A case report of haemolytic disease of the foetus and newborn caused by Alloantibody D and Jka in a Rhesus D negative Nigerian woman: Justification for the implementation of universal access to prophylaxis and evidenced-based best practices

2020 ◽  
Vol 28 (3) ◽  
pp. 245-252
Author(s):  
Osaro Erhabor ◽  
Williams Bitty Azachi ◽  
Erhabor Tosan
Keyword(s):  
Case Report ◽  
Best Practices ◽  
Pregnant Women ◽  
Universal Access ◽  
Haemolytic Disease ◽  
Nigerian Woman ◽  
Intrauterine Transfusion ◽  
History Of ◽  
Evidenced Based

A case report of a 38 years old ABO group A and Rhesus D negative multiparous, gravidae 8 and para 2, Nigerian woman who had a case of premarital miscarriage and who was not offered anti-D prophylaxis as part of her management. Lady went on to develop alloantibody D and Jka. Lady has had 7 further pregnancies post the miscarriage. The first child who is B Rhesus D positive is the only surviving child. The surviving child was delivered severely jaundiced and needed management post-delivery for haemolytic disease of the foetus and newborn (HDFN). Lady has had a history of a stillbirth. She was given a non-clinically indicated anti-D prophylaxis during the second pregnancy despite having been previously sensitized. The second baby died 3 months after delivery from complications of HDFN. She had had a further history of 5 miscarriages. She has had challenge with conception since 2010. Alloantibody testing confirms the presence alloantibody D and anti-Jka. Finding from this is a clear case of sub-optimal laboratory, obstetric and neonatal care offered particularly to pregnant women who are Rh D negative and those with alloantibodies in Nigeria. The Nigerian government will need to implement evidenced-based best practices; determination of alloantibody status of pregnant women during their first antenatal visit; provision of facilities for alloantibody identification, titration, quantification and feto maternal haemorrhage testing (FMH); implementation of a policy on universal access to anti-D prophylaxis for pregnant Rh D negative women who are not previously sensitized; provision of facilities required for the optimal intrauterine management of HDFN (foetal genotype testing, intrauterine transfusion, doppler ultrasound to diagnose anaemia inutero and provision of donor blood that meet the minimum requirements for intrauterine transfusion); determination of Rh D status of women who require a termination of pregnancy and provision of prophylactic anti-D for those found Rh D negative within 72 hours of procedure and the optimization of the knowledge of Medical Laboratory Scientist, Obstetricians, Neonatologist, Pharmacist and Traditional Birth Attendants in a bid to reduce the residual number of women who become sensitized and the number of preventable deaths of babies with HDFN.

scholarly journals Determination of Risk Factors for Pre–Eclampsia in aTertiary Hospital of Bangladesh

2017 ◽  
Vol 16 (1) ◽  
pp. 29-32
Author(s):  
Sabina Yeasmin ◽  
M Jalal Uddin
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Early Stage ◽  
Past History ◽  
Tertiary Care ◽  
Care Hospital ◽  
Socioeconomic Condition ◽  
Low Socioeconomic ◽  
History Of

Background: Pre-eclampsia is an idiopathic disorder of pregnancy characterized by proteinuric hypertention and still one of the important causes of maternal and fetal mortality.The identification of its predisposing factors before and during early stage of pregnancy will help in reducing the mortality.Objective:The objective of the present study is to determine the risk factors for pre-eclampsia among pregnant women in a tertiary level hospital.Methods: This study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care hospital in Chittagong, Bangladesh, from January to June 2015.A total number of 50 pregnant women with pre-eclampsia who admitted in this hospital were selected as study group.This was hospital based descriptive study.Results: Most of the partcipants were within 21-30 years of age group and mean age 24.06 ± 3.71.The factors that were found to be significant predictors of risk for development of PE were primigravida, low socioeconomic condition,family history of PE & hypertension, past history of PE and hypertention, past history of diabetes mellitus was also associated with development of PE.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 29-32

scholarly journals Severe Haemolytic Disease of Foetus and Newborn due to Anti-c Alloimmunisation in a Multiparous Malay Woman: A case study

