Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study).

BACKGROUND: The influence of pregnancy on Multiple Sclerosis (MS) has been extensively studied but such influence on Latin American women with MS has not been characterized. Our objective was to describe the course of pregnancy and birth outcome in Argentinean MS patients and the evolution of MS during pregnancy and after delivery. METHOD: We used a retrospective design in eight MS centers in Argentina and administered a survey to women with definite MS (Mc Donald) with pregnancies during or after MS onset. We contacted 355 women of which 81 met inclusion criteria. We recorded 141 pregnancies. RESULTS: Involuntary abortion was observed in 16% of pregnancies (95% CI = 10-23). Thirty five women received immunomodulatory therapy (IMT) before 42 pregnancies. Twenty three (55%) out of 42 pregnancies were exposed to IMT. The mean time of IMT discontinuation before conception in 19 (45.2%) pregnancies without exposure, was 104 days (95% CI = 61.0-147.0). There were 103 deliveries: 79% full term. Birth defects were detected in 19% of pregnancies exposed to IMT (95% CI = 4-46) and in 2% of non-exposed (95% CI = 0.3-8.0). The mean relapse rate was: pre-pregnancy year: 0.22 (95% CI = 0.12-0.32); pregnancy: 0.31 in 1st (95% CI = 0.10-0.52), 0.19 (95% CI = 0.03-0.36) in 2nd, and 0.04 in 3rd trimester (95% CI = -0.04-0.12); 1st trimester post delivery: 0.82 (95% CI = 0.42-1.22). CONCLUSION: We observed a higher rate of birth defects among infants exposed to immunomodulators in utero than those not exposed. The reduction in MS relapses during 2nd and 3rd trimester of pregnancy and its increase during postpartum is consistent with previous reports.

Maternal obstetric emergencies in rural Africa.

PIP: In Africa the future mother and the mother in labor continue to be very much at risk. Thus far it has been impossible to obtain accurate maternal death rates. The results of hospital practice limited to the West African Sahel (Senegal, Mauritania, Niger) for more than 10 years is the focus. Attention is on 2 types of emergency - major dystocia and ruptured uterus - because of their frequency and their sequelae. These emergencies are resented by surgeons who believe that obstetrics should not be a matter of last resort hysterectomies and futile attempts to repair torn bladders and rectums. In developing countries these emergencies should be a major concern of the health service, because of the extent to which they continue to be a threat to mother and child. These emergencies are discussed at length in terms of dealing with them at the curative level, at the preventive level, and the obstetric risks. At the curative level they require prompt surgical care in easily reached centers with good equipment and staff. At the preventive level there is greater chance of effective prevention by screening and systematic antenatal supervision. The obstetric risks could be reduced in all African mothers if a suitable action program was adopted.^ieng