Treatment Of Pregnant Patients Research Articles

Nonobstetric emergencies in pregnancy: Trauma and surgical conditions

Nonobstetric surgical emergencies may be difficult to recognize in pregnant patients whose normal physiologic state is altered by pregnancy. Early suspicion and serial examination in pregnancy may result in appropriate interventions for appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Treatment in pregnant patients who experience trauma must be systematic so that situations at risk for maternal and fetal loss can be recognized.

Intravenous immunoglobulin treatment of pregnant patients with unexplained recurrent abortions.

Intravenous immunoglobulins, first given to recurrent aborters with anti-phospholipid syndrome, have been administered to unexplained aborters since 1986. They probably have immunomodulatory properties beyond supplying blocking antibodies. When pregnancy was confirmed, women were started with a loading dose which was repeated every 3-4 weeks until the second trimester. Dosages were empirical. Pregnancy rates ranged between 50 and 82%. The main maternal complications, i.e. allergic reactions and infections, were rare.

Optimisation of Antirheumatic Drug Treatment in Pregnancy

Active rheumatic disease during pregnancy may require drug treatment to ensure the mother's health is maintained and that there is a good outcome for the fetus. However, knowledge on the use of antirheumatic drugs during pregnancy is limited, rendering decision making difficult both for the patient and the physician. The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis has been investigated in depth for aspirin (acetylsalicylic acid) and indomethacin only. Information about the use of ibuprofen, sulindac, ketoprofen and diclofenac during pregnancy is scanty and there is no such information for newer agents such as the fenemates and oxicams. There is no evidence for teratogenicity of any NSAID in humans. However, due to the shared property of inhibition of prostaglandin synthesis, adverse effects such as constriction of the ductus arteriosus in utero, persistent pulmonary hypertension in the neonate and prolongation of pregnancy and labour are possible. When administered to pregnant patients, NSAIDs should be given in the lowest effective dose, and should be withdrawn within the 8 weeks prior to expected delivery. Transplacental passage varies for different corticosteroids. Because of the inability of the fetal liver to convert prednisone to its active metabolite and the ability of the placenta to convert prednisolone to the inactive prednisone, both prednisolone and prednisone are drugs of choice in pregnant patients requiring corticosteroid treatment. Corticosteroids do not increase the risk of congenital malformations. Possible adverse effects are perinatal infection and adrenal insufficiency in the newborn. Both events are only rarely reported in the literature, which comprises information on more than 1000 pregnancies. The clinical experience on the effect of slow-acting antirheumatic drugs (SAARDs) on pregnancy is insufficient to draw substantial conclusions. Available data from the literature give no clear evidence of an increased risk of teratogenicity for any of these drugs. Rheumatologists differ in their view on the advisability of using SAARDs during pregnancy. Hydroxychloroquine, which is regarded as less toxic than chloroquine, is recommended by some rheumatologists for the treatment of pregnant patients with active systemic lupus erythematosus (SLE) or rheumatoid arthritis. Sulfasalazine can be continued during pregnancy. Data on gold compounds and penicillamine are sparse and inconclusive. A reasonable approach is to stop these agents as soon as pregnancy is confirmed. The limited experience with cyclosporin has been obtained when the drug was used to prevent allograft rejection. Further data regarding the use of this drug in pregnant patients with rheumatic diseases are needed.(ABSTRACT TRUNCATED AT 400 WORDS)

Safety of Chloroquine in Pregnancy

To the Editor:— I have read with considerable interest a quotation from an article I wrote in 1962, which was quoted in the March 1, 1965, issue ofThe Journal( 191 : 765), in the letter, Safety of Chloroquine in Pregnancy. I hope that the quotation, which is correct as stated, will not be taken as an endorsement for the use of chloroquine in the treatment of pregnant patients. We have used large quantities of antimalarial drugs, notably chloroquine and hydroxychloroquine in treatment of rheumatoid arthritis since approximately August of 1957. It is my personal belief that of the two drugs, chloroquine is more effective as an antiarthritic agent; but there is reason to believe that in our series of patients, one or two have sustained, perhaps, permanent damage to the retina; so that based upon our own experience, as well as that reported in the literature otherwise, we have completely

Diabetic Acidosis During Chlorothiazide Therapy

CHLOROTHIAZIDE is widely used in the treatment of pregnant patients with edema. 1 When this condition is complicated by diabetes, the increased excretion of sodium, potassium, and chlorides due to this drug may accelerate ketosis. Two cases of diabetes with pregnancy in whom acidosis may have been aggravated by administration of chlorothiazide are here described. Case Reports Case 1.— A 38-year-old housewife was admitted to Providence Hospital, Washington, D. C., on Oct. 30, 1959, complaining of low abdominal pains. She had been a diabetic for 21 years and at the time of admission was 7 months pregnant. Expected confinement date was Dec. 22, 1959. At 3 months gestation her diabetes was well controlled by 10 units of isophane (NPH) insulin a day. She then noted persistent glycosuria and gradually increased the insulin dose to 40 units of isophane at 6 A. M., supplemented by 10 to 20 units of regular

Present-day treatment of tuberculosis and pregnancy.

The incidence of tuberculosis complicating pregnancy at the New York Lying-In Hospital has remained between 1.5 and 2.0% of all antepartum admissions and is similar to previous studies covering 1933-1951. Modified bed rest is advised during pregnancy and complete bed rest is no longer used as the sole treatment for pregnant patients with tuberculosis. Definitive therapy for tuberculosis has been given; antimicrobial drugs were used in 37% of pregnant patients and major thoracic surgery in 11%, compared to 1 % and 2%, respectively, in our previous series. The management of delivery in the patient with tuberculosis should be individualized. The labor and delivery should be made as easy as possible and heavy sedation and unnecessary operative interference should be avoided. Preference is for regional anesthesia for delivery in the tuberculous patient.