Hemolytic Anemia in Pregnancy: Fetomaternal Outcome

Article1 April 1941ACQUIRED HEMOLYTIC ICTERUSWILLIS M. FOWLER, M.D.WILLIS M. FOWLER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-14-10-1838 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHemolytic icterus, in its literal sense, is a term so broad and inclusive that it may embrace a wide variety of conditions in which there is hemolysis of the erythrocytes and anemia. By common usage the term is applied to a more specific entity characterized not only by increased hemolysis and anemia, but by splenomegaly, increased fragility of the erythrocytes and evidences of bone marrow stimulation. This disease has been subdivided into the familial or congenital (Chauffard-Minkowski) type and the acquired (Hayem-Widal) type. The former represents a definite, clear-cut, clinical entity, whereas there is a diversity of opinion as to...Bibliography1. CHENEYCHENEY WFG: Chronic hereditary hemolytic jaundice, Am. Jr. Med. Sci., 1934, clxxxvii, 191-213. CrossrefGoogle Scholar2. DAWSON L OF PENN.: Hemolytic icterus, Brit. Med. Jr., 1931, l, 963-966. Google Scholar3. THOMPSON WP: Hemolytic jaundice, Jr. Am. Med. Assoc., 1936, cvii, 1776-1781. CrossrefGoogle Scholar4. WATSON CJ: Hemolytic jaundice and macrocytic hemolytic anemia: certain observations in a series of 35 cases, ANN. INT. MED., 1939, xii, 1782-1796. Google Scholar5. KRUMBHAAR EB: A classification and analysis of clinical types of splenomegaly accompanied by anemia, Am. Jr. Med. Sci., 1915, cl, 227-245. CrossrefGoogle Scholar6. LYNCH JH: Acquired hemolytic icterus, Nebr. State Med. Jr., 1932, xvii, 71-75. Google Scholar7. WITTS LJ: The pathology and treatment of anemia. III. The hemolytic anemias, Lancet, 1932, i, 601-605. CrossrefGoogle Scholar8. TILESTON W: Hemolytic jaundice, Medicine, 1922, i, 355-388. CrossrefGoogle Scholar9. GALLIEJANES WERM: Hemolytic jaundice associated with splenomegaly, Canad. Med. Assoc. Jr., 1926, xvi, 379-383. Google Scholar10. MURDOCK TP: Hemolytic anemia of pregnancy with reports of cases, ANN. INT. MED., 1927, i, 133-136. LinkGoogle Scholar11. MINOT GR: Two curable cases of anemia. I. Chronic hemolytic anemia, Med. Clin. N. Am., 1921, iv, 1733-1750. Google Scholar12. ALLAN W: Hemolytic anemia in pregnancy, Surg., Gynec. and Obst., 1928, xlvii, 669-672. Google Scholar13. DAWSON L OF PENN.: Indications for, and results of, removal of the spleen, Brit. Med. Jr., 1932, ii, 699-700. Google Scholar14. WISE WD: Hemolytic jaundice, Am. Jr. Surg., 1933, xx, 722-736. CrossrefGoogle Scholar15. DOANWISEMANERF CABKLA: Studies in hemolytic jaundice, Ohio State Med. Jr., 1934, xxx, 493-504. Google Scholar16. DUTHIE ES: Acquired hemolytic jaundice, Lancet, 1937, i, 1167-1169. CrossrefGoogle Scholar17. SHARPEDAVIS JCHH: Severe reactions following transfusion in hemolytic jaundice, Jr. Am. Med. Assoc., 1938, cx, 2053-2056. CrossrefGoogle Scholar18. WITTS LJ: A note on blood transfusion, Lancet, 1929, i, 1297-1299. CrossrefGoogle Scholar19. LEDERER M: A form of acute hemolytic anemia probably of infectious origin, Am. Jr. Med. Sci., 1925, clxx, 500-510. CrossrefGoogle Scholar20. LEDERER M: Three additional cases of acute hemolytic (infectious) anemia, Am. Jr. Med. Sci., 1930, clxxix, 228-236. CrossrefGoogle Scholar21. BRILL IC: Acute febrile anemia; a new disease?, Arch. Int. Med., 1926, xxxvii, 244-247. CrossrefGoogle Scholar22. MURRAY-LYON RM: Familial acholuric jaundice simulating Lederer's anemia, Brit. Med. Jr., 1935, i, 50-52. CrossrefGoogle Scholar23. PAYNE RV: Acute hemolytic anemia; death after transfusion, Guy's Hosp. Rep., 1934, lxxxiv, 65-71. Google Scholar24. DAMESHEKSCHWARTZ WSO: Hemolysins as the cause of clinical and experimental hemolytic anemias, Am. Jr. Med. Sci., 1938, clxxxxvi, 768-792. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Iowa City, Iowa*Received for publication December 22, 1939.From the Department of Internal Medicine, State University of Iowa, College of Medicine, Iowa City, Iowa. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIs there a Primary, Acquired Hemolytic Jaundice? 1 April 1941Volume 14, Issue 10Page: 1838-1848KeywordsAnemiaBone marrowHemolytic anemiaSplenomegaly Issue Published: 1 April 1941 PDF downloadLoading ...

