Background: Oxidative stress could play a part in pre-eclampsia, and there is some evidence to suggest that vitamin C and vitamin E supplements could reduce the risk of the disorder. Our aim was to investigate the pot...Background: Oxidative stress could play a part in pre-eclampsia, and there is some evidence to suggest that vitamin C and vitamin E supplements could reduce the risk of the disorder. Our aim was to investigate the potential benefit of these antioxidants in a cohort of women with a range of clinical risk factors. Methods: We did a randomised, placebo-controlled trial to which we enrolled 2410 women identified as at increased risk of pre-eclampsia from 25 hospitals. We assigned the women 1000 mg vitamin C and 400 IU vitamin E (RRR α tocopherol;n = 1199) or matched placebo (n = 1205) daily from the second trimester of pregnancy until delivery. Our primary endpoint was pre-eclampsia, and our main secondary endpoints were low birthweight ( < 2.5 kg) and small size for gestational age ( < 5th customised birthweight centile). Analyses were by intention to treat. This studyis registered as an International Standard Randomised Controlled Trial, number ISRCTN 62368611. Findings:Of 2404 patients treated, we analysed 2395 (99.6% ). The incidence of pre-eclampsia was similar in treatment and placebo groups (15% [n = 181]vs 16% [n = 187], RR 0.97[95% CI 0.80- 1.17]). More low birthweight babies were born to women who took antioxidants than to controls(28% [n = 387]vs 24% [n = 335], 1.15 [1.02- 1.30]), but small size for gestational age did not differ between groups(21% [n = 294]vs 19% [n = 259], 1.12 [0.96- 1.31]). Interpretation:Concomitant supplementation with vitamin C and vitamin E does not prevent pre-eclampsia in women at risk, but does increase the rate of babies born with a low birthweight. As such, use of these high-dose antioxidantsis not justified in pregnancy.展开更多
Pregnancy associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. The incidence is rare;however it is important to be aware of its occurrence with the increased...Pregnancy associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. The incidence is rare;however it is important to be aware of its occurrence with the increased challenges posed by delays in diagnosis, treatment and optimization of maternal and fetal outcomes. The case report presented is of a 36 years old, Para 0 + 2 known diabetic and hypertensive pregnant woman, first seen in the antenatal clinic at 14 weeks of gestation. The patient requested for a breast examination following National campaigns conducted during the International Breast Cancer Awareness month. The examination revealed a grossly enlarged right breast with “peau de orange” skin changes. The patient eventually underwent radical mastectomy. Histopathology revealed a grade 3 invasive ductal carcinoma with lymphovascular invasion (Stage TNM). This case is presented to highlight missed opportunities in antenatal clinic settings for screening, diagnosis and treatment of cancer of the breast in pregnancy. The role of a multidisciplinary approach to management has also been emphasized.展开更多
To study whether paramedical workers from rural primary health centers in India are able to administer oral misoprostol and actively manage the third stage of labor to prevent postpartum hemorrhage (PPH). Method: Clus...To study whether paramedical workers from rural primary health centers in India are able to administer oral misoprostol and actively manage the third stage of labor to prevent postpartum hemorrhage (PPH). Method: Cluster randomization was used to enroll 1200 women at 30 peripheral health centers from 5 states in India, 600 forming the study’s intervention group (active management of the third stage of labor with 600 μ g of oral misoprostol) and 600 forming the comparison group (in which the current government guidelines for the prevention of PPH were followed). The primary outcome was blood loss after delivery, which was measured using a calibrated blood collection drape. Results: Age, literacy level, occupation, and gravidity were similar in the 2 groups. More than 70% of women in both groups had moderate anemia (hemoglobin level < 10 g/dL). Paramedical workers followed instructions in almost all deliveries in the intervention group (99% ). There was a significant reduction in duration of the third stage of labor (7.9 ± 4.2 min vs. 10.9 ± 4.3 min; p < .001) and median blood loss after delivery (100 mL vs. 200 mL; p < .001) in the intervention group. Overall, a low incidence of PPH was observed ( < 1% ) in both groups. A greater number of women had moderate to severe shivering (12.7% vs. 0.5% ) and a temperature higher than 38° C (9.7% vs. 4.3% ) in the intervention group, which was statistically significant. Conclusion: Simple interventions can be easily implemented in rural health care settings to reduce the blood loss during labor. This finding has significant implications for developing countries, in which the prevalence of anemia is high.展开更多
