No abstract

Evans syndrome is characterised by simultaneous or sequential development of autoimmune thrombocytopenia and autoimmune haemolytic anaemia in the absence of a known underlying cause.1,2 Autoantibodies against erythrocytes, platelets and neutrophils have been shown in Evans syndrome. Both the occurrence of isolated episodes of thrombocytopenia and haemolytic anaemia and the results of in vitro studies have suggested the roles of noncrossreacting autoantibodies targeted at different antigenic determinants on red cells and platelets. Both humoral and cellular immune response abnormalities have been shown in Evans syndrome. 1There have been a few case reports of Evans syndrome during pregnancy. 3,4 We present a case of Evans syndrome during pregnancy, complicated by mild pre-eclampsia and fetal death in utero. Case reportA 19 year old primigravid woman presented initially for antenatal care at 13 weeks of pregnancy on April 9, 2002. Evans syndrome had been diagnosed last year, and she was taking prednisolone 20 mg daily. She presented with anaemia, splenomegaly and thrombocytopenia at the first time of diagnosis. Laboratory investigations at that time revealed thrombocytopenia, positive direct and indirect Coombs test and positive anti-IgG. Antinuclear, anticardiolipin and antiphospholipid antibodies were all negative. The prednisolone dose was increased to 60 mg daily and was gradually reduced to 20 mg daily. On physical examination at the first antenatal visit, her blood pressure was 100/60 mmHg, pulse rate was 80/min and respiratory rate was 20/min. Her height and weight were 162 cm and 65 kg, respectively. The uterine size was consistent with 18 weeks of pregnancy. Initial blood tests included a haematocrit of 31.8%, a white blood cell count of 12,500 cells/mm 3 with 81.9% neutrophils and a platelet count of 68,000/mm 3 . The prothrombin time and partial thromboplastin time were normal. A VDRL test was positive 1:4, and a TPHA test was reactive. A HBsAg test was negative as was anti-HIV testing. Ultrasonography revealed a single viable fetus compatible with 18 weeks of pregnancy. The dose of prednisolone (20 mg daily) was continued. She was also prescribed intramuscular benzathine penicillin 2.4 megaunits weekly for three weeks for treatment of syphilis in pregnancy (treated as latent syphilis of unknown duration) as recommended from the Centers for Disease Control 5 after the platelets increased. The pregnancy was unremarkable until 31 weeks of gestation. She was then admitted into the hospital because of mild pre-eclampsia. Specialists in perinatology, haematology and infectious medicine were consulted to look after her. Her blood pressure was 140/90 mmHg and she had 1+ proteinuria. The haematocrit level was 35.6% and the platelet count was 62,000/mm 3 on admission. Ultrasonography demonstrated a normal fetus with an estimated fetal weight of 1475 g, approximate for 31 weeks of gestation. The dose of prednisolone was increased to 60 mg daily in view of the fall in the number of platelets. The platelet count re...

With an improvement in cardiac imaging during the past 20 years, fetal echocardiography has progressively altered the practice of obstetricians and become a principle armamentarium for the diagnosis of fetal heart diseases. We presented a case of pulmonary atresia with intact ventricular septum diagnosed prenatally using fetal echocardiography.

No abstract

Five thousand cases of laparoscopic tubal electrocoagulation were performed for voluntary interval sterilization in outpatient Thai women from January 1974 through June 1978. Immediate complications occurring during surgery resulted from mesosalpingeal hemorrhage, which was successfully managed by omental packing with or without repeated electrocoagulation. The overall failure rate was 0.40%. The authors find this method of tubal electrocoagulation for fertility management to be reliable and safe as an outpatient procedure and to provide rapid convalescence.