[Psychoses during puerperium complicated by infection].
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DESIGN: The multipara with spleen's tumor was diagnosed and observed during pregnancy, labour and puerperium. The spleen's tumors are very rare and they should be examined individually. Termination of the pregnancy by cesarean section was performed because of the big risk for the mother and child (tumor's crack, haemorrhage, infection). After 3 months post partum the spleen with tumor was operated (splenectomy). It was cystic spuria. RESULTS: The cystic spleen was diagnosed by accidental abdominal USG and this test prevented threatening complications. CONCLUSIONS: The abdominal USG should be used in pregnancy.
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Methods of intensive treatment of puerperium with severe haemorrhagic shock of a dramatic course are analysed in the paper. In 20% of patients shock occurred due to non-obstetric reasons. It is stated, that haemorrhagic shock predisposes to various complications, which in turn require multidirectional treatment. It is stressed, that monitored therapy by means of adequately selected fluids should be supplemented by immediate and appropriate oxygen therapy.
BACKGROUND: Risks associated with IVF and related assisted reproduction technologies include complications of ovarian stimulation, surgical procedures and pregnancy itself. Serious complications are uncommon but may be potentially life threatening. The aims of this study were to compare the mortality rates of women who received IVF treatment, as well as those who were referred but were not treated, with the mortality rate in the general female population, to determine the maternal mortality rate following IVF conception and to establish whether any deaths had occurred as a result of treatment complications. METHODS: Deaths were identified in a cohort of 29 700 Australian IVF patients by record-linkage with the National Death Index and a cancer registry. RESULTS: The all-cause mortality rates in IVF patients (treated and untreated) were significantly lower than in the general female population of the same age. In treated women, 72 deaths were observed and 125 deaths were expected giving an age-standardized mortality ratio of 0.58 (95% confidence interval 0.48-0.69). Two maternal deaths were identified in the 42 days of the puerperium. Complications of ovarian hyperstimulation syndrome could not be directly related to any of the deaths identified in this cohort. CONCLUSIONS: As well as providing some reassurance about the safety of IVF treatments, the findings point to the existence of a 'healthy patient effect' whereby the unhealthiest women in the population are deterred from pregnancy and infertility treatment.
BACKGROUND: The purpose of this study was to determine normal values and evaluate clinical variables associated with postoperative C-reactive protein serum concentration after uncomplicated abdominal delivery. METHODS: C-reactive protein serum concentrations were determined serially by a quantitative immunoturbidimetric assay in 479 clinically non-infected parturients undergoing uncomplicated Cesarean section, before operation and during the first week of puerperium. Associations between clinical variables and maximal postoperative C-reactive protein levels were examined by variance analysis. RESULTS: The preoperative values were significantly higher in parturients from whom samples were obtained after the onset of labor and/or rupture of the membranes (16 +/- 10 (s.d.) mg/l) compared with the preoperative values obtained from parturients operated with no labor and intact membranes (12 +/- 7 (s.d.) mg/l) (p < 0.0001). An overall significant increase was observed in C-reactive protein concentrations after delivery, peaking on the second postoperative day, compared with the preoperative values. In the parturients operated upon after the onset of labor or ruptured membranes, postoperative values were 24% higher up to the sixth postoperative day than in parturients operated upon with intact membranes and no labor. The onset of labor, duration of operation, the number of vaginal examinations and the duration of internal monitoring before operation were associated with the maximal postoperative C-reactive protein concentrations, but they explained only 9% of postoperative CRP level variation. CONCLUSIONS: The wide range of serum C-reactive protein concentrations during puerperium complicates its use as a simple marker in obstetric postoperative complications. However, after normal uncomplicated operative delivery, C-reactive protein concentrations rapidly decrease towards the baseline after the second to third postoperative day.
INTRODUCTION: The principal causes of morbidity and mortality during pregnancy in Mexico, are preeclampsia/eclampsia, obstetric hemorrhage and puerperium complications; this is, 62% of maternal deaths in last years. HELLP syndrome was observed between 5 to 25% of the mortality in pregnancies of 36 weeks or less. OBJECTIVE: To analyze patients with HELLP syndrome in ICU's (Intensive Care Unit) of a Gynecology and Obstetric Hospital, related to the abnormal hematological, hepatic and renal results with the obstetric case history and the clinical complications. MATERIALS AND METHODS: A transversal study in patients with HELLP syndrome during 1998 and 1999 were carry out. CASE DEFINITION: Peripheral blood with Microangiopathic hemolysis, elevated liver enzymes: AST, ALT over 40 UI/L, even when were LDH lower than 600 UI/L. It was evaluated the hepatic and renal function, platelets count, microangiopathic hemolysis, arterial pressure, seizures, icteric skin color, blindness, visual disturbances, nausea, vomiting and upper quadrant right abdominal pain. In newborn we analyzed gestational age, sex, weight and APGAR. We studied for an association between maternal and biochemical variables with Correlation Pearson Test, and dependence between variables with lineal regression model. RESULTS: 2878 patients with hypertensives disorders in pregnancy (11.64%). The 1.15% (n = 33) had HELLP syndrome with specific maternal mortality of 0.4 per 10,000 live birth, perinatal mortality of 1.62 per 10,000 live birth; and renal damage in 84.5%. Coefficient beta was higher between number of pregnancies to platelets count (-0.33) and creatinine clearance (-0.401). CONCLUSION: We found an important renal damage, low platelets, elevated liver enzymes in women with two or more pregnancies. Then we propose there are similarities between HELLP syndrome and Systemic Inflammatory Response Syndrome (SIRS) because they could have the same pathophysiology.
