The incidence of significant fetomaternal hemorrhage in patients undergoing cesarean section

Article Abstract:

Certain kinds of blood group incompatibility (resulting from reactions of antigens, or proteins, on the surfaces of red blood cells) between mother and fetus cause the mother to manufacture antibodies against the fetal antigens. In subsequent pregnancies, these antibodies cross the placental barrier and kill fetal red blood cells, producing a condition called hemolytic disease of the newborn (erythroblastosis fetalis). Although the incompatibility (called Rh incompatibility) is treated by giving Rh immune globulin (a protein) to the mother, it is possible that the normal dose of Rh immune globulin (300 micrograms) is not always sufficient to 'neutralize' the maternal immune response. Conditions in which insufficiency is likely to occur are those in which transfer of significant amounts of blood between fetus and mother has taken place (fetomaternal hemorrhage), such as during forceps delivery, manual removal of the placenta, and fetal distress. To determine whether cesarean section, too, increases the risk of fetoplacental hemorrhage, 199 patients undergoing cesarean section were studied to estimate the amount of fetal blood present in the maternal circulation immediately after surgery. By calculating the ratio of fetal cells to maternal cells, an estimate of the volume of fetal hemorrhage into the maternal circulation was made. Results showed that 162 patients had no detectable fetomaternal hemorrhage; 27 had between 5 and 25 milliliters (ml) of blood transfer; five had between 25 and 30 ml; and five had more than 30 ml. The rates for significant fetomaternal hemorrhage did not differ according to the reason the cesarean was performed. The findings suggest that fetomaternal hemorrhage should be quantified for Rh-negative women with Rh-positive infants (the situation in which antibodies are formed) who undergo cesarean section. This would allow administration of an appropriate amount of Rh immune globulin to provide protection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Measurement, Prevention, Complications and side effects, Hemorrhage, Erythroblastosis fetalis, Rho(D) immune globulin

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The effect of mode of delivery on the perinatal outcome in fetuses with abdominal wall defects

Article Abstract:

Omphalocele and gastroschisis are birth defects of the abdominal wall in which the abdominal organs lie outside the body of the fetus. In the case of omphalocele, the organs are usually covered with a membranous sac; the condition is often (in as many as 40 percent of cases) associated with chromosomal abnormalities. In gastroschisis, the organs float without any covering in the amniotic fluid (in which the fetus is suspended); this is associated with a much lower rate of chromosomal and other anomalies (less than 5 percent). Improved methods of prenatal diagnosis now enable early detection of these defects, and questions arise as to the optimal management during the perinatal period (the weeks just before and just after birth). In particular, the advisability of vaginal versus cesarean delivery is being debated; older reports recommend cesarean section. To evaluate this issue, medical records of 125 cases of abdominal wall defects (56 with gastroschisis, 69 with omphalocele) treated by one neonatal surgical team over a two-year period were reviewed. Results showed that prenatal diagnosis had been made in 10 fetuses, of whom 9 survived. Approximately the same proportion of infants (one-fourth) in each group (omphalocele and gastroschisis) was delivered by cesarean section, and the rates of premature birth were also similar. A detailed description of the outcomes is provided. In general, infants with omphalocele had higher mortality and long-term morbidity, due mostly to other congenital anomalies. No differences according to method of delivery were found for neonatal survival (first six weeks after birth), short- or long-term infant outcome, or frequency of major anomalies. The overall survival rate was 80 percent, which is comparable to that in other studies. Cesarean section should be recommended in such cases only for obstetric reasons, and not because of the diagnosis of abdominal wall defect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Management, Abnormalities, Fetus, Birth defects, Hernia, Navel, Umbilical hernia

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Gentamicin and clindamycin therapy in postpartum endometritis: the efficacy of daily dosing versus dosing every 8 hours

Article Abstract:

Women with a uterine infection called endometritis can be treated with a once-a-day dose of gentamicin and clindamycin instead of taking three doses every day, according to a study of 110 women. Endometritis can occur in up to 8% of all pregnant women after they have their baby. A once-a-day treatment is less expensive and is less likely to cause side effects.

Drug therapy, Gentamicin, Gentamicins, Endometritis, Clindamycin

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