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PubMedDate not supplied

Hemolytic uremic syndrome in pregnancy.

A 22-year-old primipara presented with hypertension, anemia, thrombocytopenia and elevated liver enzymes. She was initially managed as a case of HELLP syndrome but, with conventional treatment, the expected improvement did not occur. She later developed intractable oliguria and azotemia. The importance of considering hemolytic uremic syndrome, a distinct part of the spectrum of preeclampsia, separate from but overlapping with HELLP syndrome, was discussed. The need for vigilance in the management was emphasized since the definitive treatment and prognosis differ greatly between the two conditions.

Asia↗
PubMedDate not supplied

Fasting oral glucose challenge test as a predictor of gestational diabetes mellitus.

Gestational diabetes greatly affects maternal and fetal morbidity. Its early detection can make possible prevention of adverse outcomes. There is great controversy, however, regarding the appropriate screening test to accurately predict its presence. The universal screening test used, the oral glucose challenge test (OGCT), is not exempt from this controversy. Should it be administered in the fasting or fed state? This paper shows that the sensitivity of OGCT administered in the fasting state is 96.6%, much higher than that administered in the fed state which is 60%.

Asia↗
PubMedDate not supplied

A randomized controlled trial of the efficacy of transcutaneous electrical nerve stimulation (TENS) versus lidocaine in the relief of episiotomy pain.

The aim was to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and local infiltration of 2% lidocaine in the relief of episiotomy pain measured using a pain visual analog scale (VAS). A randomized, double blind, controlled clinical trial was conducted from January 1 to May 15, 1998, in the Labor-Delivery Complex of Chong Hua Hospital, Cebu City. Skin electrodes were attached to two acupoints. "Shenmen" on the wrist and "hegu" on the hand are acupoints for general pain relief and relaxation. These acupoints were stimulated using a nerve stimulator. Stimulation was started during advance labor and discontinued right after episiorrhaphy. VAS scores were taken during certain periods and compared with VAS scores for those using the conventional method of 2% lidocaine infiltration into the episiotomy site. There were 68 patients who met the inclusion criteria. 38 in the TENS group and 30 in the Control group. The patients profile of the two groups did not differ significantly in terms of age, age of gestation, parity, and length of episiotomy. Among those with VAS score of 5 (bearable), 37% was failed TENS, requiring rescue anesthesia. The proportion of patients with pain during episiotomy and 12 hours after episiorrhaphy showed no significant difference between the two groups. But during episiorrhaphy and 1 hour after episiorrhaphy, the TENS group was superior to the lidocaine group, with p-values of 0.05 (0.0392 and 0.0063, respectively) based on the Mann Whitney U-Test. Ambulation time was shorter in the TENS group. Episiotomy tenderness was nil in the TENS group. There was no swelling and edema in the perineum of patients in the TENS. The need for oral analgesics was likewise much lower in the TENS group. TENS as a form of anesthesia-analgesia cannot totally alleviate episiotomy pain as measured by VAS scoring system, with 37% as failed TENS. The study showed there was a difference only in pain relief during repair, and 1 hour after repair. With TENS being superior to lidocaine, ambulation time was shorter and episiotomy tenderness was nil in the TENS group. Likewise, lesser number of patients requested for oral analgesics in the TENS group.

Anesthesia↗
PubMedDate not supplied

Admission test as predictor of intrauterine fetal asphyxia.

This study determined the accuracy of the admission test in predicting intrauterine fetal asphyxia. A total of 229 subjects were included. The admission test, a short continuous electronic fetal monitoring recording, was made immediately on admission, on all patients in labor, and was categorized as "reassuring", "equivocal", or "ominous". Intrauterine fetal asphyxia was considered to be present when the umbilical cord blood pH was 7.2 and/or the Apgar score was 7 at 1 minute; an "ominous" admission test has a high accuracy (LR = 8.54) in predicting intrauterine fetal asphyxia, while a "reassuring" admission test does not rule out the possibility of asphyxia (LR = 0.39). "Reassuring" tracing is associated with low risk (6.5%) for asphyxia as measured by Apgar score and umbilical cord pH, while "ominous" tracing is associated with high risk (50%) for asphyxia. In detecting an umbilical cord pH of 7.2, fetal heart rate variability is the most specific (98%), while absence of acceleration is the most sensitive (50%).

Asia↗
PubMedDate not supplied

First established pregnancy and birth after induction of ovulation with recombinant human follicle stimulating hormone during in vitro fertilization-embryo transfer and intracytoplasmic sperm injection.

This case report describes the first established pregnancy and birth in the Philippines after induction of ovulation with recombinant follicle stimulating hormone (rec FSH) during In Vitro Fertilization-Embryo Transfer (IVF-ET) and Intracytoplasmic Sperm Injection (ICSI) in a Filipino woman with pelvic endometriosis who underwent right oophorectomy for endometrioma 1 year prior to IVF-ET and ICSI. Husband's semenalysis revealed adequate volume with 10% normal forms. Gonadotrophin releasing hormone agonist (Lupron) 375 mg subcutaneous was given for 2 cycles. 100 IU B.I.D. (a total of 2200 IU) of rec FSH was administered intramuscularly daily with single preovulatory follicle seen upon transvaginal ultrasonographic examination of 10,000 IU of human chorionic gonadotrophin, after which a viable singleton pregnancy was revealed at a gestational age of 8 weeks. The course of pregnancy until term was uneventful and ended with abdominal delivery at a gestational age of 37.3 weeks secondary to poor Fetopelvic Index with oligohydramnios. A healthy girl was born and pediatric examination did not demonstrate any abnormality.

Asia↗