The aim of the study was to determine which of the absenteeism parameters was responsible for the changes in absenteeism rate in the period between 1967 and 1987 and to detect the major reasons of sick absenteeism over the period. The study was carried on in an electronic plant. Changes in the sick absenteeism rate in this plant reflect general variations in morbidity and disease incidence during these years. The changes result mainly from an extremely fast growth of absenteeism rate caused by circulatory and musculoskeletal system diseases and from a constant level of absenteeism rate observed as a result of digestive system diseases. Overall, the analysis showed that the duration of individual cases of absenteeism grew with time, the process which resulted in higher absenteeism among workers suffering from circulatory and musculoskeletal system diseases, chronic gastric and duodenal ulcer diseases, hepatopathies, gallbladder diseases, +pancreatic diseases and from pregnancy, delivery and puerperium complications. This growing duration of absenteeism cases may be related to the intensity of the observed pathologies, to complications and to effectiveness of medical treatment.
In 1983 the IMSS-COPLAMAR Program (administrated by the Mexican Institute of Social Security since 1979) established an integral health care model aimed at preparing both the clinical workers and the people of the communities to their care, so they could: 1) Identify the most frequent diseases in their town, together with their conditional causes; 2) Plan, program and execute activities oriented to reduce the morbi-mortality of those ailments; 3) Evaluate the results and, based on them decide to continue or to modify the program. The application of this pattern has made possible to maintain or intensify the improvements obtained since the beginning by the IMSS-COPLAMAR Program (low frequency of preventable disease, a decrease in the consultation demand rate, an increase in the health promotion activities), but additionally it has promoted the adoption of measures to resolve the common health problems in the Mexican rural population. Since the beginning of this program (1983) a decrease in the frequency of digestive infections has been observed and we remark progresses in the control of pregnancy, childbirth and puerperium complications, and malnutrition. An important decrease in consultation demand rate has been registered and a big increase in the promotional activities, in accordance to the increase of the community participation through the health committees, voluntary promotors, traditional therapeutics, and rural assistants. The rural population covered by the IMSS-COPLAMAR Program increased from 11.5 millions in 1983 to 13.7 millions in 1985.
In light of concern regarding the effect of pregnancy on renal allograft recipients and the lack of information about their offspring, we studied ten infants born to eight allograft recipients (five female and three male). In all five female recipients, allograft function remained normal throughout pregnancy and the puerperium. Complications of pregnancy were minimal. Four patients were delivered by cesarean section, three for obstetrical reasons and one electively. Three of ten infants were premature births. There were no significant neonatal complications. At time of follow-up study, the offspring were 4 months to 6 8/12 years of age; physical examination was normal on all offspring. Developmental test results ranged from 82 to 131. Parents tended to be overly cautious and sought medical attention at the first sign of illness. Our data indicated no adverse effect on renal allograft function of the female recipients and no physical or developmental abnormalities in the offspring.
The disease-related temporary incapacity for work, its causes and duration are essential factors in the assessment of health status of the occupationally active population. The aim of the present study was to investigate the main causes of work disability among the rubber industry workers, with special regard to sickness absence among workers directly enganged in manufacture. The study was performed in 1995 on a sample of 973 workers (456 males and 517 females) at a plant producing rubber footware. The number of days of work disability from a particular disease, frequency and duration per year were examined. The analysis concerned such parameters of sickness absence as the lost time rate, average duration of absence, and percentage of workers on a sick-leave. The results revealed that during the period under study the main medical causes of the sickness absence included: a) for males--cardiovascular diseases (48% of the total sickness absence), respiratory diseases (18%), gastrointestinal disease (8%) and the nervous system and sense organs diseases (8%); b) for females--cardiovascular diseases (24%), respiratory diseases (16%), pregnancy, childbirth and puerperium complications (11%) and neoplasms (10%). The sickness absence of workers directly involved in the manufacture appeared to be by 72% higher than that noted for workers of other departments, with the age- and gender-standardized lost time rate of 4.74. The differences can be related mainly to a higher percentage of the sick in the group of 'production workers' (43%) as compared to the 'non-production' ones (28%). The findings of our study indicate that in the rubber industry workers a high rate of absence due to some groups of diseases may be associated with exposure to hazardous agents in their work environment.
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The issues related to breast-feeding and problems of the puerperium are often obfuscated by the general but outdated practice of recommending cessation of lactation. This article examines recent literature (June 1991 to May 1992) on breast-feeding and the treatment of puerperal problems, emphasizing that breast-feeding may be maintained during virtually all treatment modalities. Additionally, the use of drugs to support or suppress lactation has been of interest, and the increased attention to the fertility impact of breast-feeding, breast-feeding and maternal health, and human immunodeficiency virus and breast-feeding has resulted in several new articles of note. In general, the recent study of breast-feeding has identified many positive side effects, while other articles confirm that the treatment for retained placenta, postpartum pain, and puerperal infection, as discussed in recent literature, do not contraindicate breast-feeding.
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