OBJECTIVE: To assess risk factors for legal induced abortion related deaths. METHODS: This is a descriptive epidemiologic study of women dying of complications of induced abortions. Numerator data are from the Abortio...OBJECTIVE: To assess risk factors for legal induced abortion related deaths. METHODS: This is a descriptive epidemiologic study of women dying of complications of induced abortions. Numerator data are from the Abortion Mortality Surveillance System. Denominator data are from the Abortion Surveillance System, which monitors the number and characteristics of women who have legal induced abortions in the United States. Risk factors examined include age of the woman, gestational length of pregnancy at the time of termination, race, and procedure. Main outcome measures include crude, adjusted, and risk factor-specific mortality rates. RESULTS: During 1988-1997, the overall death rate for women obtaining legally induced abortions was 0.7 per 100,000 legal induced abortions. The risk of death increased exponentially by 38%for each additional week of gestation. Compared with women whose abortions were performed at or before 8 weeks of gestation, women whose abortions were performed in the second trimester were significantly more likely to die of abortion-related causes. The relative risk (unadjusted) of abortion-related mortality was 14.7 at 13-15 weeks of gestation (95%confidence interval [CI] 6.2, 34.7), 29.5 at 16-20 weeks (95%CI 12.9, 67.4), and 76.6 at or after 21 weeks (95%CI 32.5, 180.8). Up to 87%of deaths in women who chose to terminate their pregnancies after 8 weeks of gestation may have been avoidable if these women had accessed abortion services before 8 weeks of gestation. CONCLUSION: Although primary prevention of unintended pregnancy is optimal, among women who choose to terminate their pregnancies, increased access to surgical and nonsurgical abortion services may increase the proportion of abortions performed at lower-risk, early gestational ages and help farther decrease deaths.展开更多
文摘Background: Oxidative stress could play a part in pre-eclampsia, and there is some evidence to suggest that vitamin C and vitamin E supplements could reduce the risk of the disorder. Our aim was to investigate the potential benefit of these antioxidants in a cohort of women with a range of clinical risk factors. Methods: We did a randomised, placebo-controlled trial to which we enrolled 2410 women identified as at increased risk of pre-eclampsia from 25 hospitals. We assigned the women 1000 mg vitamin C and 400 IU vitamin E (RRR α tocopherol;n = 1199) or matched placebo (n = 1205) daily from the second trimester of pregnancy until delivery. Our primary endpoint was pre-eclampsia, and our main secondary endpoints were low birthweight ( < 2.5 kg) and small size for gestational age ( < 5th customised birthweight centile). Analyses were by intention to treat. This studyis registered as an International Standard Randomised Controlled Trial, number ISRCTN 62368611. Findings:Of 2404 patients treated, we analysed 2395 (99.6% ). The incidence of pre-eclampsia was similar in treatment and placebo groups (15% [n = 181]vs 16% [n = 187], RR 0.97[95% CI 0.80- 1.17]). More low birthweight babies were born to women who took antioxidants than to controls(28% [n = 387]vs 24% [n = 335], 1.15 [1.02- 1.30]), but small size for gestational age did not differ between groups(21% [n = 294]vs 19% [n = 259], 1.12 [0.96- 1.31]). Interpretation:Concomitant supplementation with vitamin C and vitamin E does not prevent pre-eclampsia in women at risk, but does increase the rate of babies born with a low birthweight. As such, use of these high-dose antioxidantsis not justified in pregnancy.