2022 ◽  
Vol 5 (S2) ◽  
pp. 15-17
Author(s):  
Salfarina Iberahim ◽  
Mohd Nazri Hassan ◽  
Zefarina Zulkafli ◽  
Wan Suriana Wan Ab Rahman ◽  
Noor Haslina Mohd Nor ◽  
...  
Keyword(s):  
At Risk ◽  
Case Report ◽  
Pregnant Woman ◽  
Early Detection ◽  
Haemolytic Disease ◽  
Foetal Loss ◽  
Antibody Screening ◽  
Antenatal Period ◽  
History Of

Severe haemolytic disease of foetus and newborn (HDFN) is commonly caused by anti-D, anti-c and anti-K alloimmunisation. However, anti-c associated HDFN are infrequent because the majority of infants are relatively often c-negative. This case report describes a severe HDFN due to anti-c alloimmunisation in a multiparous Rhesus D positive mother. The baby was delivered prematurely at 32 weeks of gestation and unable to survive due to hydrops foetalis. Failure to detect anti-c alloimmunisation at the early antenatal period and unknown previous RBC alloimmunisation status were the main reasons for poorly suspicion of HDFN, which lead to improper foetal management and end up with foetal loss.  Thus, routine antenatal RBC antibody screening during the early antenatal period is recommended for every pregnant woman with a history of HDFN or at risk for alloimmunisation for early detection and management of HDFN to prevent severe related morbidity or mortality.

scholarly journals Appropriate Evaluation of Psychiatric Patients Highlighted by Creutzfeldt-Jakob Disease: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 656-659
Author(s):  
Kathryn Bartlett ◽  
Kathleen Kane ◽  
Bryan Kane ◽  
Kevin Weaver ◽  
Gavin Barr
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Suicidal Ideation ◽  
Daily Living ◽  
Psychiatric Patients ◽  
Neurologic Examination ◽  
Detailed History ◽  
History Of ◽  
Jakob Disease

Introduction: Determination of medical stability for patients presenting with psychiatric complaints is common for emergency clinicians. A thorough history and physical examination is important. Case Report: A 53-year-old male presented to the emergency department (ED) with depression, suicidal ideation, and decline in activities of daily living over six months. While his initial neurologic examination was non-focal, subsequent re-evaluations demonstrated significant changes, and he was ultimately diagnosed with Creutzfeldt-Jakob disease. Conclusion: This case demonstrates how a detailed history of the present illness could have led to a more accurate and timely medical disposition from the ED.

scholarly journals Intensive Behavioural and Pharmacological Treatment for Tobacco Dependence in Pregnant Women with Complex Psychosocial Challenges: A Case Report

2020 ◽  
Vol 17 (13) ◽  
pp. 4770
Author(s):  
Melissa A. Jackson ◽  
Amanda L. Brown ◽  
Amanda L. Baker ◽  
Adrian J. Dunlop ◽  
Angela Dunford ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Case Report ◽  
Pregnant Women ◽  
Financial Incentives ◽  
Tobacco Dependence ◽  
Heavy Smoking ◽  
Daily Monitoring ◽  
Treatment Models ◽  
Other Substances ◽  
History Of

Up to 95% of women who use other substances also smoke tobacco during pregnancy. Challenging psychosocial circumstances and other barriers that contribute to high levels of tobacco dependence result in few quitting successfully. This case report describes the treatment of a highly tobacco dependent 34-year-old pregnant woman with a history of recent substance use, mental illness and trauma, enrolled in the Incentives to Quit Tobacco in Pregnancy program. Heavy smoking, both during the day and overnight, was reported. An extensive history of quit attempts, as well as a strong desire to cease tobacco use during pregnancy, was also noted. Treatment utilising extensive behavioural supports, including financial incentives for carbon monoxide verified abstinence and telephone-based counselling, in combination with nicotine replacement therapy (NRT), was offered to assist cessation. Excellent uptake and adherence to all aspects of treatment saw tobacco cessation achieved and maintained for 24 weeks while on the program. NRT used at doses well above those recommended for pregnancy was required to alleviate strong withdrawal symptoms and maintain abstinence. Daily monitoring of carbon monoxide, financial incentives for continued abstinence and regular phone support were critical to maintaining motivation and preventing relapse to smoking. Post-program relapse to smoking did occur, as is common, and highlights the need for longer-term intensive support for pregnant women with complex behavioural and social problems. Given the prevalence of tobacco smoking in such populations, long-term harm reduction treatment models using extensive behavioural support in combination with NRT should be considered for inclusion in current smoking cessation guidelines.

