Mean Gestational Period Research Articles

Anesthetic management in pregnant women with Fontan circulation: a case series.

Given the advances in medicine, women with Fontan circulation are now reaching childbearing age. However, data on the mode of delivery and anesthetic management of these patients are limited. We report the cases of five pregnant women with Fontan circulation. The mean age at delivery was 28 ± 3years, and the mean gestational period was 34weeks and 3days. Anticoagulation therapy was switched from warfarin and aspirin to continuous intravenous heparin. The modes of delivery were scheduled cesarean section (C/S) in one, emergency C/S in three, and vaginal delivery with epidural labor analgesia in one patient. Three patients underwent C/S under regional anesthesia; one received general anesthesia. The perinatal complications were heart failure, worsening valve regurgitation, and postoperative hematoma in three, four, and two patients, respectively. For C/S in women with Fontan circulation, regional anesthesia should be considered. Epidural labor analgesia can help prevent the decrease in pulmonary blood flow due to straining. We initiated labor analgesia or C/S with regional anesthesia at the appropriate time in four patients.

Outcomes of acute type A aortic dissection repair during pregnancy.

To evaluate the efficacy and safety of performing cesarean section surgery before aortic repair after acute type A aortic dissection (ATAAD) during pregnancy. A total of six patients who received ATAAD repair during their pregnancies were retrospectively identified in the hospital database from January 2002 to December 2021. The mean gestational period at the time of aortic repair was 35.3 ± 2.7 weeks, and the aortic root diameter ranged from 40 to 60 mm. The mean time from disease onset to arrival at the operation room was 20.3 ± 10.8h (range 10-36 h). All patients successfully received aortic repair operations following cesarean section and survived the peri-surgery period without developing major complications. All fetuses were successfully delivered. After an average follow up of 25.8months, all patients and their children had survived without developing major complications except for one mother who committed suicide 6months after discharge as a result of postpartum depression. The present study suggested that ATAAD repair can be safely performed in the third-trimester.

Predicting the Frequency of Pregnancy Induced Hypertension in Early Pregnancy by Maternal Serum Beta Human Chorionic Gonadotropin Levels

Background: During early pregnancy raised beta human chorionic gonadotropin (β-HCG) level occurs during placental development. It may be used for identifying the pregnancy induced hypertension. There are certain factors that causes pregnancy induced hypertension and preeclampsia. However, many of the associated factors and specific cause is not known. Some common risk factors for preeclampsia are nulliparity, preeclampsia in a previous pregnancy, family history, history of hypertension, renal disease and antiphospholipid antibody syndrome or thrombophilia. However no single lab investigation can be done cost-effectively to make the early diagnosis of pregnancy induced hypertension. The objective of this study was to determine the frequency of Pregnancy induced hypertension in patients with high maternal serum β-HCG at early pregnancy ( 13-20 weeks of gestation). Methodology: A descriptive cross sectional study was conducted on Out Patient Department and in patient wards of the Obstetrics and Gynecology Department of KRL General Hospital, Islamabad. The study was done from 28th December 2018 to 27th June 2019. A total of 75 pregnant women, primary gravida and multi gravida with age range from18-40years with raised β-HCG at 13-20 weeks of gestation were included. All patients were observed during their stay in the hospital for the development of any complications of pregnancy induced hypertension. Results: Mean age of pregnant females was 32.12 ± 5.29 years. Mean gestational period was 17.31 ± 2.05 weeks. Mean β-HCG levels was 7.63±3.71. Pregnancy induced hypertension (PIH) in patients with high maternal serum β-HCG at 13-20 weeks of gestation was found in 64 (85.33%) patients, however there was no Pregnancy induced hypertension in 11 (14.65%) ladies. Conclusion: The outcome of this study concluded that frequency of pregnancy induced hypertension in pregnant femal with high maternal serum β-HCG at 13-20 weeks of gestation was high. Early screening of raised β-HCG can be made for the prevention of complications due to pregnancy induced hypertension. Keywords: Beta Human chorionic gonadotropin, pre-eclampsia, pregnancy induced hypertension.

Cohort profile: Japanese human milk study, a prospective birth cohort: baseline data for lactating women, infants and human milk macronutrients

PurposeThe Japanese Human Milk Study, a longitudinal prospective cohort study, was set up to clarify how maternal health, nutritional status, lifestyle and sociodemographic and economic factors affect breastfeeding practices and...

