A 12-week randomised study comparing intravenous iron sucrose versus oral ferrous sulphate for treatment of postpartum anemia.

OBJECTIVE: To analyze the effect of intravenous ferrous sucrose compared with oral ferrous sulphate on hematological parameters and quality of life in women with postpartum anemia. DESIGN: Open randomised controlled trial. SETTING: Multicentre study comprising five obstetrical departments in Norway. POPULATION: Hundred and twenty-eight postpartum women with hemorrhagic anemia (Hb between 6.5 g/100 ml and 8.5 g/100 ml). The intervention group (59 women) received 600 mg iron sucrose intravenously followed by 200 mg iron sulphate daily from week 5. The control group (70 women) were given 200 mg iron sulphate daily. METHODS: Randomisation and start of treatment occurred within 48 hours of the delivery. Participants were followed up at 4, 8 and 12 weeks. MAIN OUTCOME MEASURES: Hemoglobin, ferritin and quality of life assessed with the Medical Outcomes Study Short Form 36 (SF-36) and the Fatigue Scale. RESULTS: After 4 weeks the mean hemoglobin values in both groups were similar (11.9 g/100ml vs. 12.3g/100ml, p=0.89). The mean serum ferritin value after 4 weeks was significantly higher in the intervention group with 13.7 microg/L vs. 4.2 microg/L in the control group (p<0.001). At 8 and 12 weeks the hematological parameters were similar. The total fatigue score was significantly improved in the intervention group at week 4, 8 and 12, whereas SF-36 scores did not differ. CONCLUSION: Women who received 600 mg intravenous iron sucrose followed by standard oral iron after four weeks, replenished their iron stores more rapidly and had a more favorable development of the fatigue score indicating improved quality of life.

[Mother-to-child transmission of HIV]. / HIV-smitte fra mor til barn.

BACKGROUND: Modern treatment of HIV-positive women has reduced the rate of transmission of HIV to their children. The relative importance of different interventions is unclear. We have studied mother-to-child transmission from the start of the Norwegian epidemic in 1983 and up to the year 2000. MATERIAL AND METHODS: Retrospective study of risk factors in HIV-positive women and children of HIV-positive mothers born in Norway and followed up at our hospital. RESULTS: 53 women gave birth to 57 live-born children, eight of whom were HIV-infected. The mothers of 4 HIV-infected children were treated with zidovudine monotherapy during their pregnancy. Out of the 12 children delivered by elective caesarean section and the 17 children (8 delivered by elective caesarean section) with mothers receiving antiviral combination therapy, none were HIV-infected. HIV-RNA was measured at the time of birth in 16 women; 8 had viral loads of less than 50 copies/ml and 8 had viral loads at the time of delivery between 50 and 57 100 copies/ml, but none of these 16 transmitted the virus to their children. None of the mothers breast-fed. INTERPRETATION: Transmission of HIV from mother to child was associated with insufficient or no antiviral therapy of mother and child. The effect of elective caesarean section could not be separated from the effect of antiviral therapy. We did not find any association between transmission of HIV and prematurity, development of immunodeficiency in the mother, special risk group status, or early membrane rupture.

[Use of the B-Lynch suture technique in postpartum hemorrhage]. / Bruk av B-Lynch-sutur ved blødning etter fødsel.

BACKGROUND: Serious postpartum haemorrhage occurs in approximately 1.4% of all deliveries in Norway and may result in hysterectomy. Stepwise devascularisation and hysterectomy are technically difficult and time consuming. A simple suture technique, B-Lynch suture, has recently been introduced, by which atonic postpartum haemorrhage may be controlled and hysterectomy avoided. MATERIAL, METHODS AND RESULTS: We have used the B-Lynch technique in five patients with serious postpartum uterine atonia and haemorrhage. In all patients serious bleeding and hysterectomy were avoided. Three of the patients are described in detail, one with failed induction of labour resulting in Caesarean section, one with placenta previa, and one with prolonged normal vaginal delivery. INTERPRETATION: If performed early, the B-Lynch suture technique is less mutilating to the woman; it may prevent excessive blood loss and is probably beneficial for the patient's future fertility. It is easy to perform in Caesarean sections and can be adopted in vaginal deliveries.