scholarly journals Features of systemic and local immunity in pregnant women with a history of sexually transmitted infections

2021 ◽  
Vol 4 ◽  
pp. 70-75
Author(s):  
E.I. Krotik
Keyword(s):  
Pregnant Women ◽  
Sexually Transmitted Infections ◽  
Control Group ◽  
Local Immunity ◽  
Sexually Transmitted ◽  
Placental Dysfunction ◽  
Infectious Origin ◽  
Tnf Α ◽  
History Of

The objective: to study the features of systemic and local immunity in pregnant women with a history of sexually transmitted infections.Materials and methods. We examined 100 patients, which were divided into groups: Group I (main) – 50 pregnant women with a history of sexually transmitted infections, with a high risk of placental dysfunction of infectious origin; Group II (control) – 50 pregnant women without obstetric and somatic pathology, who became pregnant spontaneously and had vaginal delivery.In-depth immunological examination included: determination of absolute (×109/л) and relative (%) number of subpopulations of CD3+ lymphocytes (T-lymphocytes), CD4+ (helpers-inductors), CD8+ (cytotoxic suppressors), CD56+ (natural killers), CD19 + (B-lymphocytes); determination of levels of IgG, IgM, IgA in serum and vaginal secretions; studied the content of a number of cytokines (interleukins – IL-1, IL-2, IL-4, IL-10, TNF-α, INFγ) in serum and vaginal contents.Results. The results of studies indicate that in pregnant women with a history of sexually transmitted infections (STIs), that formulate a group of high infectious risk, changes in systemic and local immunity, cytokine status are statistically prognostic. Levels of pro-inflammatory cytokines IL-1, IL-2, TNF-α and anti-inflammatory cytokines IL-4, IL-10 and γ IFN in serum and vaginal contents can be used as prognostic criteria for complications before their clinical manifestations and clinical features of pregnancy. It was also detected that the percentage of СD56+-lymphocytes with properties of natural killers was greater in group of pregnant women with a history of sexually transmitted infections than in the control group dynamically throughout pregnancy (12,3±1,7%, 15,1±1,7%, 13,9±1,73% against 8,6±1,4%, 8,1±1,18%, 7,2±0,98%; р<0,05). Studies also showed a significant increase in IgG levels in pregnant women with a history of sexually transmitted infections compared to the pregnant women in the control group (p <0,05).Conclusion. The study of systemic and local immunity, cytokine status in pregnant women with a history of sexually transmitted infections expands the possibilities of choice of rational, pathogenetic therapy, thereby reducing the incidence of early placental dysfunction of infectious origin, intrauterine infection, obstetric and perinatal complications in these patients.

scholarly journals Post exenteration surgery rehabilitation with orbital prosthesis – A case report

2022 ◽  
Vol 13 (1) ◽  
pp. 072-076
Author(s):  
Ainy Fitri Nuriyanto ◽  
Agus Dahlan ◽  
Abil Kurdi
Keyword(s):  
Case Report ◽  
Material Selection ◽  
Treatment Plan ◽  
Self Confidence ◽  
Prosthesis Retention ◽  
Orbital Prosthesis ◽  
History Of ◽  
Medical Adhesive ◽  
Orbital Defects

Orbital defects with total loss of eyelids and the eyeball cannot be satisfactorily repaired by reconstructive surgery. Therefore, a prosthetic placement is the treatment of choice to return the individual’s confidence by producing an acceptable and lifelike appearance. Male patient, 31 years old, came with history of exenteration surgery four months ago on right eye because of infection few years before. Patient wanted orbital prosthesis to improve esthetic and self-confidence. He lost his right eye ball and some part of right eyelid. Treatment of choice that would be fabricated was orbital prosthesis with medical adhesive retention support. Orbital prosthesis was one of the alternative that can be chose to reconstruct orbital defect. The success of the prosthesis was determined by the exactness of diagnosis, treatment plan determination, material selection, determination of prosthesis retention, and technique in processing the prosthesis.