Association of Placental Weight With Birth Weight, Gestational Age, and Risk Factors Related to Maternal Morbidity, Diet, Activity, and Rest

Background: Placental weight and its relationship to infant size at birth have been studied for more than a century.[1] A low placental weight is associated with the medical complications in the mother.[2] The risk of essential hypertension in adult life falls with increasing birth weight and rises with increasing placental weight and that the mothers at highest risk are those with a high placental weight relative to birth weight-that is, a high placental ratio.[3] Aims/Objective: To study association of placental weight with birth weight, gestational age and maternal morbidity, diet, activity and rest. Settings and Design / Methods and Material: A cohort of 1876 apparently healthy pregnant women registered and attending antenatal clinic of Krishna Hospital was studied to find out the correlation of the placental weight with the LBW and preterm births and their association with selected maternal risk factors. Statistical Analysis Used: Correlation (r), Chi-square test, Analysis of Variance (ANOVA) and Boneferroni test, Unpaired 't' test, were used. Results: There was a statistically significant association of the mean placental weight with the mean birth weight and proportion of LBW of the baby as indicated by ANOVA test. (F= 29.627; p<0.001) and (χ2 =102.6; p<0.001) respectively. There was a statistically significant association of the mean placental weight with the mean gestational period of the baby and proportion of the preterm births as indicated by ANOVA test. (F= 7.694; p<0.001) and (χ2=18.377;p<0.001) respectively. Daily frequency of meals < 4, antenatal morbidity of preeclampsia, PIH and APH were associated with lesser placental weight. Conclusion: There was a significant association of placental weight with birth weight, gestational age, maternal morbidity and frequency of maternal meals.

Nomogram of fetal right portal vein diameter at gestational age 30 to 35 weeks and prediction of small for gestational age at birth.

To construct the nomogram of fetal right portal vein (RPV) diameter at 30 to 35 weeks' gestation in Thai pregnant population and the use of RPV measurement to predicting small for gestational age (SGA) fetus. A prospective, cross-sectional study of singleton pregnancies at antenatal visit between 30 and 35+6 weeks of gestation in single center, Bhumibol Adulyadej Hospital (BAH) was conducted from January to August 2020. Ultrasonography of fetal biometry and RPV diameter measurement were performed as well as immediate newborn birth weight measurement. The nomogram of fetal RPV was developed for standardization for Thai people. A total of 219 singleton pregnant women were enrolled and ultrasonographic measurement of RPV and fetal biometry was obtained. Mean maternal age and gestational period were 29.4 years and 33.0 weeks, respectively. One third of participants were classified as obese. RPV diameter ranged from 1.85 to 6.07 mm and increased linearly with gestational age. The optimal threshold of RPV diameter for diagnosis SGA was less than 3.06 mm with area under ROC curve at a level of 0.613 (95%CI 0.496 to 0.731). Sensitivity and specificity were 38.46% and 83.94%, respectively. There was no fetal death or neonatal morbidity in the present study. RPV diameter increases in size depending on gestational age. RPV diameter at 30 to 35+6 weeks gestation was a useful measurement for SGA prediction. RPV measurements greater than 3.06 mm strongly indicated normal fetal growth.

CHARACTERISTICS OF POST-NATAL PAKISTANI WOMEN WITH CHRONIC APICAL PERIODONITITIS

Background: Premature parturition difficulties are the key reason of death for children less than 5 years, resulting more than 1 million mortality in 2015 alone. Many disabilities among children are associated with preterm. Chronic Apical Periodontitis has been reported to be a prevalent disease especially in adults. CAP is usually a condition in which apical portion of the root of tooth is chronically inflamed.
 
 Objective: The purpose this research was to identify the characteristics of chronic apical periodontitis among post-natal Pakistani women.
 
 Methodology: This cross-sectional study was conducted at among 150 post-natal women suffered from CAP at Gynaecology ward, Unit III, Civil Hospital Karachi. Data were collected from women who delivered babies on that day at the Gynae ward CHK and satisfied the criteria to be included in the study. Principal Investigator assessed radiographs for the presences of CAP. SPSS version 21.0 was used to enter and analysed the study data.
 
