Constitutional hypofibrinogenemia associated with third trimester hemorrhage.

This case of a 31-year-old white woman presenting at 32 weeks gestation with vaginal bleeding supports a possible association between constitutional hypofibrinogenemia and third trimester hemorrhage. Clot based fibrinogen assays were persistently low for the third trimester (patient: 102 to 155 mg per dl; normal range: 400 to 650 mg per dl) and at follow-up, ten months post-partum (patient: 90 mg per dl; normal range 180 to 436 mg per dl); an immunologic fibrinogen level was comparable. The patient gave an unremarkable bleeding history. Of 11 previously reported pregnancies in five hypofibrinogenemic patients, six terminated in placental abruption during the third trimester, two others were complicated by significant post-partum hemorrhage, and one by spontaneous abortion. This case report emphasizes that low functional levels of fibrinogen are potentially disruptive to the integrity of the uteroplacental interface. The pregnant state unmasks and amplifies an otherwise silent to mild hemostatic disorder.

Heterozygous beta-thalassemia in pregnancy.

Present and past reproductive performance and various hematologic parameters were studied among 29 women with heterozygous beta-thalassemia. The pregnancy outcome and complications did not differ from those in the general population. Antepartum anemia and a distinctly lowered mean corpuscular volume were present almost universally.

Hematologic problems in pregnancy V. Obstetric transfusion therapy.

A study of 37,186 admissions, from 1970 through 1974, to a large southern charity hospital obstetrics service revealed a striking 63 per cent reduction in number of patients receiving blood transfusions. Analysis showed no change in patient population, bleeding disorders, toxemia, incidence of obstetric hemorrhage, serious febrile morbidity, or incidence of antepartum anemia. In the study period cesarean section rate increased 77 per cent and anemia at delivery markedly decreased. Transfusions associated with spontaneous abortion decreased by 70 per cent, and after the third study year no patient undergoing legal abortion received blood. The study demonstrated improvement in specific hematinic therapy of antepartum anemia and avoidance of transfusion therapy in the presence of uncharacterized antepartum or puerperal anemia. Despite the remarkable decrease in blood transfusions, obstetric outcome (including perinatal mortality rate, maternal mortality rate, and serious febrile morbidity) did not suffer but, indeed, improved.

Amniotic fluid urea nitrogen in the prediction of respiratory distress syndrome.

Amniotic fluid urea nitrogen levels can be used to predict the neonate not at risk for the development of respiratory distress syndrome. A prospective study of 110 pregnancies compared amniotic fluid urea nitrogen concentrations with the lecithin/sphingomyelin ratio and presence of phosphatidylglycerol. After determination of gestational age, amniotic fluid was analyzed for urea nitrogen concentration and an aliquot was sent to the hospital's commercial laboratory for lecithin/sphingomyelin and phosphatidylglycerol measurement. An amniotic fluid urea nitrogen level less than 7.4 mg/dl predicted the presence of neonatal respiratory distress syndrome in 12 of 13 patients independent of gestational age and birth weight. This assay can be performed at the bedside with simple equipment in 70 seconds at approximately one-fortieth the cost of present standard lung maturity studies.

Lactation suppression and puerperal fever.

Seventy-five puerperal women who did not wish to breast-feed were treated with bromocriptine mesylate (Parlodel) or placebo in a prospective, randomized, double-blind study. Results revealed a puerperal fever incidence of 18.6%, 13.3% of which was due to breast engorgement and 5.3% to an infectious process. Parlodel prevented puerperal fever in 87.9% of patients. If Parlodel was given within 18 hours of delivery, physiologic puerperal fever was prevented in 100% of cases.

Longitudinal study of platelet indices during normal pregnancy.

The purpose of this longitudinal, prospective study was to define platelet indices during normal pregnancy and to compare them to normal nonpregnant values. Indices evaluated included platelet count, mean platelet volume, and platelet distribution width. No significant change occurred in the mean platelet count or mean platelet volume from the second to the third trimester; however, platelet distribution width increased progressively and significantly during this interval (p less than 0.0001). Mean platelet volume versus platelet count showed a significant inverse relationship (p less than 0.0001) and was congruent with normal nonpregnant values. Mean platelet volume versus platelet distribution width exhibited a significant direct relationship (p less than 0.03) that differed remarkably from normal nonpregnant values. These data support the concept of normal pregnancy as a compensated state of progressive platelet consumption. These findings may have important diagnostic and prognostic applications in discerning acute states of platelet consumption superimposed on the compensated consumption of normal pregnancy.

Reduced dose of Rho(D) immune globulin following induced first-trimester abortion.

A double-blind study of women after first-trimester abortion supports the efficacy of low-dose Rho(D) immune globulin (human) in the prevention of Rh sensitization. Twenty-seven per cent of patients demonstrated a fetomaternal blood leak based on Kleihauer-Betke stains. In follow-up testing, the percentage of positive titers and the absolute titer of detectable antibody at various intervals were related to the dose of administered immune globulin. This study confirmed the possible risk of sensitization in Rh-negative postabortal women and suggests the practical use of single low-dose immune globulin preparations in prevention.