The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy

Article Abstract:

Syphilis is usually treated successfully with antibiotic therapy. In some cases, however, a transient short-term reaction can develop after treatment for early syphilis. The Jarisch-Herxheimer reaction, characterized by sudden fever, rash, muscle pain and headache, can occur within a few hours after antibiotic treatment. Although the mechanism is unclear, the reaction is thought to be caused by the rapid death of the organisms. The Jarisch-Herxheimer reaction in pregnant women receiving antibiotic therapy for syphilis has not been well-studied. The Jarisch-Herxheimer reaction in both the mother and fetus was studied in 33 pregnant women (30 women with early stage syphilis, and three women with syphilis for more than one year) receiving penicillin therapy. Of these, 15 had a Jarisch-Herxheimer reaction: all three with late disease, 12 out of 20 with secondary-stage disease, and none of the 10 with early or late latent stage disease. Fever was present in 73 percent of the patients, uterine contractions in 67 percent and decreased fetal movement in 67 percent. Fever appeared 2-8 hours after therapy began, and peaked 6-12 hours later. The fever was gone within 24 hours. Of the 10 women experiencing uterine contractions, uterine activity and decreased fetal movements were associated with high fever in eight. Syphilis was detected in three fetuses born to mothers experiencing the Jarisch-Herxheimer reaction, including one stillbirth. One infant died one week after treatment, and another died 26 hours after treatment for secondary syphilis. None of the fetuses born to women without the reaction developed congenital syphilis. The Jarisch-Herxheimer reaction occurring after antibiotic therapy to treat pregnant women with syphilis can cause uterine contractions and transient changes in fetal well-being. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Causes of, Drug therapy, Syphilis, Syphilis, Congenital, hereditary, and infantile, Congenital syphilis

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Sexual assault in pregnancy

Article Abstract:

In the United States, the incidence of sexual assault, most often against women, has increased at a rate that is four times the overall crime rate. Victims of sexual assault suffer both physical and psychological injury. The effects of sexual assault in pregnant women have not been extensively studied, but it is known that more pregnant women are admitted to emergency departments for battering than nonpregnant women. The frequency and severity of domestic violence against pregnant women have been shown to be increased, and the pregnant abdomen tends to be the primary site of physical attack against this group. Sexual assault against pregnant women in Dallas between 1983 and 1988 country was assessed. Of 5,734 cases of sexual assault against women, 114 involved pregnant women. The incidence of sexual assault ranged between 0.55 and 0.75 per 1,000 deliveries. Pregnant sexual assault victims tended to be black, in their 20s, an average of 15 weeks pregnant, and without previous care during pregnancy. Sexual assault involved vaginal intercourse in 95 percent of cases, oral sex in 27 percent, and anal penetration in 6 percent. Although physical injury occurred more frequently against nonpregnant women, injury to the head, neck, and extremities occurred more often than to the abdomen, chest, and back in all patients. No injuries to the trunk were detected in women who were 20 or more weeks pregnant. Although sexual assault during pregnancy did not result in miscarriage, birth weight was low in 24 percent of cases and delivery was premature in 16 percent of cases. These findings suggest that sexual assault during pregnancy is associated with less physical injury than against nonpregnant women and does not immediately affect the outcome of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Crimes against, Demographic aspects, Pregnant women, Rape, Assault and battery

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Cerebrovascular accidents complicating pregnancy and the puerperium

Article Abstract:

Pregnancy-related deaths have decreased considerably since the first half of this century. As this decline has occurred, an increase in the percentage of maternal deaths associated with cerebrovascular accidents, or strokes, has been noted. From 1974 to 1978, 4 percent of maternal deaths were related to strokes and from 1980 to 1985, this rate doubled at 8 percent. This study examined the characteristics of pregnancies complicated by strokes. Women who gave birth at a hospital serving a medically indigent population were assessed from January 1984 to July 1990. Of 89,913 women who delivered, 15 had pregnancy-related strokes, yielding a rate of 1 stroke victim for every 6000 women giving birth. Six women had hemorrhagic strokes (caused by blood vessel rupture); three of these women had developed pregnancy-induced hypertension and two had hypertension that was not related to pregnancy. Nine of the women had ischemic strokes (blockage of blood flow in the brain); three of these strokes were caused by an arterial embolism (clotted tissue blocking an artery), and four were caused by thrombosis, the development of a blood clot in a vessel. Three of the 15 women died, and 5 of the 12 women who survived are impaired. These results indicate that strokes can be a great danger to pregnant women. Any symptoms of stroke should be seriously evaluated. Pregnancy-induced hypertension should be closely monitored and controlled. Further studies examining causes of and prevention of pregnancy-related strokes are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient outcomes, Mortality, Risk factors, Stroke (Disease), Stroke, Mothers, Maternal mortality, Hypertension in pregnancy, Gestational hypertension

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