Chronic Kidney Disease and Pregnancy: Maternal and Fetal Outcomes

Preeclampsia is a condition of hypertension occurring after 20 weeks of gestation, accompanied by organ dysfunction and proteinuria. Preeclampsia is classified into Early Onset Preeclampsia (EOPE), which occurs before 34 weeks of gestation, and Late Onset Preeclampsia (LOPE), which occurs after 34 weeks of gestation. EOPE carries a higher risk of maternal and fetal complications compared to LOPE. This research aims to analyze the complications in mothers and fetuses with EOPE and LOPE that were terminated at RSUD Raden Mattaher Jambi between 2020 and 2022. This descriptive research was conducted in the Medical Records Department of RSUD Raden Mattaher, Jambi, involving 82 patients who experienced both maternal and fetal complications with EOPE and LOPE that were terminated. Sampling was carried out using the total sampling technique based on inclusion and exclusion criteria. The results of this research showed that the prevalence of EOPE was 69.5%, while LOPE accounted for 30.5%. Maternal complications were more commonly found in EOPE cases, including eclampsia (42.1%), HELLP syndrome (36%), premature rupture of membranes (14%), placental abruption (14%), and maternal mortality (5.3%). Fetal complications in EOPE included Respiratory Distress Syndrome (RDS) (10.5%), prematurity (26.3%), low birth weight (29.8%), Intrauterine Growth Restriction (IUGR) (10.5%), and Intrauterine Fetal Death (IUFD) (1.8%). The perinatal mortality rate in EOPE was 7%, with asphyxia recorded in 12.3% of cases. EOPE is more frequently encountered than LOPE and is associated with more severe maternal and fetal complications. Early detection and management of EOPE are crucial to reducing complications and improving pregnancy outcomes.

Though the same types of complication were found in both elective cesarean section (ElCS) and emergence cesarean section (EmCS), the aim of this study is to compare the rates of maternal and fetal morbidity and mortality between ElCS and EmCS. Full-text articles involved in the maternal and fetal complications and outcomes of ElCS and EmCS were searched in multiple database. Review Manager 5.0 was adopted for meta-analysis, sensitivity analysis, and bias analysis. Funnel plots and Egger's tests were also applied with STATA 10.0 software to assess possible publication bias. Totally nine articles were included in this study. Among these articles, seven, three, and four studies were involved in the maternal complication, fetal complication, and fetal outcomes, respectively. The combined analyses showed that both rates of maternal complication and fetal complication in EmCS were higher than those in ElCS. The rates of infection, fever, UTI (urinary tract infection), wound dehiscence, DIC (disseminated intravascular coagulation), and reoperation of postpartum women with EmCS were much higher than those with ElCS. Larger infant mortality rate of EmCS was also observed. Emergency cesarean sections showed significantly more maternal and fetal complications and mortality than elective cesarean sections in this study. Certain plans should be worked out by obstetric practitioners to avoid the post-operative complications.