 Results: Mean age of participants was 26.61 ± 4.83. Among all participants 63 (42%) were unable to read or write. There were 100 (66.7%) participants who had monthly income < 10,000. Majority of the participants had ? 6 members in family. Majority 104 (69.3%) were multigravida while 46 (30. %) were primigravida. Mean gestational period in weeks was 36.16 ± 2.31. Majority of the participants 115 (76.7%) had CAP in single tooth, 32 (21.3%) had in 2 teeth and 3 (2%) had CAP in 3 teeth. PAI score was significantly associated with birth type (normal term and preterm). Baby weight was significantly differed between PAI scores.
 Conclusion: Results of this study indicate most of the study women were illiterate and belong to low income family. There was higher percentage of multigravida and most of the deliveries were normal vaginal. CAP in single tooth was found among majority of the study women.

Blood Test Results of Pregnant COVID-19 Patients: An Updated Case-Control Study.

Background: Coronavirus disease (COVID-19) is a current global public health emergency. However, current research on the blood test results of pregnant women with COVID-19 is insufficient.Methods: A case-control study was carried out based on clinical blood test results. Pregnant COVID-19 patients, pregnant COVID-19 patients with diabetes, and pregnant COVID-19 patients with hypertension, were assessed in this study. Also, 120 controls were matched by age, parity, fetus number, and presence of chronic disease. T-tests, Chi-square tests, Wilcoxon signed-rank tests, and Kruskal-Wallis tests were used to compare data from the blood tests and liver function indices among the selected groups.Results: Between January 24 and March 14, 2020, 60 pregnant COVID-19 patients delivered at the Maternal and Child Health Hospital of Hubei Province. The average maternal age of pregnant COVID-19 patients was 30.97 years and the mean gestational period was 37.87 weeks. 71.67% (43/60) of pregnant COVID-19 patients gave birth by cesarean delivery. In total, 21.67% (13/60) were diagnosed with diabetes and 18.33% (11/60) were diagnosed with hypertension during pregnancy. Compared to controls, pregnant COVID-19 patients showed significantly lower numbers of blood lymphocytes and higher numbers of neutrophils, as well as higher levels of C-reactive protein and total bilirubin. Among the three groups, pregnant COVID-19 patients with diabetes had significantly higher levels of neutrophils and lower levels of total protein. Aspartate transaminase levels were higher in pregnant COVID-19 patients with hypertension than in pregnant COVID-19 patients with no comorbidities and controls with hypertension.Interpretations: Blood and liver function indices indicate that chronic complications, including hypertension and diabetes, could increase the risk of inflammation and liver injury in pregnant COVID-19 patients.

The effect of myo-inositol, vitamin D3 and melatonin on the oocyte quality and pregnancy in in vitro fertilization: a randomized prospective controlled trial.

To evaluate the efficacy of a treatment with Myo-inositol (MI) plus melatonin and vitamin D3 in women underwent intra cytoplasmatic sperm injection (ICSI). 100 women undergoing ICSI procedure were enrolled and randomly divided 1:1 in two groups. The study group was treated with 2 g MI, 50 mg Alpha-Lactalbumin (alpha-LA) and 200 µg folic acid in powder every morning for 6 months (3 months before oocyte pick up and 3 months after ICSI); the same patients underwent treatment with 600 mg MI, 1 mg melatonin plus 200 µg folic acid during the evening for 3 months before oocyte pick up; subsequently the pick up these patients were treated with 600 mg MI, 200 µg folic acid, 1 mg melatonin, 50 µg vitamin D3 as cholecalciferol until the 12th week of gestation. The control group was treated with 200 µg folic acid twice a day. Clinical pregnancy rate was evaluated as primary outcome, followed by blastocyst and oocyte quality, as well as gestational period as secondary outcomes. Treatment significantly improved blastocyst and oocyte quality in the study group, achieving the 42% of clinical pregnancies vs. 24% in the control group, even though the course of pregnancy did not significantly differ between the groups. However, the mean gestational period was shorter in the control group. The supplementation of MI in combination with melatonin in the first 3 months before oocyte pick up and with vitamin D3 in the further 3 months could represent an innovative support for all those women undergoing ICSI.

Seroprevalence of Hepatitis B virus infection and associated factors among pregnant women at Korle-Bu Teaching Hospital, Ghana.

