RESUMO
BACKGROUND: Intraplacental choriocarcinoma (ICC) is a rare form of gestational trophoblastic disease that has been documented as complicating near-term pregnancies with massive fetomaternal haemorrhage (FMH), intrauterine fetal demise, neonatal anaemia, and disseminated disease of both mother and child. CASE: A 31-year-old woman at 38 weeks of gestation underwent caesarean section due to reduced fetal movements. The caesarean section was complicated by disseminated intravascular coagulopathy (DIC). Massive FMH and choriocarcinoma were diagnosed after delivery. DISCUSSION: Review of the literature demonstrated this to be the first published case of DIC associated with choriocarcinoma, a rare complication. The literature suggests post-partum serial measurement of beta human chorionic gonadotropin (ß-HCG) in women with unexplained massive FMH. This case demonstrates the potential to reduce morbidity and mortality by earlier diagnosis of choriocarcinoma by means of surveillance of serial ß-HCG levels in patient and child. OUTCOME: The patient underwent 4-agent chemotherapy after methotrexate alone failed to achieve remission. ß-HCG levels were undetectable at the time of publishing this case report and the child is healthy with no complications.
RESUMO
A cross sectional study was carried out to assess immunisation coverage among 257 urban and 339 rural children aged 13-36 months who were vaccinated at pulse polio booths in Shimla hills. 84.37% urban children and 57.59% rural children were fully vaccinated. BCG scar was negative in a large number of children, especially from rural areas. Increasing maternal education was associated with complete immunisation. OPV I-III dropouts were 3% among urban children and 15% among rural. The corresponding dropout rates for DPT I-III were 1% and 8% respectively. The immunisation coverage in this region was higher than others. Sustained efforts are required to achieve full immunisation coverage and eradicate polio and measles.
PIP: In India, where the universal immunization program launched in 1985 has dramatically reduced the incidence of preventable childhood diseases, pockets of low immunization still exist in the country's tribal and hilly areas. To obtain an accurate picture of immunization coverage in Shimla district, a cross-sectional study of 257 urban and 339 rural children 13-36 months of age from 30 urban and 30 rural clusters was conducted. Study participants were recruited at pulse polio booths in Shimla hills on a national immunization day in 1995. 286 (84.37%) urban and 148 (57.59%) rural children were fully vaccinated. The drop-out rates for oral polio vaccine were 3% among urban children and 15% among rural children; for diphtheria-pertussis-tetanus vaccine, these rates were 1% and 8%, respectively, and for measles vaccine, they were 94.1% and 81.3%, respectively. Complete immunization was positively associated with maternal education. Sustained efforts are required to achieve full immunization coverage in India.
Assuntos
Proteção da Criança , Imunização/normas , Saúde da População Rural , Saúde da População Urbana , Estudos Transversais , Humanos , Índia , Lactente , Mães/educaçãoRESUMO
A cross sectional study of 398 mothers and infants was conducted to assess the age at first breast feeding, and its determinants, in Shimla. We found that the timely first suckling rate was 0.10 in urban group and 0.11 in rural group. The median age at initiation of breast feeding was five hours among urban cases and four hours among rural cases. Most of the infants were breast fed by the age of 24 hours which is a positive sign and is higher than previous studies. Absence of definite trend vs mother's education may be due to other factors. A community-based educational programme to promote early breast feeding is required, along with training on lactation management counselling for health workers. This will help in achieving healthy child development through prevention of childhood malnutrition.
