Simplified care of women with prolonged or persistent retention of the placenta: the use of paracervical block.

Thirty patients with prolonged or persistent retention of the placenta were randomized to either paracervical block or intravenous cocktail of pethidine and diazepam. When paracervical block worked, the analgesia produced was better than that usually achieved with intravenous cocktail of pethidine and diazepam. From a cost-benefit point of view paracervical block is preferable to intravenous cocktail. No significant side-effects occurred during the trial.

A case of advanced viable extrauterine pregnancy.

Advanced extrauterine pregnancy with a successful outcome is a rare event. A case is presented of a 34-year-old woman at 35 weeks gestation whose abdominal pregnancy was successfully managed. The diagnostic and management problems associated with abdominal pregnancy are discussed, and especially the controversial issues of the treatment of the placenta after delivery. The reasons for the high maternal and perinatal mortality associated with the condition are analyzed.

Fatal post-splenectomy sepsis in a Papua New Guinean highlander.

A fatal case of overwhelming post-splenectomy sepsis (OPSS) occurring 5 years after splenectomy for trauma in a Papua New Guinean highlander is presented. The diagnosis of pneumococcal infection was made from a peripheral blood smear. The finding of OPSS in Papua New Guinea is cited as additional evidence in favour of a policy of conservative management, where possible, of ruptured spleen.

Perinatal outcome and associated factors of persistent breech presentation at the Port Moresby General Hospital, Papua New Guinea.

A study of 502 singleton persistent breech presentations and 502 controls of cephalic presentations during labour, at the Port Moresby General Hospital, was carried out from January 1988 to July 1993. In 76 (15%) of the cases, at least one attempt was made at external cephalic version. Backward logistic regression analysis showed that Momase or Islands region ethnicity, previous breech delivery, lack of antenatal care, preterm delivery, low birthweight and congenital anomalies were significantly associated with persistent breech delivery. The perinatal outcome of babies with breech presentation was worse than among babies with cephalic presentation.

A case of factor V deficiency presenting as menorrhagia.

Factor V deficiency is a rare hereditary disorder. We report a patient with factor V deficiency who presented with menorrhagia and pelvic haematoma. The Haematology Department at the Royal Brisbane Hospital performed the definitive factor assays leading to the diagnosis. The challenges of her management were obtaining adequate supplies of factor V and her socioeconomic circumstances. The main future challenge will be the supervision of her pregnancies.

Hepatitis B surface and e antigen seropositivity in mothers and cord blood at Port Moresby General Hospital: implications for a control program.

Analysis of 100 unselected paired maternal and cord blood samples showed 11 mothers to be HBsAg positive and 6 of these to be also HBeAg positive. 5 cord blood samples were HBsAg positive and 3 were HBeAg positive. Assuming a protective efficacy rate of 75%, the present plasma-derived hepatitis B virus vaccine control program is likely to prevent the perinatal acquisition of the hepatitis B virus carrier state in 27 per 1000 children. The addition of immunoglobulin prophylaxis would be likely to reduce this by another 5 per 1000, but its use does not appear practicable at the present time.

PIP: 100 mother-infant pairs were tested for hepatitis B surface and e antigen and the results used to estimate effectiveness of the current vaccination program in Papua New Guinea. The 100 mothers and neonates born at the Port Moresby General Hospital in May-June 1990 were tested for HBsAg and HBeAg with the reversed passive hemagglutination technique (Green Cross Corp., Japan). 11 mothers were positive for HBsAg, and 6 of these for HBeAg. 5 cord bloods were positive for HBsAg, and 2 of these for HBeAg. 1 infant was positive for HBeAg only. All 3 infants positive for HBeAg were born of HBeAg mothers. It is assumed that HBsAg in infants is from passive transfer from the mother. HBeAg is indicative of a highly infectious state in a mother, and active infection in a newborn. It was calculated that the currently used plasma-derived vaccine, which has a protective efficacy rate (PER) of 75%, would be expected to protect 25/1000 children from becoming carriers, compared to 5/1000 more if immunoglobulin were given in addition. The higher costs of the new recombinant vaccine and of the plasma vaccine plus immunoglobulin were considered impractical.

The disposition of oral amodiaquine in Papua New Guinean children with falciparum malaria.

AIMS: We assessed the disposition of oral amodiaquine (AQ) and CYP2C8 polymorphism in 20 children with falciparum malaria. METHODS: AQ and DEAQ concentrations were determined with SPE-HPLC method. CYP2C8 genotypes were assessed by PCR-RFLP method. RESULTS: AQ was not detectable beyond day 3 postdose. Cmax for DEAQ was reached in 3.0 days. The mean values for t1/2, MRT, and AUCtotal were 10.1 days, 15.5 days and 4512.6 microg l(-1) day, respectively. All the children were CYP2C8* homozygous. CONCLUSION: Our data are consistent with those previously reported, and the AQ regimen seems pharmacokinetically adequate in the absence of CYP2C8 polymorphism.