Risk factors predisposing to abruptio placentae. Maternal and fetal outcome

OBJECTIVE

Abruptio placentae is one of the leading causes of perinatal deaths. Abruptio placentae increase the neonatal morbidity and mortality. It is one of the recognized causes of low birth weight. The purpose of this study was to examine the risk factors for abruptio placentae together with the maternal and fetal outcome in a large population based data set.

METHODS

All cases of abruptio placentae presented to the Department of Obstetrics, Wad Medani Teaching Hospital, Sudan during the period January 1997 through to December 2002 were collected. All infants born to those cases were also collected and analyzed as live birth or stillbirth. The live born infants were followed for one month to detect the neonatal deaths. The study also aimed to determine the predisposing factors for abruptio placentae. The study was designed as a case control study from live, singleton births and singleton fetal death.

RESULTS

The total number of abruptio placentae collected during this period was 1028, while the total number of births during the same period was 15620 giving and incidence of 1028/15620 (6.5%) for abruptio placentae. The combined stillbirths and first month deaths were 20.2%. Abruptio placentae was associated with pre-eclampsia, diabetes, polyhydramnios and hypertension. Parity and maternal age were not associated with an increased incidence of abruption placentae.

CONCLUSION

This study had the advantage of complete ascertainment of all reported cases of abruptio placentae during a period of 6-years. We found an increased risk for abruptio placentae associated with maternal diabetes, hypertension, pre-eclampsia and polyhydramnios. We found that infants born after abruptio placentae were small for gestational age and had lower Apgar scores than the control infants. The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers were there is advanced maternal and neonatal facilities.

Biochemical assessment of home made fluids and their acceptability in the management of diarrhea in children in the gezira state, Sudan

OBJECTIVES

To determine the biochemical constitution of homemade fluids and assess their acceptability and efficacy for the management of acute diarrhea in Sudanese children.

MATERIAL AND METHODS

This is a cross-sectional study of 150 children selected randomly. The fluids studied were 36 samples of sorghum-based solutions (nasha) and 10 samples of rice water. Samples were randomly collected from households and analyzed to determine the pH, carbohydrates, proteins, fat, crude fiber, ash and electrolytes (Na(+), K(+) and Cl(-)).

RESULTS

In addition to being very useful for rehydration, the two fluids were found to contain considerable amounts of nutrients. The sodium and chloride contents of homemade fluids were found to be much lower than those of the WHO/UNICEF ORS (oral rehydration solution). These electrolytes can be adjusted by adding table salt (3-3.5 g NaCl to one litre of sorghum-based solution and 2.3-2.6 g NaCl to one liter of rice water) to bring them to concentration comparable to that of the standard ORS.

CONCLUSION

Homemade solutions can be modified by adding table salt to bring them to the standard ORS and can be used successfully to prevent dehydration. This will solve the problem of the availability of ORS and reduce morbidity and mortality from diarrhea.

Antichlamydial activity of lacrimal fluid in patients with trachoma

The effect of lacrimal fluid on the growth of Chlamydia trachomatis in cycloheximide-treated McCoy cells was studied in 172 persons with active trachoma (Group A), in 54 with scarring trachoma (Group B) and in 40 healthy subjects (Group C). The patients in groups A and B were treated with tetracycline eye ointment for 4-6 weeks after which tears were collected for retesting. Pooled lacrimal fluid from patients with active trachoma, collected before treatment, had a higher antichlamydial activity compared with healthy individuals. No reduction of the chlamydial inclusion count was seen with such fluid from patients with scarring trachoma. After tetracycline treatment, patients with active trachoma had a slight decrease in their inhibitory activity. In patients with scarring trachoma, the treatment did not significantly reduce the inclusion count. Antichlamydial antibodies were detected more often in patients with active trachoma than in patients with scarring trachoma, while the healthy individuals had no such antibodies. Ultrafiltered and nonfiltered lacrimal fluids were equally effective in inhibiting C. trachomatis inclusion-formation. The inhibitory principle had a molecular weight of less than 10,000 Da.