Objective: To determine the frequency of adolescent pregnancy and its related maternal and fetal complications. Study Design: Cross-sectional descriptive study Place and Duration of Study: Outpatient Departments of Tertiary Care Hospitals of Peshawar from 1st January to 31st December 2016. Patients and Methods: A total of 200 pregnant women (booked or unbooked) of age of 13-19 years, delivered at tertiary care hospital were included. All pregnant females of 13-19 years including primary or multiparous had any other medical illness except pregnancy associated problems were excluded. Results: 41% adolescent mothers were primigravida and 59% were multigravida of the same group. Adolescent pregnant females were 21% between 13-15 years, 28% between 16-17 years and 51% between 18-19 years of adolescent mothers. Among ethnic groups adolescent pregnancy in Pashtuns were 48.5%, Hindko were 10%, Punjabi were 10.5%, Muhajirs were 20.5% and others were 10.5%. Maternal complications in adolescent mothers were anaemia 72%, caesarean section 7.5%, pregnancy induced hypertension 8%, post-partum haemorrhages 6.5% and instrumental delivery 6%. Foetal complications includes low birth weight 54.5%,pre-mature births 13%,still birth 9%, birth trauma 8.5%, respiratory infections 15%. Conclusion: Adolescent pregnancies are quite prevalent in the District Peshawar. Most prevalent age group of adolescent mothers was 18-19 years. Most frequent maternal complication among adolescent mothers were anemia, while low birth weight was more frequent among fetal complications.

Background: Smoking is very important during pregnancy because of severe fetal and maternal complications. No community-based studies have been conducted on pregnant women in Iran. This study aimed to investigate the prevalence of smoking during pregnancy, as well as maternal and neonatal complications in Mashhad, Iran, during 2017.Methods: This cross-sectional study reviewed the information of 1140 and 92,225 smoking and non-smoking pregnant women during pregnancy, respectively, and 3-5 days after delivery using Sina Electronic Health Record System in Mashhad, Iran, during 2017. All data were extracted, encoded, and entered into SPSS software (version 16).Results: Out of the total of 93,365 pregnant women with a mean age of 22.36 years, the prevalence of smoking during pregnancy was significantly higher among those who live in the city (i.e., Mashhad), compared to individuals living in the suburbs or villages. The mean rates of stillbirth, prematurity, very-low-birth-weight, and low-birth-weight were higher in smoking pregnant mothers, compared to non-smoking ones (p <0.0001). The prevalence of smoking among literate and employed pregnant mothers was significantly higher than illiterate and unemployed pregnant women (p <0.0001). The mean birth weight of newborns of smoking mothers (1528gr) was less than the half mean of the birth weight (3180gr) of newborns of non-smoking mothers (p <0.0001).Conclusion: The prevalence of smoking in mothers living in Mashhad, Iran, was 1.2%, which is less than the global average. The results of this study showed that smoking during pregnancy has many maternal and fetal complications.

Background:Recent guidelines provide better treatment and management of pregnancy in women with systemic lupus erythematosus (SLE). In this analysis, we aimed to systematically assess the maternal and fetal complications associated with SLE using the most recent studies (2017–2019) to obtain an updated result of the present situation.Methods:http://www.clinicaltrials.gov, MEDLINE, Cochrane Central, Web of Science, EMBASE, and Google Scholar were searched for English based studies comparing maternal and fetal complications in pregnant women with versus without SLE. Maternal and fetal complications were the endpoints in this analysis. The RevMan software 5.3 (latest version) was the most suitable analytical software for this analysis. Data were represented by risk ratio (RR) with 95% confidence interval (CI).Results:A total number of eight million eight hundred and twelve thousand two hundred seventy-two (8,812,272) participants were included in this analysis, consisting of 9696 SLE-associated pregnancy. Based on an analysis of recently published studies (2017–2019), pre-eclampsia/eclampsia was significantly higher in pregnant women with SLE (RR: 3.38, 95% CI: 3.15–3.62; P = .00001). SLE was also associated with an increased risk of stillbirth (RR: 16.49, 95% CI: 2.95–92.13; P = .001) and fetal loss (RR: 7.55, 95% CI: 4.75–11.99; P = .00001). Abortion (RR: 4.70, 95% CI: 3.02–7.29; P = .00001) and the risk for cesarean section due to complications (RR: 1.38, 95% CI: 1.11–1.70; P = .003) were also significantly higher in pregnant women with SLE. In addition, fetal complications including preterm birth (RR: 2.33, 95% CI: 1.78–3.05; P = .00001), infants who were small for gestational age (RR: 2.50, 95% CI: 1.41–4.45; P = .002) and infants with low birth weight (RR: 4.78, 95% CI: 3.65–6.26; P = .00001) were also significantly higher in newborns from mothers with SLE. Moreover, the risk of newborns who were admitted to the neonatal intensive care unit (RR: 2.79, 95% CI: 2.31–3.37; P = .00001), newborns with an APGAR score <7 within 1 minute (RR: 2.47, 95% CI: 1.68–3.62; P = .00001) and 5 minutes (RR: 3.63, 95% CI: 2.04–6.45; P = .0001) respectively, were significantly highly associated with SLE.Conclusions:Based on the most recent studies, we could conclude that maternal and fetal complications were significantly higher in SLE-associated pregnancy. Therefore, SLE should still be considered a severe risk factor for pregnancy.

BackgroundProteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies.MethodsWe conducted electronic searches in MEDLINE (1951 to 2007), EMBASE (1980 to 2007), the Cochrane Library (2007) and the MEDION database to identify relevant articles and hand-search of selected specialist journals and reference lists of articles. There were no language restrictions for any of these searches. Two reviewers independently selected those articles in which the accuracy of proteinuria estimate was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standards.ResultsSixteen primary articles with a total of 6749 women met the selection criteria with levels of proteinuria estimated by urine dipstick, 24-hour urine proteinuria or urine protein:creatinine ratio as a predictor of complications of pre-eclampsia. All 10 studies predicting maternal outcomes showed that proteinuria is a poor predictor of maternal complications in women with pre-eclampsia. Seventeen studies used laboratory analysis and eight studies bedside analysis to assess the accuracy of proteinuria in predicting fetal and neonatal complications. Summary likelihood ratios of positive and negative tests for the threshold level of 5 g/24 h were 2.0 (95% CI 1.5, 2.7) and 0.53 (95% CI 0.27, 1) for stillbirths, 1.5 (95% CI 0.94, 2.4) and 0.73 (95% CI 0.39, 1.4) for neonatal deaths and 1.5 (95% 1, 2) and 0.78 (95% 0.64, 0.95) for Neonatal Intensive Care Unit admission.ConclusionMeasure of proteinuria is a poor predictor of either maternal or fetal complications in women with pre-eclampsia.

Relapsing Coombs-negative haemolytic anaemia in pregnancy with haemolytic disease in the newborn A rare form of acquired haemolytic anaemia is Coombs-negative haemolytic disease restricted to the period of pregnancy.'-3Unlike previously reported cases, in our patient transient haemolytic disease developed in the infant also, lending support to the assumption of an autoimmune mechanism. Case reportThe patient was first examined because of anaemia in March 1959 at the age of 25 in the 8th month of pregnancy.Anaemia had also been present during her first pregnancy, but no further investigations were done.During the third month of the second pregnancy weakness, palpitations, and exertional dyspnoea developed.She was pale.The liver and spleen were not

Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. It is also a growing problem worldwide and is associated with many maternal and fetal complications during and after pregnancy. This study aimed to investigate the neonatal and maternal complications of gestational diabetes in the Iranian population of pregnant women. This prospective cohort study was carried out on the health assessment data of pregnant women in the age range of 18-45 years who were referred to health centers affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2019 to September 2020. Overall, 2,500 pregnant women with GDM and 7,700 healthy pregnant women were enrolled in the GDM and healthy groups, respectively. Individuals' data were recorded in an electronic health record system (SINA System) and were later collected and analyzed. Significant between-group differences were observed in terms of cesarean delivery risk, hypertension, fetal macrosomia, preeclampsia, preterm birth, fetal birth weight, and neonatal icterus in GDM and non-GDM groups. However, no significant differences were found in terms of stillbirth, and low birth weight between the two groups. Based on the logistic regression model, GDM significantly increased the risk of cesarean delivery, fetal macrosomia, and neonatal icterus. The fetal macrosomia leading to the cesarean delivery, and neonatal icterus were determined as the significant complications of GDM in the Iranian population. These results can provide valuable insight into healthcare planning.

