International Invention Journal of Medicine and Medical Sciences

Number Vol. 3(4), 2016

58-61
The outcome of continuing intrauterine pregnancies in presence of intrauterine contraceptive device

Authors: Dr. Tarek Ramadan Abbas MD

Abstract

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Number of views: 591

Our study aim to investigate the outcome of intrauterine pregnancies with retained or removed intrauterine devices (IUDs). In a retrospective study, we reviewed medical records of women who had CuT380 IUD and got pregnant from February 2011 to February 2016 in Bab Alshaaria university hospital, 192 pregnancies with IUD were analyzed. IUDs were removed from 152 patients and retained for 40 patients. The combined risk of adverse pregnancy outcomes (miscarriage, intrauterine fetal death, intrauterine growth retardation, preterm birth and preterm premature rupture of membranes) was 36.8% in the IUD-removed group and 63.3% in the IUD-retained group [p<0.01; relative risk (RR) =2.0; 95% confidence interval (CI) 1.3–3.3]. Newborns of the IUD-retained women had significantly lower Apgar scores and significantly higher admission rate to the neonatal intensive care unit than IUD-removed women(p<0.01; RR=4.5; 95% CI1.5–12.9). Women who conceived with an IUD and chose to continue the pregnancy without removing the IUD need close followup, as there appears to be higher risk of adverse pregnancy and neonatal outcome. Furthermore, when the IUD is retained, there is increased risk of miscarriage and adverse pregnancy outcome compared to removal of the IUD.

62-67
Thrombotic thrombocytopenia purpura in a Nigerian girl

Authors: Kaladada I. Korubo, MB.BS, FMCPath

Abstract

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Number of views: 456

Thrombotic thrombocytopenic purpura is a rare congenital or acquired disorder either due to mutations in the ADAMTS13 gene or development of antibodies to the ADAMTS13 protein. TTP causes a life-threatening form of thrombotic microangiopathy that is characterized by thrombocytopenia, microangioapathic haemolytic anaemia, fever, neurological symptoms and renal impairment. ADAMTS13 functions to cleave large von Willebrand factor multimers and in its absence there is unregulated VWF-dependent platelet thrombosis. A nineteen year old female presented with a history of menorrhagia, petechiae and purpural haemorrhages, painful right jaw, anaemia of 8.1g/dL and thrombocytopenia of 31 X 109/L. Her blood film showed numerous schistocytes with thrombocytopenia on film. Bone marrow aspirate revealed increased megakaryocytic and erythroid activity. The uric acid and lactate dehydrogenase parameters were elevated but her renal functions and other investigations were essentially normal. At presentation she was initially commenced on high dose prednisolone, however on review of the peripheral blood schistocytes and thrombocytopenia a provisional diagnosis of thrombotic thrombocytopenia was made and ADAMTS13 was done which revealed low ADAMTS13 levels. This is a case report to document this rare disorder for the first time in our environment which was successfully treated without the use of plasma exchange, plasma infusion or blood transfusion but rather with high dose prednisolone.