Objectives To examine variations in the registration of extremely low birthweight and early gestation births and to assess their effect on perinatal and infant mortality rankings of industrialised countries.
E clampsia accounts for 12% of maternal deaths worldwide and occurs predominately in developing countries. Clinical signs and symptoms preceding the development of eclampsia are nonspecific and efforts to find reliable warning signs have not been successful, primarily because the data used have been collected retrospectively. Because eclampsia is 10 to 30 times more common in developing countries compared to developed countries, a prospective study of signs and symptoms preceding eclampsia may be possible in these less-developed regions. This prospective observational study was designed to characterize the symptoms that immediately preceded eclamptic seizures in women admitted to a single center in rural Tanzania in 2007 and 2008.Eclampsia was defined as a witnessed tonic-clonic seizure in the third trimester or the puerperium in the presence of hypertension or proteinuria or both. At a patient's presentation to the hospital, demographic characteristics, clinical presentation, and obstetric/medical history were obtained by interview, physical examination, and review of antenatal records. Women were asked about the presence or absence of severe headache, visual disturbances, epigastric pain, nausea, or vomiting before the seizure. Hypertension was treated with oral methyldopa or intravenous hydralazine. Diazepam or magnesium sulfate was used to treat the seizures.Of 3267 deliveries at the Teule Hospital, 46 women presented with an eclamptic seizure (1.4%). Forty-two women had received ongoing prenatal care. Twenty-four women (52%) had antepartum seizures. The mean gestational age at the time of the seizure was 35 weeks (range, 28 to 42 wk). Intrapartum seizures occurred in 7 women (15%), with a mean gestational age of 37 weeks (range, 36 to 40 wk). Postpartum seizures occurred in 15 women (33%), 9 occurred within 48 hours of delivery, and 6 (13%) were classified as late and occurred >48 hours after delivery. All women were normotensive at their first antenatal appointment. During hospitalization for eclampsia, 30 women had severe hypertension (160/ 110 mm Hg) and 16 had moderate hypertension (> 140/90 mm Hg). Twenty-nine women were treated with magnesium sulfate, and the others were treated with diazepam because of limited access to supplies of magnesium sulfate. The most common prodromal symptoms were headache and visual disturbances, reported by 37 (80%) and 21(45%) women, respectively, none of whom had a history of significant headaches. Epigastric pain was reported by 9 women (20%) and only 1 patient reported severe nausea or vomiting. The degree of hypertension did not affect the number of women reporting a headache or visual disturbances as 80% of women with severe hypertension and 81% of those with moderate hypertension reported headache and 43% and 50%, respectively, reported visual disturbances. Seizure timing did not alter the incidence of reported headache or visual disturbances. Both headache and visual disturbances occurred at a similar frequency, whether eclampsia occurred antepartum or postpartum, w...
Objective: To examine the impact of pre-pregnancy diabetes mellitus (DM) on the population birth prevalence of congenital anomalies in Canada. Methods:We carried out a population-based study of all women who delivered in Canadian hospitals (except those in the province of Quebec) between April 2002 and March 2013 and their live-born infants with a birth weight of 500 grams or more and/or a gestational age of 22 weeks or more. Pre-pregnancy type 1 or type 2 DM was identified using ICD-10 diagnostic codes. The association between DM and all congenital anomalies as well as specific congenital anomaly categories was estimated using adjusted odds ratios; the impact was calculated as a population attributable risk percent (PAR%).Results: There were 118 892 infants with a congenital anomaly among 2 839 680 live births (41.9 per 1000). While the prevalence of any congenital anomaly declined from 50.7 per 1000 live births in 2002/03 to 41.5 per 1000 in 2012/13, the corresponding PAR% for a congenital anomaly related to pre-pregnancy DM rose from 0.6% (95% confidence interval [CI]: 0.4-0.8) to 1.2% (95% CI: 0.9-1.4). Specifically, the PAR% for congenital cardiovascular defects increased from 2.3% (95% CI: 1.7-2.9) to 4.2% (95% CI: 3.5-4.9) and for gastrointestinal defects from 0.8% (95% CI: 0.2-1.9) to 1.4% (95% CI: 0.7-2.6) over the study period. Conclusion:Although there has been a relative decline in the prevalence of congenital anomalies in Canada, the proportion of congenital anomalies due to maternal prepregnancy DM has increased. Enhancement of preconception care initiatives for women with DM is recommended.
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