Myasthenia gravis (MG), an autoimmune neuromuscular disease affecting women of childbearing age, exerts an impact on pregnancy, and vice versa. The purposes of the study were to evaluate adverse pregnancy outcomes and postpartum exacerbation in a cohort of Asian MG women, and to explore the predictors for these outcomes. Thirty-seven MG pregnancies of 33 women followed in Xiangya and the second Xiangya hospitals between January 2012 and January 2022, were included in this study. Baseline maternal data, maternal complications, and neonatal outcomes were extracted from medical records. MG courses were evaluated during pregnancy and postpartum 1 year. In 5.4% of cases, MG exacerbation was reported during gestation, mostly in the third trimester, and in 38.9% in the postpartum period. Maternal complications were measured in 59.5% of women, gestational diabetes mellitus (GDM) taking the lead (29.7%) followed by premature rupture of membranes (PROMs) (18.9%). Transient neonatal MG (TNMG) and hyperbilirubinemia (HB) were seen in 24.3% of newborns. Body mass index (BMI) was the only independent predictor for maternal obstetric complications (p=.017), while thyroid disorders for GDM (p=.006). Younger mothers tended to give birth to babies with TNMG (p=.015). Primipara was the only risk factor for HB (p=.015). Higher gestational BMI gain (GBG) (p=.049) and without thyroid disorder (p=.017) were independent risk factors for puerperal exacerbation. Activated partial thromboplastin time and thyroid-stimulating hormone levels could be reliable to predict puerperal exacerbation. Most MG patients have unaffected courses during pregnancy but face a higher rate of maternal and fetal complications. Risk factors identified in our study aid the management of pregnancy in MG women.

BackgroundPregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.MethodsThis prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.ResultsPrevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.ConclusionPrevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.

Hypovitaminosis D is a global health problem that affects all age groups. Pregnant women are considered a high-risk group and the condition has potentially associated maternal and fetal complications. The goal of the present review is to analyze the magnitude and consequences of hypovitaminosis D in pregnant women and the safety of vitamin D supplementation. Prevalence of hypovitaminosis D during pregnancy is very high, even in sunny countries. Maternal vitamin D deficiency has been associated with increased risk of specific hypertensive disease of pregnancy, bacterial vaginosis, prematurity, gestational diabetes mellitus, osteomalacia, and muscle weakness. It has also been linked to prematurity, low birth weight, and fetal infectious complications. Due to potential maternal and fetal complications, it is extremely important to achieve adequate vitamin D levels prior to pregnancy. During pregnancy, it would be prudent to monitor serum vitamin D levels and implement preventive measures to reduce maternal and fetal morbidity. No consensus exists in the medical literature regarding vitamin D supplementation in pregnant women.

Iron deficiency anemia (IDA) during pregnancy is a global public health concern, associated with significant maternal and neonatal complications. Intravenous (IV) iron therapy has emerged as a potential alternative to oral iron for rapid correction of anemia, but its impact on clinical outcomes remains unclear. This meta-analysis aimed to evaluate the effectiveness and safety of IV iron compared to oral iron in improving maternal and neonatal outcomes during pregnancy. A systematic review of randomized controlled trials (RCTs) was conducted using major databases. A total of 15 studies, involving 4,215 pregnant women, met the inclusion criteria. Meta-analyses were performed to assess maternal and neonatal complications, adverse events, and hemoglobin (Hb) improvement. The findings demonstrated that IV iron therapy significantly improved Hb levels more rapidly than oral iron, with a mean rise of 2.05 g/dL for IV iron compared to 1.65 g/dL for oral iron. Women receiving IV iron experienced 21% fewer maternal complications, although the difference was not statistically significant for individual complications. Neonatal outcomes, including birth weight, cord Hb levels, and preterm births, showed no significant differences between the two groups. Adverse events were significantly less frequent in the IV group (OR 0.38; 95% CI: 0.24-0.58; p < 0.01), indicating a better safety profile. This study highlights the superior efficacy of IV iron for rapid anemia correction and reduced adverse events in pregnant women. However, no significant advantage was observed for neonatal outcomes or individual maternal complications. The evidence quality for Hb improvement was high, while that for maternal and neonatal clinical outcomes varied from moderate to low. Further research is needed to explore the impact of IV iron on critical clinical outcomes and to determine the most cost-effective regimens for anemia management during pregnancy.

BackgroundBlood pressure is considered to be the most predictive of complications in women with pre-eclampsia compared to the other tests.MethodsWe performed systematic quantitative review of test accuracy studies. We conducted...