文摘Pregnancy associated breast cancer is defined as breast cancer diagnosed during pregnancy or in the first postpartum year. The incidence is rare;however it is important to be aware of its occurrence with the increased challenges posed by delays in diagnosis, treatment and optimization of maternal and fetal outcomes. The case report presented is of a 36 years old, Para 0 + 2 known diabetic and hypertensive pregnant woman, first seen in the antenatal clinic at 14 weeks of gestation. The patient requested for a breast examination following National campaigns conducted during the International Breast Cancer Awareness month. The examination revealed a grossly enlarged right breast with “peau de orange” skin changes. The patient eventually underwent radical mastectomy. Histopathology revealed a grade 3 invasive ductal carcinoma with lymphovascular invasion (Stage TNM). This case is presented to highlight missed opportunities in antenatal clinic settings for screening, diagnosis and treatment of cancer of the breast in pregnancy. The role of a multidisciplinary approach to management has also been emphasized.
文摘To study whether paramedical workers from rural primary health centers in India are able to administer oral misoprostol and actively manage the third stage of labor to prevent postpartum hemorrhage (PPH). Method: Cluster randomization was used to enroll 1200 women at 30 peripheral health centers from 5 states in India, 600 forming the study’s intervention group (active management of the third stage of labor with 600 μ g of oral misoprostol) and 600 forming the comparison group (in which the current government guidelines for the prevention of PPH were followed). The primary outcome was blood loss after delivery, which was measured using a calibrated blood collection drape. Results: Age, literacy level, occupation, and gravidity were similar in the 2 groups. More than 70% of women in both groups had moderate anemia (hemoglobin level < 10 g/dL). Paramedical workers followed instructions in almost all deliveries in the intervention group (99% ). There was a significant reduction in duration of the third stage of labor (7.9 ± 4.2 min vs. 10.9 ± 4.3 min; p < .001) and median blood loss after delivery (100 mL vs. 200 mL; p < .001) in the intervention group. Overall, a low incidence of PPH was observed ( < 1% ) in both groups. A greater number of women had moderate to severe shivering (12.7% vs. 0.5% ) and a temperature higher than 38° C (9.7% vs. 4.3% ) in the intervention group, which was statistically significant. Conclusion: Simple interventions can be easily implemented in rural health care settings to reduce the blood loss during labor. This finding has significant implications for developing countries, in which the prevalence of anemia is high.
文摘OBJECTIVE: To assess risk factors for legal induced abortion related deaths. METHODS: This is a descriptive epidemiologic study of women dying of complications of induced abortions. Numerator data are from the Abortion Mortality Surveillance System. Denominator data are from the Abortion Surveillance System, which monitors the number and characteristics of women who have legal induced abortions in the United States. Risk factors examined include age of the woman, gestational length of pregnancy at the time of termination, race, and procedure. Main outcome measures include crude, adjusted, and risk factor-specific mortality rates. RESULTS: During 1988-1997, the overall death rate for women obtaining legally induced abortions was 0.7 per 100,000 legal induced abortions. The risk of death increased exponentially by 38%for each additional week of gestation. Compared with women whose abortions were performed at or before 8 weeks of gestation, women whose abortions were performed in the second trimester were significantly more likely to die of abortion-related causes. The relative risk (unadjusted) of abortion-related mortality was 14.7 at 13-15 weeks of gestation (95%confidence interval [CI] 6.2, 34.7), 29.5 at 16-20 weeks (95%CI 12.9, 67.4), and 76.6 at or after 21 weeks (95%CI 32.5, 180.8). Up to 87%of deaths in women who chose to terminate their pregnancies after 8 weeks of gestation may have been avoidable if these women had accessed abortion services before 8 weeks of gestation. CONCLUSION: Although primary prevention of unintended pregnancy is optimal, among women who choose to terminate their pregnancies, increased access to surgical and nonsurgical abortion services may increase the proportion of abortions performed at lower-risk, early gestational ages and help farther decrease deaths.
