifestations of their sickling disorder, or (2) because of symptoms of air hunger or significantly increased fatigue associated with the development of more severe anemia. Seventy per cent of pregnancies resulted in viable infants, though one third weighed less than 2500 g. The Johns Hopkins data compares favorably with that from 5 other centers, and the authors conclude that until results are reported from large trials using contemporary methods “it would seem wise to continue individualized therapy (withholding transfusions until there is evidence of maternal distress) and to optimize facilities for neonatal care in these as in all patients.” Also of note was the late complication of transfusion of development of multiple antibodies, resulting in future difficulty in cross matching blood for these patients.
taneous midtrimester losses (17.7%) and three neonatal deaths of premature infants. There were a total of 8 pregnancies (12.9%) delivered prematurely (prior to 35 weeks). Hysterosalpingograms were done only on those patients who demonstrated repeated losses. All 25 of these had documented structural abnormalities of the uterus. Cervical cerclage was required in 8 pregnancies for demonstrated cervical incompetence. The authors conclude that although DES-exposed women do have difficulty conceiving, their major problem seems to be related to increased fetal wastage in all three trimesters. They feel the issue of incompetent cervices has not been resolved, since few of their patients showed clinical evidence of incompetency, and most of the hysterosalpingograms showed long narrow cervices rather than short dilated ones. They suggest following patients closely with vaginal exams beginning about 12 weeks, and cerclage be performed only if dilatation is observed.
Sickle Cell Disease in Pregnancy Charache S, Scott J, Niebyl J, Bonds D: Management of sickle cell disease in pregnant patients. Obstet Gynecol 55407.
Length of Labor Is Main Determinant of Postpartum Morbidity D’Angelo L, Sokol R: “Time-related peripartum determinants of postpartum morbidity.” Obstet Gynecol 55:319.
This report compares data from a total of 74 pregnancies in 42 patients with sickling disorders seen at Johns Hopkins Hospital with similar data from other centers. The authors express their concern over the increasing use of prophylactic transfusion at the time of delivery and the general use of transfusion to treat manifestations of anemia. They advocate a more conservative approach, and have reviewed all cases from their
Journal of Nurse-Midwifery
??
The purpose of this prospective study was to evaluate the numerous factors believed to be implicated in the development of postpartum, especially post-
Vol. 25, No. 6, November/December
Comght
19f#o
@ 1980 by the American Cokge of Nurse-Midwives
Berger M, Goldstein D: Impaired reproductive performance in DESexposed women. Obstet Gynecol 55125, 1980. This is a report on the reproductive performance of 69 patients in the authors’ private practice who were at risk for becoming pregnant. Forty-six patients achieved 80 pregnancies (fertility rate of 66.7%). Of the 32 patients electing to continue their pregnancies, there were 36 pregnancy failures (58.1%) and 26 live births (41.9%). The failures consisted of 19 spontaneous first-trimester losses (30.6%) 3 tubal pregnancies (4.8%) 11 spon40 0091-2182/80/060040+3$02.25
institution over a 19-year period in order to compare their approach with the approach of others. Neither the mere existence of sickle cell disease nor increased anemia without symptoms were used as an indication for transfusion. Patients were transfused for two indications: (1) because of clinical deterioration in the vaso-occlusive manifestations of their sickling disorder, or (2) because of symptoms of air hunger or significantly increased fatigue associated with the development of more severe anemia. Seventy per cent of pregnancies resulted in viable infants, though one third weighed less than 2500 g. The Johns Hopkins data compares favorably with that from 5 other centers, and the authors conclude that until results are reported from large trials using contemporary methods “it would seem wise to continue individualized therapy (withholding transfusions until there is evidence of maternal distress) and to optimize facilities for neonatal care in these as in all patients.” Also of note was the late complication of transfusion of development of multiple antibodies, resulting in future difficulty in cross matching blood for these patients.
taneous midtrimester losses (17.7%) and three neonatal deaths of premature infants. There were a total of 8 pregnancies (12.9%) delivered prematurely (prior to 35 weeks). Hysterosalpingograms were done only on those patients who demonstrated repeated losses. All 25 of these had documented structural abnormalities of the uterus. Cervical cerclage was required in 8 pregnancies for demonstrated cervical incompetence. The authors conclude that although DES-exposed women do have difficulty conceiving, their major problem seems to be related to increased fetal wastage in all three trimesters. They feel the issue of incompetent cervices has not been resolved, since few of their patients showed clinical evidence of incompetency, and most of the hysterosalpingograms showed long narrow cervices rather than short dilated ones. They suggest following patients closely with vaginal exams beginning about 12 weeks, and cerclage be performed only if dilatation is observed.
Sickle Cell Disease in Pregnancy Charache S, Scott J, Niebyl J, Bonds D: Management of sickle cell disease in pregnant patients. Obstet Gynecol 55407.
Length of Labor Is Main Determinant of Postpartum Morbidity D’Angelo L, Sokol R: “Time-related peripartum determinants of postpartum morbidity.” Obstet Gynecol 55:319.
This report compares data from a total of 74 pregnancies in 42 patients with sickling disorders seen at Johns Hopkins Hospital with similar data from other centers. The authors express their concern over the increasing use of prophylactic transfusion at the time of delivery and the general use of transfusion to treat manifestations of anemia. They advocate a more conservative approach, and have reviewed all cases from their
Journal of Nurse-Midwifery
??
The purpose of this prospective study was to evaluate the numerous factors believed to be implicated in the development of postpartum, especially post-
Vol. 25, No. 6, November/December
Comght
19f#o
@ 1980 by the American Cokge of Nurse-Midwives