IntroductionHepatitis B virus infection is a global public health problem. Though, the disease is endemic in sub-Saharan Africa, little is known about its epidemiology among pregnant women in Ghana. This study sought to determine the seroprevalence of Hepatitis B virus infection and associated factors among pregnant women attending antenatal care at Korle-Bu Teaching Hospital; Ghana’s largest hospital.MethodsWe conducted a facility-based cross-sectional survey among 232 antenatal attendants. Participants were recruited using systematic random sampling technique and screened with HBsAg Rapid Test. Data was analyzed with the aid of Statistical Package for Social Sciences (SPSS), version 23.0. Results were presented using descriptive statistics, Fisher’s Exact test and Logistic Regression analysis.ResultsTwo hundred and twenty-one (221) of the total sample (n = 232) agreed to participate in this study; representing a response rate of 95%. The mean age of the participants was 31 years and standard deviation of 5.3. The mean gestational period at recruitment was 28 weeks and standard deviation of 6.8. Majority of the participants were married (83.3%), parous (69.6%), educated (91.4%) and employed (90.5%). The prevalence of HBsAg was 7.7%. We found no significant association between socio-demographic characteristics of the participants and HBV infection.ConclusionSeroprevalence of 7.7% indicates moderate endemicity. Socio-demographic characteristics did not influence HBV infection among pregnant women attending antenatal care at Korle-Bu Teaching Hospital. The findings provide empirical evidence that will contribute to knowledge of HBV epidemiology in Ghana.

Association between insulin and post-caesarean resuscitation rates in infants of women with GDM: A retrospective study.

Gestational diabetes mellitus (GDM) and caesarean deliveries independently increase the risk of postoperative complications. There are limited data on the influence of insulin use on the outcomes of neonates who were delivered via caesarean section. We sought to investigate the impact of insulin use in women with GDM on resuscitation rates of infants post caesarean delivery. A retrospective database review of women with singleton term (≥ 37 weeks) pregnancies who were on insulin for GDM delivering between January 2005 and December 2014 at a major metropolitan hospital in Sydney. One thousand eight hundred and fifty-seven women with GDM were identified. The mean age was 31.01 ± 5.63 years and mean gestational period of 39.07 ± 1.00 weeks. 31.0% received insulin treatment for GDM. Women who were on insulin were older (31.9 ± 5.7 vs 30.6 ± 5.6 years, P < 0.001), had a higher body mass index (BMI) (31.2 ± 7.7 vs 29.0 ± 7.4 kg/m2, P < 0.001), higher rates of preeclampsia (7.3% vs 4.1%, P = 0.004), lower rates of alcohol consumption (0.4% vs 1.7%, P = 0.014), and had infants with lower resuscitation rates (21.2% vs 28.6%, P = 0.001). Infants who required resuscitation had a lower gestational age, lower five-minute APGAR score, and lower birth weight, length, and head circumferences. On multivariate analysis, women with GDM treated with insulin (odds ratio [OR] = 0.69, CI = 0.54-0.89, P = 0.004), higher gestational age (OR = 0.88, CI = 0.78-0.99, P = 0.032), higher maternal BMI (OR = 1.02, CI = 1.01-1.04, P = 0.005), and emergency caesarean (OR = 2.33, CI = 1.74-3.12, P < 0.001) independently predicted incidence of resuscitation. The findings suggest a relationship between insulin use and reduced resuscitation rates of infants born from mothers with GDM. Further studies investigating the role, dosage, and criteria for insulin use in women with GDM are required.

Relationship between Partial Uterine Cervical Tissue Excision and Preterm Birth: An Experimental Animal Study.

Objective To investigate whether the uterine cervix excision is associated with preterm birth in female mice. Study Design Sexually mature female C57BL/6 mice (n = 40) were randomly divided into four groups (A, sham; B, cervical excision; C, lipopolysaccharide, 100 µg intrauterine injection; and D, cervical excision + lipopolysaccharide injection), with 10 mice per group. Three weeks after cervical excision, timed mating was performed. On gestational day 16, lipopolysaccharide was injected between the first and second horns of the right uterus near the cervix. The uterine cervix was obtained after delivery and was histologically analyzed. Results The mean gestational period in group D was significantly lower than those in the other groups (17, 19.5, 19, and 18.2 days in groups D, A, B, and C, respectively; p = 0.034). The cervical length was shorter in the cervical excision groups (p = 0.004). The muscle-to-collagen ratio in the proximal cervix was higher in group D (p = 0.037). Conclusion Prepregnancy cervical excision and subsequent lipopolysaccharide injection showed a high rate of preterm birth, which was higher than the known lipopolysaccharide injection related preterm birth rate. Prepregnancy cervical excision appears to have additive effects with inflammation in inducing preterm birth, which are associated with the relative muscular component amount.

