Biomedical subjects
S Bergström
Publications and source records attributed to S Bergström.
[Female circumcision--a humiliation with deep cultural roots].
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[Abortions of female fetuses in India--a prenatal sexual discrimination].
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[At least half a million cases of maternal deaths per year. A chronic disaster with devastating effects on survival of children].
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[Family planning in South Africa--coloured people and blacks are neglected groups].
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Mozambique--delegation of responsibility in the area of maternal care.
The shortage of physicians in Mozambique has necessitated the training and delegation of maternity care to other available health personnel, such as traditional birth attendants, midwives, and nurses. In addition, surgical technicians have been trained to perform major surgical procedures, including cesarean sections and hysterectomies.
Pregnancy-associated hypertension in Maputo. A study on maternal characteristics and perinatal outcome in 1275 consecutive cases.
A total of 1275 consecutive cases of pregnancy-associated hypertension were registered in the Maputo Central Hospital (corresponding to 2.9% of a total of 43,794 city parturients). In the hypertensive and in the reference populations the following prevalence figures were registered, respectively: age below 25 years, 52% and 23% (P < 0.0005); nulliparity, 33% and 19% (P < 0.0005); twin pregnancies, 3.9% and 1.7% (P < 0.0005); stillbirths, 5.7% and 2.3% (P < 0.0005); and low birthweight (LBW), 22.9% and 10.7% (P < 0.0005). In the hypertensive population the prevalence of LBW newborns was 20.1% in the liveborn group, while it was 68.4% in the stillborn group (P < 0.0005). In the ongoing perinatal audit it was found useful to review hypertensive women separately, in order to assess current routines in cases of pregnancy hypertension.
Sole is the mirror of newborn's health.
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Coma in Mozambican gravidas: causes and perinatal outcome.
Ninety-one consecutive cases of coma were identified among gravidas at Maputo Central Hospital. The commonest causes were eclampsia (70 cases), cerebral malaria (six cases), and meningitis (five cases). Fetal mortality in eclampsia was 23 per cent and maternal mortality 10 per cent. There was a markedly higher incidence of eclampsia during the colder months.
Homozygosity for the transthyretin-Met30-gene in seven individuals with familial amyloidosis with polyneuropathy detected by restriction enzyme analysis of amplified genomic DNA sequences.
Familial amyloidotic polyneuropathy (FAP) with a mutation in position 30 of transthyretin (TTR) (previously called prealbumin) is an autosomal dominant inherited disorder characterized by varying degrees of peripheral neuropathy, nephropathy, gastrointestinal problems, and vitreous amyloid. We have earlier diagnosed homozygosity for the TTR-Met30-gene using Southern analysis in four Swedish individuals. We have found it possible to detect homozygosity for the Met-30 mutation by amplifying discrete regions of the TTR-gene using polymerase chain reaction (PCR), and the amplification products restricted with NsiI analysed by gel electrophoresis. Clinical data on seven homozygous individuals, including three new cases, are presented.
Heterogeneity of outer membrane proteins in Borrelia burgdorferi: comparison of osp operons of three isolates of different geographic origins.
Biochemical and immunochemical studies of the outer membrane proteins of Borrelia burgdorferi have shown that the OspA and OspB proteins from strains of different geographic origins may differ considerably in their reactivities with monoclonal antibodies and in their apparent molecular weights. To further characterize this variation in Osp proteins between strains, the osp operons and deduced translation products from two strains, one from Sweden (ACAI) and one from eastern Russia (Ip90), were studied. Polyacrylamide gel electrophoresis and Western blot (immunoblot) analyses confirmed differences between ACAI, Ip90, and the North American strain B31 in their Osp proteins. The sequences of the ospA and ospB genes of ACAI and Ip90 were compared with that of the previously studied osp operon of B31 (S. Bergström, V. G. Bundoc, and A. G. Barbour, Mol. Microbiol. 3:479-486, 1989). The osp genes of ACAI and Ip90, like the corresponding genes of B31, were found on plasmids with apparent sizes of about 50 kb and are cotranscribed as a single unit. Pairwise comparisons of the nucleotide sequences revealed that the ospA genes of ACAI and Ip90 were 85 and 86% identical, respectively, to the ospA gene of strain B31 and 86% identical to each other. The ospB sequences of these two strains were 79% identical to the ospB gene of B31 and 81% identical to each other. There was significantly greater similarity between the ospA genes of the three different strains than there was between the ospA and ospB genes within each strain. These studies suggest that the duplication of osp genes in B. burgdorferi occurred before the geographical dispersion of strains represented by ACAI, Ip90, and B31.
Materno-fetal transmission of syphilis in Mozambican parturients.
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Vulvar oedema among pregnant Mozambican women.
