P. Chandra

The British Journal of Haematology publishes original research papers in clinical, laboratory and experimental haematology. The Journal also features annotations, reviews, short reports, images in haematology and Letters to the Editor.

OBJECTIVES: To compare pregnancy outcomes for teenagers with those for older gravidas. METHODS: A retrospective case control study was undertaken to compare teenagers who delivered between January 1996 and October 1999 at a public urban hospital with a group of older gravidas. RESULTS: Young pregnant teenagers were more likely to be nulliparous. They weighed less and gained less in pregnancy. More teen pregnancies occurred among Hispanics than other ethnic groups. The younger the teenager, the more likely for her infant to be of low or very low birth weight or growth restricted. There were fewer postmature deliveries, macrosomic fetuses and cesarean deliveries in young gravidas. Perinatal mortality was unaffected by maternal age. CONCLUSIONS: This investigation demonstrates that, while pregnancy outcomes in teenagers have improved in recent years relative to historical patterns, teenagers face continuing problems requiring special attention by care givers.

In Brief BACKGROUND: Avitaminosis can result from the acute malnutrition associated with prolonged pregnancy-related hyperemesis. Serious complications may arise from thiamine deficiency under these circumstances. CASE: We review the relevant literature and describe a case with central nervous system involvement presenting with typical manifestations of Wernicke’s encephalopathy, apparently precipitated by a combination of hyperemesis gravidarum, diabetic ketoacidosis, and intravenous glucose administration. CONCLUSION: While this life-threatening complication is rare, it is important for all who care for obstetric patients to be aware of it and alert to its development. Early recognition is critical given the need to treat affected women expeditiously to help avoid potentially fatal adverse consequences. Prophylactic thiamine supplementation should be considered in the care of gravidas with hyperemesis. Acute thiamine deficiency due to hyperemesis gravidarum may cause life-threatening Wernicke’s encephalopathy, particularly if compounded by diabetic ketoacidosis and intravenous glucose administration.

BACKGROUND: Hemorrhage is a serious threat with placenta accreta, often requiring aggressive operative intervention by hysterectomy and resuscitative measures with large-volume blood replacement to ensure survival. Refusal to accept transfusion makes management especially difficult. CASE: We report a Jehovah's Witness patient who had 9 previous cesarean deliveries and presented with anemia and placenta previa percreta invading the bladder wall. Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization. The placenta was left in situ after the delivery with no untoward consequences. Methotrexate was held in readiness, but was not required as adjuvant therapy. CONCLUSION: Effective care of such patients requires close collaborative team effort and advanced planning to ensure a good outcome.