Geraldine Connolly

THE HELLP SYNDROME, A PROSPECTIVE STUDY*

Objective.We undertook this study to evaluate the incidence and outcome of HELLP in Irish patients. In addition, duration and trends of the abnormal laboratory results were studied. Study Design.This prospective observational study screened 12068 pregnant women between January 1995 and March 1997. Any pregnant woman with hypertension, proteinuria, thrombocytopenia or anemia was monitored for hemolysis and elevated liver transaminases, from the time of recruitment till six weeks postpartum or resolution. Results.Thirteen of 12068 pregnant women (0.11%) developed HELLP. All had hypertension and 84.6% had proteinuria. Delivery was the only factor found to terminate the syndrome. Acute renal dysfunction was noted in 53.8% but none required dialysis. Laboratory parameters stabilized by the sixth postpartum day. Fetal mortality was 1 out of 14. There were no maternal deaths. Conclusions.HELLP syndrome is a rare but potentially serious complication of pregnancy. Correlation with laboratory data and early intervention are vital in achieving a favorable outcome for both mother and fetus.

A new predictor of cephalopelvic disproportion

Cephalopelvic disproportion (CPD) is a recognised obstetric problem with potential risk to both mother and infant. Identification of those mothers at risk of CPD is difficult and has concentrated in the past on such measurements as maternal shoe size and height. Our objective in this study was to examine new anthropomorphic parameters as indicators of CPD. This was a case controlled study of sixty consecutive women, and their partners, who had caesarean section performed for CPD and 60 case matched controls. Measurements included maternal and paternal head circumference, height, shoe-size, body mass index (BMI), infant weight and head circumference. Parity, gestation at delivery, and mode of onset of labour were recorded. Data were analysed using Stata Release 6. Prognostic factors were tested for association with CPD using conditional logic regression. The most important anthropomorphic risk factors for CPD were maternal head circumference in relation of height ( P < 0.001), and paternal head to height ratio ( P = 0.017). Head to height ratio is taken as the head circumference in centimeters divided by the height in metres. Body mass index was higher in CPD cases (maternal case mean = 27.1, control mean = 25.5; paternal case mean = 27.2, control mean = 26.2). Infant head circumference was not a predictor. Primiparity was an important independent predictor ( P <0.001), regardless of the mode of onset of labour. Maternal or paternal shoe-size, induction of labour and gestation at delivery were not predictors. The risk profile for CPD which emerges is one of a tall father where both mother and father have large head-to-height ratios.

Pregnancy in Irish renal transplant recipients in the cyclosporine era.

BackgroundThe effect of renal transplantation on pregnancy in Irish women not receiving CyA has been reported previously.AimTo examine all pregnancies occurring in Irish female renal transplant recipients since the introduction of CyA.MethodsUsing a community based approach, we identified 29 pregnancies in 19 women, aged between 16 and 45, mean age 30.3 years.ResultsThese pregnancies ended in four miscarriages (13%), two intra-uterine deaths (6.9%) and 23 live births (79.3%). Of these live births, 73.9% were premature (≤36 weeks) and 65.2% were of low birth weight (<2500g). Admission to the neonatal intensive care was necessary in 61%, and two babies (8.7%) died in the neonatal period. Mean gestational age was 34 weeks, and mean birth weight was 2190g. There was no change in graft function during pregnancy, with a small rise in serum creatinine post-partum (+9.64μmol/L). The renal graft failed in three women (15.8%) by the end of the follow-up period. Compared with the precyclosporine era, the live birth rate was higher (79.3% versus 58%) with a trend towards lower birth weight and shorter gestation.ConclusionRenal transplantation with CyA use is not a contraindication to pregnancy, but it is associated with increased risk, especially when the serum creatinine is >175μmol/L.

Teenage pregnancies and risk of late fetal death and infant mortality

This paper presents findings of a study of 2228 teenage pregnancies delivered in 1992-96 at the Rotunda hospital. About 17.2% of the total teenage population was delivered in the Republic of Ireland. The teenagers were divided into two groups those under 17 years of age and those aged 17 years or older. The authors findings were similar to those of Otterblad Olausson et al. in that prematurity increased when all teenagers were compared with a group of mothers aged 20-25 years. However unlike the Swedish study when mothers younger than age 17 were compared with those aged 17 or older there was no significant difference in the rate of premature deliveries. The authors investigated admission rates to the neonatal intensive care unit as a measure of early neonatal well-being because their figures were too small to interpret infant mortality. They found that only 2.7% of babies born to teenage mothers were admitted. The main reason for admission was low birth weight (72% of all cases) a possible reflection of prematurity. Another factor may be a tendency identified over the study period of an increasing number of low-birth-weight babies born to teenage mothers independent of gestation. The authors study therefore disagrees with that of Otterblad Olausson et al. Indeed the incidence of cesarean section in the authors 14-15 year olds was 5.5% compared with 13.5% in the 19-year olds. (full text modified)

Massive ovarian mucinous cystadenoma in a 14-year-old girl

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A case of cervical dysgenesis

Case report A 14-year-old girl presented to hospital with cyclical lower abdominal pain and swelling over a 6-month period. She also had primary amenorrhoea. She had a background history of moderate developmental delay (46XX 7/14 translocation). Examination was difficult as the girl was unable to co-operate, but fullness and tenderness were detected in the lower abdomen. Pelvic ultrasound showed a grossly enlarged uterus with dilated fallopian tubes. The kidneys were outlined and appeared normal. Magnetic resonance imaging showed an enlarged bifid uterus with very dilated tubes. The uterus and tubes contained areas of mixed signal consistent with haematometra which did not extend downward to the level of the vagina. The cervix was not visualised. A diagnosis of obstruction at the level of the cervix was made. Examination under anaesthesia showed a blind ending vagina of normal length, an enlarged mobile uterus equal in size to 20 weeks’ gestational age with no communication between the vagina and the uterus.