Risk factors for HIV infection among asymptomatic pregnant women attending an antenatal clinic in western Kenya

2000 ◽  
Vol 11 (6) ◽  
pp. 393-401 ◽  
Author(s):  
John G Ayisi ◽  
Anna M Van Eijk ◽  
Feiko O Ter Kuile ◽  
Margarette S Kolczak ◽  
Juliana A Otieno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Consumption ◽  
Hiv Infection ◽  
Pregnant Women ◽  
Vaginal Discharge ◽  
Universal Access ◽  
Antenatal Clinic ◽  
Antibody Testing ◽  
Western Kenya ◽  
History Of

Our objective was to evaluate HIV prevalence and identify risk factors for HIV infection among women attending the antenatal clinic (ANC) at a large public hospital in Kisumu town, western Kenya. Between June 1996 and November 1997, in the context of a study to determine the effect of placental malaria on mother-to-child transmission of HIV in western Kenya, HIV-1 antibody testing was offered to women with a singleton uncomplicated pregnancy of 32 weeks' gestation attending the ANC. Women were interviewed using a structured questionnaire and had a fingerstick blood sample collected for haemoglobin (Hb), malaria smears, and HIV antibody testing. Overall HIV seroprevalence was 26.1% (743/2844) (95% confidence interval (CI): 24.5-27.7) and in bivariate evaluation was significantly associated with anaemia (Hb< 11 g/dl) (risk ratio (RR) 1.8), malarial parasitaemia (RR 1.6), fever (axillary temperature 37.5 C at screening) (RR 1.6), a history of being treated for either vaginal discharge (RR 1.5) or tuberculosis (RR 1.6), reported alcohol consumption (RR 1.6), being an unmarried multigravida (RR 2.2) or a history of the most recent child having died (RR 2.0). Poisson regression analysis for all women identified 5 significant factors independently associated with HIV seropositivity: anaemia (adjusted RR 1.7; 95% CI 1.3-2.0), malarial parasitaemia (adjusted RR 1.7; 95% CI 1.4-2.0), a history of being treated for vaginal discharge (adjusted RR 1.5; 95% CI 1.1-2.0), fever (adjusted RR 2.0; 95% CI 1.3-3.2) and reported alcohol consumption (adjusted RR 1.6; 95% CI 1.1-2.5). Multigravidae women whose most recent child had died were also more likely to be HIV seropositive (adjusted RR 1.9; 95% CI 1.7- 2.8). Only 5.5% (156/2844) of the women had none of these risk factors, of whom 12% (18/156) were HIV(+). Even though the model containing the 5 identified factors fitted the data well (goodness-of-fit xi2=18.41, P =0.10), its collective capacity to predict HIV infection was poor; while 74% of the truly positive women were correctly predicted positive by the model, 52% of the truly negative women were misclassified. Among pregnant women attending the ANC in western Kenya, we were unable to identify a subgroup at risk of HIV infection using non-serological information, indicating that wherever possible universal access to voluntary HIV counselling and testing would be preferable to targeted screening.

scholarly journals Tourism as a sphere of attracting investments in regional economic development: new approaches and best practices

2020 ◽  
Vol 175 ◽  
pp. 10005
Author(s):  
Galina Bykovskaia ◽  
Vera Frolova ◽  
Anna Babaeva
Keyword(s):  
Economic Growth ◽  
Best Practices ◽  
Tourism Industry ◽  
Local History ◽  
Development Programs ◽  
Voronezh Region ◽  
Patriotic Education ◽  
History Of ◽  
Growth Prospects

The article deals with the problem of patriotic education by means of local history and younger generation familiarization with tourism and travelling. It is characterized history of the memorable places formation in Voronezh region, and described the priorities for the tourism industry development according to the requirements of the time. The results of the study are necessary for the creation of the region development programs and determination of economic growth prospects.

State-by-State Use of AMA Guides

2019 ◽  
Vol 24 (5) ◽  
pp. 3-7, 16
Keyword(s):  
Expert Testimony ◽  
Narrow Range ◽  
The United States ◽  
Workers Compensation ◽  
Federal Employees ◽  
Permanent Disability ◽  
Sixth Edition ◽  
History Of ◽  
Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

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