During a 3-year period, a total of 22 pregnant women with vulvar oedema were observed in a high-risk antenatal clinic (ANC) in Maputo. They were compared with 22 unselected normal ANC attenders, matched for age, parity, gestational length and area of living. Reported and observed genital ulcers were more prevalent in the oedema group than in the referent group. Reported and observed vaginal discharge was also significantly more common in the oedema group. Syphilis screening by VDRL was positive in 61.9% of oedema cases while positivity reached 5.0% in referents (p < 0.005). Cases found seropositive on screening were confirmed using Wassermann reaction (WR) in a reference laboratory, in which WR-positive cases underwent FTA-ABS analysis and IgM assay with solid-phase haemadsorption. IgM-positive individuals were significantly more prevalent among WR-positive oedema cases than among WR-positive referents (p < 0.05). It is concluded that among antenatal attenders in Maputo presenting with vulvar oedema, a significant proportion is associated with recent syphilis. Vulvar oedema should be considered as an important marker for seropositive syphilis during pregnancy.
Puerperal measurement of the symphysis-fundus distance.
Three groups of puerperal women were compared. The first group comprised 51 women with clinically evident endometritis-myometritis. This group was compared to 51 referents (group 2), matched for age, parity and days after delivery. Group 3 comprised 69 randomly selected, healthy puerperal women coming for postnatal check-up of their newborns. Groups 1 and 2 were compared regarding symphysis-fundus (SF) distance. It was found that puerperal women with clinical signs of endometritis-myometritis and healthy, matched referents (groups 1 and 2) did not differ in uterine size as measured by the SF distance. The uterine involution can be followed by simple anthropometry by assessment of the SF distance over the puerperal period. It is concluded that the allegedly swollen and enlarged uterus in puerpera with endometritis-myometritis post partum does not differ in fundal height from the uterus of healthy, normal puerpera.
Parity-related prevalence of rhesus antigens among Mozambican parturients.
The potential risk of rhesus alloimmunization and the ensuing risk of fetal death with increasing parity were investigated in two groups of parturients; primiparous and grand multiparous (para > or = 5) women with liveborns. It was hypothesized that significantly fewer women of the latter than of the former group would be rhesus negative, since grand multiparity would be expected to be associated with an increased risk of late fetal death in rhesus-negative parturients. Primiparous (n = 390) and grand multiparous (n = 755) parturients with liveborns were studied in order to identify D- and Du-negative individuals. Sixteen out of 390 primiparas (4.10%) and 28/755 (3.71%) grand multiparas were D and Du negative. The difference did not reach statistical significance. It appears that being a D- and Du-negative grand multiparous parturient, in the absence of anti-D prophylaxis, is not a significant reproductive disadvantage to being primipara in terms of an increased risk of having stillborn babies.
Role of rhesus alloimmunization in the etiology of late fetal death in Maputo.
Grand multiparous parturients with unexplained late fetal death (n = 70) and with surviving newborns (n = 755) were analyzed and compared regarding blood group in general and presence of D and Du antigens in particular. In the stillbirth group, none of the parturients had any signs of disease (syphilis, preeclampsia, placental abruption, severe anemia or fever) that could be associated with the fetal death. It was found that none of the parturients with stillbirth were D- and Du-negative while 28/755 (3.71%) of parturients with liveborn babies were D- and Du-negative. It is concluded that, among grand multiparous parturients with otherwise unexplained late fetal death, the risk of having fetomaternal rhesus incompatibility as stillbirth etiology is insignificant. The advantage of introducing anti-D immunoglobulin for prophylaxis against rhesus alloimmunization would presumably be insignificant.
Perinatal audit of one hundred consecutive vacuum extractions in Maputo.
The extraordinary demands on obstetrical services that prevail in many developing countries necessitate critical reviews of existing norms for obstetrical management. Vacuum extractions were studied in this context as a part of the regular perinatal audit carried out at the Maputo Central Hospital, the only hospital in Maputo with emergency surgery catering to the 43,000 annual deliveries. Extractions performed with the fetal head above the ischiatic spines were associated with a high number of complications and an 81% risk of neonatal asphyxia and also with a number of severe neonatal traumas. The risk of intracranial hemorrhage tended to be higher with extractions of fetuses with the head at or above the ischiatic spines, particularly when there was concomitant intrapartum asphyxia. It is concluded that a frequent perinatal audit of selected risk deliveries is a useful monitoring tool for examining prevailing indications for various obstetric interventions.
Obstetrical risk factors and pregnancy outcome in rural Mozambique. A prospective study.
A study of 373 pregnant women in two rural areas of Mozambique indicates that 38% of pregnant women are classified as having high risk factors according to the antenatal card. A postpartum follow-up of 200 women showed that data were available for 85% of the enrolled women. The 10 women (7%) that had suffered perinatal deaths did not have an overrepresentation of high risk factors according to the card. Neither of the 2 women suffering maternal deaths had had any risk criteria according to the card. More efficient risk criteria will presumably be the outcome of further research for an improved antenatal card.