Maternal morbidity and associated factors at a tertiary care Centre in Karachi: A critical analysis.

The study was conducted to identify maternal morbidity and associated factors such intensive care unit admission and surgical intervention. Pregnant and six-week post-partum women without any other comorbidy were recruited from January 2014 to December 2015 from the Department of Gynaecology and Obstetrics at Liaquat National Hospital, Karachi. A structurally designed questionnaire was used to record demographic data and factors related to the management and intervention of maternal conclusions. A total of 213 patients were included in the study, with an average age of 27.87 ± 5.26 years, mean parity of 2.02 ± 1.88 and mean gestational period of 32.48 ± 7.93. The details of 186 neonatal cases were also recorded: 47 neonates were admitted to the intensive care unit, while 23 were kept on ventilation. The primary complication was post-partum hemorrhage. The most common intervention methods used was lower segment cesarean section. The concept of maternal morbidity is developing as a new indicator for the assessment of maternal healthcare services. Public health awareness programs should be conducted for health professionals to combat the high incidence of maternal morbidity.

Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin

BackgroundIt is difficult to predict the neurologic outcome and ambulatory status in children with perinatal neurologic insult until 2–5years age. This study aims to correlate clinical optic nerve head (ONH) findings-cupping, pallor and hypoplasia, with gestational period and neurologic (motor) outcomes in patients with cerebral palsy (CP) from perinatal insults. Methods54 consecutive patients with CP from perinatal insults were enrolled. Patients with intraocular disease, retinopathy of prematurity and hydrocephalus were excluded. ONH was labeled as pale, hypoplastic or large cup (cup/disc ratio≥0.5) if 2 ophthalmologists independently agreed after an ophthalmoscopic examination. Inter-rater reliability was excellent. ResultsMean age at examination was 10.98±6.49years; mean gestational period was 33.26±4.78weeks. Abnormal ONH (pallor, cupping or hypoplasia) was seen in 38/54 (70%) patients. Of patients with pallor (n=17), 88% were quadriplegic and 82% non-ambulatory. Mean cup/disc ratio was 0.45±0.22; 50% patients had large cup. Multivariate logistic regression models showed that disc pallor was associated with non-ambulatory status (OR: 21.7; p=0.003) and quadriplegia (OR: 12.8; p=0.03). Large cup was associated with age at examination (OR 1.15; p=0.03). Cup/disc ratio showed positive correlation with age at examination (Pearson's r=0.39; p=0.003). There was no significant association of ONH parameters with gestational age. ConclusionClinically observed ONH changes (pallor, cupping and hypoplasia) are common in CP. Presence of ONH pallor serves as an indicator for poor motor outcome in patients who develop CP from perinatal causes and should prompt early referral for rehabilitation.

Pregnancy Profile and Perinatal outcome in Gestational Diabetes Mellitus: A Hospital Based Study’

Objective: The objective of the study was to measure the proportion of GDM in antenatal outdoor of a hospital, to find out the mean gestational period at which most delivery occurred in GDM and to assess the perinatal outcome.Study design : It was a prospective analytical study conducted in BSMMU, from March,2010 to February,2011.Method: 1489 pregnant women, not known to be diabetic previously, were selected by consecutive sampling in first trimester from Obstetrics outdoor, BSMMU. Their FBS and blood glucose 2hrs after 75gm oral glucose were recorded. We investigated blood glucose in first, second and third trimester in the same pregnant women for screening GDM. Cut off GDM values in fasting stage was e” 6.1mmol/l and 2 hrs after 75gm oral glucose was e” 7.8mmol/l .Result: The proportion of GDM in Obstetrics Outdoor of BSMMU was 6.85%. The mean gestational period at which delivery occurred was lower in GDM ( 36.9 ± 2.2 wks ) than that in non-GDM (39 ± 1.6 wks ) .The most common (31.4%) gestational week during delivery in GDM was 37 completed weeks. Birth weight of 40.2% babies were in the range of 2.5kg to 3.0kg, 31.4% in the range of 3.1 to 3.5 kg and 1% neonate died after birth in GDM.Conclusion: Presently GDM is diagnosed early. The mean gestational period at delivery in GDM is 36.9±2.2 wks. Majority neonatal birth weight is of normal range. Neonatal mortality rate is not increased and is not significantly different from non-GDM women.J Bangladesh Coll Phys Surg 2015; 33(2): 79-85

Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women with ureteral stones and hydronephrosis

The aim of this study is to identify bacterial agents and their antibiotic susceptibility patterns isolated from pregnant women with symptomatic ureterolithiasis. Seventeen patients who had proven ureteral stones, positive urine cultures and underwent intervention for ureterolithiasis treatment between January, 2008 to December, 2011 were included in this study. Bacteriuria was defined as accounts of 105 cfu/ml in urine culture. The mean age and gestational period was 24.5 years and 25.5 weeks. The major symptoms were renal colic, hematuria and fever-chills. The overall prevalence of urinary tract infection (UTI) in pregnancy with ureteral stones was 17/65 (26.2%). Escherichia coliare the most common etiological agent (64.7%), followed by Klebsiella andStaphylococcus. The rate of resistance of E. coli to amoxicillin-clavulanate, ampicilin, cefotaxime, ciprofloxacin, trimethoprim/ sulfamethoxazol, ceftriaxone, piperacillin/ tazobactam and imipenem were 50, 45.5, 100, 18, 36.4, 28.6, 36.4, 0%, respectively. The rate of resistance of Klebsiella to Ampicilin were 80% and Amoxicillin-Clavulanate, Cefazolin, Cefepime, Ceftazidim were 60%. There were no resistance of Klebsiella to ciprofloxacin, gentamicin, meropenem and amikacin. Significant bacteriuria was observed in these patients and we recommend urine cultures in all pregnant women with ureteral stones during pregnancy. Ceftriaxone is recommended for the patients who have UTI with ureteral stones during pregnancy because of its high specificity and sensitivity. Key words: Pregnancy, urine culture, bacteriuria, antibiotic susceptibility.

Outcome of Pregnancy and Effects on the Right Heart in Women With Repaired Tetralogy of Fallot

Improved medical techniques have allowed most women with repaired tetralogy of Fallot (TOF) to reach childbearing age. The predictors of adverse events and the effects of pregnancy on cardiac function have not been clearly described in these patients. In the present study we retrospectively reviewed 40 deliveries in 25 patients with repaired TOF. There were 23 patients in New York Heart Association (NYHA) class I, and 2 in classes II-III before pregnancy. The mean age at delivery was 29.1 years and the mean gestational period was 37.8 weeks. Seven pregnancies (17.5%) in 7 patients were complicated with cardiac events such as a decline in NYHA class and arrhythmia. History of ablation and the baseline cardiothoracic ratio on chest radiography were predictors of adverse events. Peak plasma brain natriuretic peptide (BNP) level after the second trimester was higher in patients with cardiac events. Left ventricular size and contraction did not change from before to after pregnancy, but the right ventricle was enlarged at 6 months after delivery. Many of the pregnancies in women with repaired TOF were successful. However, careful management is required for some patients and the BNP level may be a useful marker to identify these patients. Because the right heart tended to be enlarged in the late postpartum period, pregnancy may also affect the long-term prognosis of patients with repaired TOF.

