Obstetric performance, perinatal outcome and risk of infection to the newborn in spontaneous and artificial rupture of membranes during labour

OBJECTIVE

To compare the obstetric performance, perinatal outcome and risk of neonatal infection in labour following spontaneous (SROM) and artificial (AROM) rupture of membranes.

DESIGN

Prospective, non-randomised, comparative study during a one-month period in 1995. The study was approved by the ethics committee of the Faculty of Medicine, University of Colombo.

SETTING

University Obstetrics Unit at De Soysa Hospital for Women, Colombo.

PATIENTS

324 women who were in early established labour after 37 weeks of gestation. 151 of these had SROM and 173 AROM. The AROM and SROM groups among primigravidae and multigravidae were considered separately.

RESULTS

Oxytocin use in multigravidae was significantly higher in the AROM group than in the SROM group (p < 0.001). The emergency caesarean section (LSCS) rate in primigravidae was significantly higher in the AROM group than the SROM group (p < 0.001). A significantly larger number of primigravid AROM women had abnormal fetal heart rate changes on auscultation (p < 0.05) and cardiotopographic (CTG) patterns (p < 0.001) when compared with primigravid SROM women. Choreoamnionitis and funisitis were commoner in the AROM group although the difference was not statistically significant.

CONCLUSIONS

AROM appears to be associated with a higher chance of fetal distress particularly in primigravidae. Both AROM and SROM are associated with a potential risk of infection at intrauterine sites.

Thyrotropin response to thyrotropin-releasing hormone in elderly patients with and without acute illness

The response of thyrotropin (TSH) to thyrotropin-releasing hormone (TRH) was measured in 70 clinically euthyroid elderly patients who were acutely ill and in 70 age- and sex-matched euthyroid controls who were free of acute disease. The incremental TSH response (delta TSH) was often blunted (less than 2 mU/l) in both groups, though more often in those with acute illness (30%) than in those without (19%). However, in patients from both groups who had a blunted delta TSH, there was often a substantial proportional rise in TSH. A substantial proportional TSH rise may be useful in differentiating between genuine thyroid disease and euthyroid sick syndrome in elderly patients with a blunted delta TSH.

Thyroid function tests in elderly patients with and without an acute illness

Thyroid function was assessed by measurement of free thyroid hormones and thyrotrophin (TSH) in 78 acutely ill elderly patients and in a control group without acute illness. Abnormal results with any test were more frequently found in the acutely ill group than in controls. In particular, abnormal TSH values were found in 40% of the acutely ill group and in only 8% of controls (p less than 0.001). Seven acutely ill subjects had very low TSH levels (less than 0.04 mU/l) and a blunted response to thyroid-releasing hormone (TRH). With few exceptions these abnormalities could not be attributed to thyroid disease. This suggests that pituitary TSH secretion can be impaired in euthyroid sick old people. High sensitivity TSH assays may therefore be inappropriate as first-line tests of thyroid function, at least in this select group.

Does smoking improve colitis?

In 14 of 30 patients with ulcerative colitis who resumed smoking there was an improvement in their symptoms over the subsequent median period of 6 weeks. This group smoked a median number of 20 cigarettes, compared with 10 by those who did not improve.

Markers of the nutritional status in acutely ill elderly patients

We recorded anthropometric and laboratory data in 98 sick old people on admission to a high-dependency unit. The measurement of triceps skinfold thickness and arm muscle area was feasible even in very ill people, while measurement of the body mass index was difficult and sometimes unreliable. Anthropometric measurements indicated that our study group was better nourished than a local population, with just 3 subjects (3%) being fat depleted and a further 4 (5%) being protein depleted. Serum albumin was the laboratory variable that correlated best with anthropometric parameters. However, it was low in 47% of the subjects, indicating that its lower reference value needs to be redefined in this select group.

Systemic lupus erythematosus presenting with cardiac tamponade due to a haemorrhagic pericardial effusion

A 14 year old girl presented with cardiac tamponade due to a haemorrhagic pericardial effusion. Systemic lupus erythematosus was diagnosed. Pericardial stripping was performed due to recurrence of the effusion despite pericardiocentesis and steroid therapy.