Mechanisms of hemolysis and anemia associated with acute antepartum pyelonephritis

Article Abstract:

As many as one-fifth of the pregnant women who develop pyelonephritis (kidney infection) have signs of bacteremia (bacteria in the bloodstream) as well, usually caused by Enterobacteriaceae (a group of bacteria found in the human intestinal tract). These organisms contain toxic substances (endotoxins), which result in deleterious effects on the body, such as lung and kidney damage. It is possible that endotoxins also cause red blood cell lysis (rupture), leading to anemia (a condition of reduced levels of red blood cells, or erythrocytes). One-fourth of pregnant women with pyelonephritis suffer from anemia. To investigate this issue, 18 pregnant women with pyelonephritis were studied. Five had bacteremia. All were treated with antibiotics. Blood samples were analyzed by conventional methods and with scanning electron microscopy, as well, a method that allows detection of abnormally-shaped erythrocytes. A control group of 25 pregnant women was studied in a similar manner. Results showed that one-third of the women with pyelonephritis were anemic and showed signs of hemolysis. Most of these women had abnormal erythrocytes on microscopic analysis. Only two women were anemic when they delivered their infants. The results indicate that hemolysis, caused by bacterial endotoxins, leads to anemia in pregnant women with pyelonephritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Anemia, Causes of, Complications and side effects, Physiological aspects, Pregnancy, Hemolytic anemia, Kidney diseases, Pyelonephritis, Anemia in pregnancy, Kidney diseases in pregnancy

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Antepartum fetal surveillance in patients with diabetes: when to start?

Article Abstract:

Fetal monitoring in pregnant diabetics should begin at 26 weeks' gestation if there is evidence of fetal growth retardation or if the patients have other health complications such as high blood pressure. Fetal monitoring can be delayed until 32 weeks' gestation in pregnant diabetics without other complicating health problems. A review of the records of 614 pregnancies in women with insulin-dependent diabetes mellitus was performed to determine at what point problems became evident. Most of the patients had weekly fetal stress tests and biophysical analyses if needed. The earliest positive test occurred on a fetus at 28 weeks' gestation. Slightly more than 7% of those studied had one positive test result. High blood pressure was the most significant factor associated with early intervention and an abnormal test result. Of the diabetic patients who had intervention in their pregnancies, 67% had high blood pressure.

Care and treatment, Evaluation, Diabetes in pregnancy, Gestational diabetes, Fetal monitoring

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