The Clinical effect of maternal hypertension on pre-term pregnancy - abstract

Pre-term neonates of hypertensive mothers have been reported to have an accelerated lung maturity and so an improved perinatal outcome compared to their normotensive counterparts. In order to substantiate this, we examined the case notes of 418 consecutive pre-term pregnancies (< 34 weeks) delivered during a 36-month period. Forty-eight cases without any other obstetric complication were identified. They were compared with 141 normotensive pregnancies identified similarly. More hypertensive mothers were delivered by Caesarean Section (77.1 per cent vs 3.5 per cent). Significantly more hypertensive pre-term pregnancies were associated with foetal distress in labour (44.8 per cent vs 2.8 per cent; p < 0.001) and low birth weight (41.7 per cent vs 1.4 per cent; p < 0.001). There were no differences in low apgar scores, respiratory distress syndrome and neonatal deaths. The findings suggest that maternal hypertension in pre-term pregnancies is associated with an increased incidence of intrauterine growth retardation and foetal distress, and that the perinatal outcome is no better than their normotensive counterparts. The previously reported benefit of "intrauterine stress" in hypertensive pregnancies is not substantiated in this series (AU)

Conservative surgical management for ectopic pregnancy

A 27 year old para 1+1 female, with a history of a previous salpingectomy for ectopic pregnancy, presented with lower abdominal pain and a period of amenorrhea of seven weeks. A diagnosis of unruptured right ampullary pregnancy was made by transvaginal ultrasound. Treatment was by linear salpingostomy with primary closure, resulting in a patent tube as demonstrated by hysterosalpingography. (AU)

Missing intrauterine contraceptive device presenting with strings at the anus

The rare condition of strings of a missing intrauterine contraceptive device presenting at the anus is described. Partial removal was achieved via the rectum and this was followed by a normal uncomplicated pregnancy and delivery. (AU)

Operative outcome following vaginal hysterectomy

The peri-operative factors surrounding the patient subjected to vaginal hysterectomy were reviewed. Most of the patients were post-menopausal, and the indication for surgery in all cases was utero-vaginal descent. Regional anaesthesia was associated with less blood loss, while lower blood losses were associated with fewer complications and shorter hospitalization. Overall, the morbidity was low (8 percent), and the mortality was zero (AU)

Accurate pre-operative diagnosis of ovarian cancer by a combination of clinical criteria, ultrasonography and CA 125 - abstract

Early pre-operative treatment of ovarian cancer is hindered by a lack of reliable criteria for its early diagnosis. This study was undertaken to assess the value of clinical criteria, ultrasonography and serum CA 125 values in the differential diagnosis of benign and malignant pelvic masses. Thirty-six consecutive patients who had elective surgery for investigation and management of an adnexal mass were enrolled in the study from May to October, 1988. All patients had a clinical examination, serum CA 125 measurement and ultrasound pre-operatively, and their menopausal status determined. Based on these findings, a scoring system was devised (Table). Twenty patients had serum CA 125 values < 35 U/ml and histology confirmed a benign ovarian lesion. The remaining 16 patients had serum CA 125 levels > 35 U/ml, and their tumours were confirmed to be malignant histologically. There were significant differences in age (p<0.01), menopausal status (p=0.01), clinical impression score (p<0.01), ultrasound score (p<0.001) and serum CA 125 level (p<0.001) in patients with benign as compared to malignant lesions. The most useful single diagnostic criterion was serum CA 125 levels, and diagnostic accuracy was increased by adding menopausal status and ultrasound findings (sensitivity > 90 per cent; specificty 95.2 per cent) (AU)

Human papilloma virus infections and other risk factors as determinants of cervical intraepithelial neoplasia in Trinidad and Tobago - abstract

Human Papilloma Viruses (HPV) are considered to play a key role in the induction of malignant neoplasms of the cervix uteri but there have been no published reports on the prevalence of genital HPV infections among women in this region where the incidence of cervical cancer is high. The objectives of this study were to assess the overall and type-specific prevalence of HPV infections of the uterine cervix in a sample of urban and rural women with and without cytologically or histologically defined cervical intraepithelial neoplasia (CIN) in this population of non-hysterectomized, non-pregnant females aged 18 - 60 years. One hundred and sixty-nine urban women, roughly half of whom had abnormal cytological diagnoses and 159 rural women were examined colposcopically and directed cervical biopsies performed. Cases and controls were identified on the basis of results of examinations of these specimens. Z-tests, kappa statistic, chi-square, odds ratio and confidence limits and multivariate logistic techniques were used where appropriate. Overall prevalence of HPV infection was 6.7 per cent, HPV DNA was detected in 5.6 per cent of controls and only 6.3 per cent of cases. HPV type 16 was the commonest isolate (54.5 per cent). HPV positivity was not an independent predictor of the risk of CIN. Early coital onset, high parity, multiple sexual partners and high gravidity were the most significant, independent predictors of the risk of CIN (AU)

Hypertensive disease in pregnant women delivering before 34 weeks gestation - abstract

Preterm delivery (delivery before 34 weeks gestation) accounts for the major part of perinatal mortality and morbidity which are worsened when hypertension is superimposed. This study analyses maternal characteristics, peripartum factors and mode of delivery in 419 consecutive preterm deliveries over the period January, 1986 to December 1989, in which 69 gravidae were hypertensive (diastolic blood pressure > 90 mm Hg) and the rest normotensive. Of the 69 hypertensive patients, 52 (75 per cent) had uncontrollable hypertension necessitating delivery and 19 (28 per cent) developed convulsions. The hypertensive mother was older, of higher parity, and had a higher frequency of previous stillbirths and Caesarean sections (CS). Acute foetal distress in labour, NST (Non-reactive non-stress test) and IUGR (Intrauterine growth retardation) were all more frequent in the hypertensive pregnancy (Table given). Ethnic origin was not associated with occurrence of hypertension in pregnancy. The overall perinatal mortality was 36 per cent in this series; and there were no maternal deaths (AU)

Congenital cytomegalovirus infection - abstract

Congenital cytomegalovirus (CSM) infection is the most common congenital infection in man. This paper reports 23 cases presenting at the Mount Hope Women's Hospital, Neonatal Unit, between January 1 and December 31, 1987. All babies were positive for CMV-specifice IgM antibody in cord blood, as assayed years and parity from 0 to 4 with a mean of 0.8. There were 8 primigravid patients. Among the infected babies, there was a striking male predominance (16.6) with significant low birth rate weight (78 percent) and prematurity (70). Only 4 (7 percent) neonates were actually growth retarded. The commonest clinical problem was suspected sepsis(57 percent), followed by jaundice (53 percent), and hepatosplenomegaly and respiratory distress (39 percent each). Congenital heart disease (13 percent), microcephaly (13 percent), hearing impairment (9 percent) and delayed development (22 percent were also noted. The overall incidence of CMV infection in this selected population was 0.38 percent, and the need for a prospective study determine the true incidence in emphasised. It is suggested that congenital CMV infection may occur for reactivation of laten infection in the multigravida in Trinidad (AU)