In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups. A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well-being with an additional benefit of reducing the incidence of transfusion related crises and other complications.
Objective To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls. Design A case‐control study. Setting Ministry of Health hospitals in Bahrain. Subjects 147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity Main outcome measures The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statisties in the index and control women. Results Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anaemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity. Conclusion Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.
Spindle-cell epithelioma or "mixed tumor" of the vagina refers to a rare neoplasm composed of a proliferation of spindle cells admixed with discrete epithelial cell islands within. The first report of this condition in the English literature appeared in 1953, 1 followed by other case reports, 2-4 and detailed study of 28 cases from Armed Forces Institute of Pathology (Washington, DC, USA). 5 We report a case of spindle-cell epithelioma of the vagina encountered for the first time in our hospital. Awareness of the prevalence of this entity among pathologists would perhaps lead to the identification of more of such cases. Case ReportA 28-year-old unmarried female complained of a mass protruding from the vagina. She had her last menstrual period one week prior to the excisional biopsy. The patient did not have any other complaints. At operation, the mass was seen to be arising from the hymen between the 4 and 8 o'clock position, and was excised without any problem and sent for histopathology.Pathological findings revealed a grossly nodular and well-defined oval mass measuring 1.5x1.5x1 cm. Microscopic sections of the circumscribed tumor with apparent expansile margins (Figure 1) showed proliferation of ovoid to spindle-shaped stromal cells. Aggregates of small blood vessels were noted intermingled with nests of spindle cells (Figure 2). These spindle cells with poorly defined cell borders showed sparse, faintly granular cytoplasm (Figure 3). The nuclei were dark, and slightly vesicular with fine chromatin. Occasionally, the cells formed cords simulating epithelial structures in the form of tubules and papillae. No foci of necrosis in the tumor were seen. There was no significant nuclear pleomorphism. A mitotic rate of one mitotic figure per ten high power fields was identified. Spherules of eosinophilic material representing hyaline globules were seen in foci. Surrounding stratified squamous epithelium (vagina lining) showed subepithelial, moderately heavy, mixed chronic inflammation. No squamous epithelium islands were detected in the tumor. Paraffin blocks were sent to the
A review of 583 perinatal deaths at the Ministry of Health hospitals in Bahrain, during the years 1985-1987 revealed a perinatal mortality rate of 19.6 per 1,000 total births. Lethal congenital malformations accounted for 145 (24.9%) deaths. Of the 438 normally formed infants there were 42.2% antepartum, 115 (26.3%) intrapartum and 138 (31.5%) early neonatal deaths; in 82.7% of cases the death was considered to be unavoidable. The population of Bahrain for 1986 according to the Central Statistics Organization (1) was 435,065, the majority of which was served by the Ministry of Health Maternity Service with approximately 10,000 deliveries per annum. The Ministry of Health provides maternity services through one main maternity hospital and 2 peripheral hospitals with consultant obstetric care. In addition to these, there are 3 maternity units run by midwives. High risk cases are usually delivered in the main hospital as there is a neonatal intensive care unit attached to it. The latter also acts as a referral centre for all sick babies in Bahrain. An analysis of the causes of perinatal deaths is an effective way of assessing the efficiency of maternity services. The objective of this study was to identify and improve the various factors influencing perinatal mortality in Bahrain.
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