Subsequent childhood asthma and wheeze amongst small-for-gestational-age infants in Manitoba and India: an International Partnership Initiative

Materials and methods 1995 Manitoba Birth Cohort nested case-control study: Gestational period and birth weight were extracted from hospital records and classified as per Canadian SGA guidelines. At 8-10 years, asthma status and presence of wheeze were ascertained via pediatric allergist assessment. Parental-reported data included wheeze (ever, current [past year], or during various activities) as per International Study of Allergies and Asthma in Children (ISSAC) questionnaire, and demographic data. Bangalore Cohort: Gestational period at birth and birth weight were measured. SGA babies were classified as per World Health Organization’s SGA guidelines. At 2-7 years, presence of wheeze was ascertained via physician assessment/prescription record and ISAAC questionnaire. Asthma status was not assessed. All data were analyzed using descriptive statistics and x tests. Results In Manitoba, 725 children (56.0% boys) were assessed. Mean gestational period was 39.5 ± 2.12 weeks (non-significant [NS] differences by gender). Mean birth weight was 3.38 ± 0.64 kg; girls were significantly smaller than boys (p < 0.006). 114 (16.1%) children (54.4% boys) were SGA. At ages 9.06 ± 0.64 years, 246 (34.1%) of children (149 boys) had asthma. No associations were identified between SGA and asthma, or between SGA and wheeze, when considering both genders combined or amongst boys only. Girls who were SGA were significantly more likely to have wheeze-related sleep disturbances than girls who were non-SGA (OR 0.33; 95% CI 0.12-0.94; p < 0.03). In Bangalore, 432 children (48.0% boys) were assessed for wheeze-like symptoms. Mean gestational period was 38.68 ± 1.62 weeks and mean birth weight was 2.87 ± 0.49 kg (both NS differences between genders). Participants’ mean age was 3.78 ± 1.30 years. 130 (30.2%) children (47.7% boys) were SGA. 71 (16.4%) of children (38.4% boys) had a doctor diagnosis of wheeze. SGA children had twice the risk of developing wheeze at follow-up (OR 2.19; 95%CI 1.30-3.68; p < 0.003). After stratification by gender, these associations were only significant amongst boys (OR 3.24; 95% CI 1.44-7.31; p < 0.003).

A fatal case of acute hepatitis E among pregnant women, Central African Republic

BackgroundHepatitis E virus (HEV) is a major public health problem in developing countries. HEV infection in pregnant women is more common and more often fatal in the third trimester. The mortality rate due to HEV-induced hepatitis is as high as 15-20 per cent. The present study was designed to determine the potential factors responsible for high mortality rate among pregnant women.FindingsTwenty one pregnant women attended the Maternity Center of Begoua in the Central African Republic during an outbreak of hepatitis E virus between July and October 2002 with symptoms of acute liver disease. Their mean gestational period was 29.9 (SD 8.3 weeks) and they were aged from 15 to 39 years old. The serology IgM showed that seven women (33%) had acute hepatitis E. Among them, one woman, aged 35 and her newborn died after an apparently normal preterm delivery. The 6 remaining young women, age 18 - 22, had preterm deliveries which included three live babies and three stillborn with one macerated.ConclusionsThese results suggest that maternal age, in addition to hormonal, immunological and environmental factors, may be a risk factor for fatal outcome.

Pregnancy after renal transplantation: A single‐center experience

To examine women with renal transplants who became pregnant, and delivered at our hospital. Twenty-six women who had undergone renal transplantation between 1977 and 2002 became pregnant, and delivered at Osaka University Hospital. Complete medical records of twenty of them were retrieved and retrospectively analyzed. Overall, twenty-nine pregnancies occurred in these twenty women after renal transplantation. There were spontaneous abortions in three cases, whereas pregnancy was artificially terminated five times. Thus, neonates were delivered in 21 of 29 pregnancies. One woman delivered twice and two women delivered twins. As a result, a total of 23 neonates were delivered. Mean gestational period was 35.4 weeks (range, 27-41 weeks), and mean birth weight was 2229 g (range, 724-3544 g). Regarding fetal complications, intrauterine growth retardation was observed in three cases. One child with intrauterine growth retardation died at 3 months old due to respiratory distress syndrome. One child displayed double-outlet right ventricle and another child had congenital unilateral hydronephrosis. Regarding maternal complications, prevalence of toxemia of pregnancy was 38.1%. In four of the 21 deliveries (19.0%), renal function exacerbated after delivery. Rates of graft survival for the 20 women at 1, 5 and 10 years after delivery were 100%, 85.1% and 74.4%, respectively. Prognosis for renal transplant resulted to be significantly poorer for recipients with hypertension before pregnancy than for recipients without hypertension before pregnancy (log-rank test, P = 0.043). Rates of graft survival after delivery were mostly favorable. However, prognosis for renal function was poorer for recipients who displayed hypertension prior to pregnancy.