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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The distinctive aspects of adolescent pregnancy in the U.S. are reviewed under the rubric of the "new morbidity": illnesses caused by social and life-style conditions. Quantitative trends in adolescent pregnancy are reviewed with statistics such as the annual U.S. Pregnancy rate for girls under 15, 5/1000, 4 times as high as Canada, the only other Western nation with a rate over 1/1000. Other countries pinpoint teen pregnancy, not sexual activity, as the key problem. Some social factors that have increased teen pregnancy are earlier menarche, increasing poverty, more single parent households. Determinants of sexually activity can be classed as individual, family and developmental. Individual factors include economic disadvantage, lack of opportunity and hopelessness and other problem behaviors. Family factors include race and female head of family. Development factors include pre- operational thinking, which prevents future planning and may require experience with sex to learn about it, and egocentricism, which implies an imaginary audience and the personal fable that "it will never happen to me." Teen pregnancy entails the medical risks of higher maternal mortality, cephalopelvic disproportion, anemia, toxemia and hypertension, resulting in prematurity and low birth weight. Social detriments are associate with teen childbearing, such as lower educational achievement, lower lifetime work accomplishment and income, larger families, cognitive delays in child development, lower school success and emotional problems for the child and higher risk for neglect and abuse. The cost of just Aid for Families with Dependent Children, Food Stamps and Medicaid for adolescent headed families is over $16 billion per year. The current administration has approached the problem by cutting funds, teaching the immorality of abortion, reducing the contraceptive availability and recommending teenage abstinence. The most effective programs in the U.S. are comprehensive school-based clinics.
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PMID:Pregnancy in adolescents. 266 90

In order to maintain adequate circulating numbers of blood cells, the bone marrow must produce billions of cells each day and must be able to rapidly increase production by 10-20-fold in response to infection and hemorrhage. The existence of circulating factors that regulate this process has been suspected for over 100 years. Recently, the genes encoding these growth factors were cloned and their functions are now identified. Interleukin-3 (IL-3) acts on the most primitive hematopoietic stem cell, driving this self-renewing cell to produce progeny of all hematopoietic lineages. Granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulates the granulocyte-macrophage progenitor cell, as well as cells committed to the erythroid lineage, to differentiate. G-CSF and M-CSF stimulate the most differentiated myeloid progenitors to produce granulocytes and monocytes/macrophages, respectively. Erythropoietin stimulates the differentiation of late erythroid progenitors. In the lymphoid progenitor lineage, IL-2 stimulates T cell differentiation; IL-4 and IL-6 stimulate differentiation of B cells. The colony-stimulating factors also enhance function and cause activation of the mature cells whose production they induce. In clinical trials, these hormones have successfully ameliorated anemia in renal failure, chronic disease, and in prematurity. They have improved pancytopenias in aplastic anemia, myelodysplastic syndromes, and congenital cytopenias, and they have hastened recovery from chemotherapy and bone marrow transplantation.
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PMID:Hematopoietic hormones: from cloning to clinic. 267 59

Iron deficiency causes different abnormalities in the three major population groups that are at risk. In pregnant women, epidemiological studies suggest that anaemia, presumably due mainly to iron deficiency, is associated with an increased risk of low birth weight, prematurity, and perinatal mortality. In iron-deficient infants and children, there is convincing evidence of impaired psychomotor development and cognitive performance. Finally, iron-deficient women during the childbearing years (and iron-deficient men) have a decreased work capacity and less efficient response to exercise. These symptoms provide ample justification for preventing and treating a common and easily correctable nutritional disorder.
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PMID:Iron deficiency: does it matter? 268 13

The intrapartum management of the patient with a multiple gestation should begin in the antenatal period. With the present widespread use of ultrasound, the number of multiple gestations diagnosed early in pregnancy has now increased, permitting determination of placentation and monitoring of fetal growth. When a patient with a twin gestation presents in labor, ultrasound should be used to establish fetal presentation and size. The fetal well-being should be evaluated with fetal heart monitoring, and assessment of potential maternal complications, such as anemia, hypertension, and polyhydramnios, should be accomplished. With more than two fetuses, cesarean delivery is recommended. The principal controversy in intrapartum management of twin gestation relates to the planned route of delivery, particularly because this consideration is influenced by malpresentation and prematurity. There is general agreement favoring vaginal delivery for vertex-vertex twin pairs. With dual fetal heart rate monitoring and appropriate delivery room preparation for emergency cesarean section, recent evidence supports planned vaginal delivery of the mature nonvertex second twin. Elective cesarean section for the nonvertex second twin estimated as weighing less than 1800 gm is advised.
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PMID:Intrapartum management of twin gestation. 268 93

From 1976 to 1979 a prospective study was run at the Women's Hospital of Heidelberg in which every women was registered who attended the hospital before the 20th week of pregnancy. After delivery the infants' development was followed up to four years. During this time 404 women received fenoterol and 74 of them had premature deliveries. While 20% of the women were primarily treated with fenoterol before the 20th week of pregnancy (threatened abortion, cerclage), 80% received the drug in the 2nd and 3rd trimester (premature contractions, abnormal fetal heart rate pattern, premature opening of the external os etc.). Risk factors and early childhood development were compared with 465 women seen in the same time who had never needed fenoterol. The data of the patients' history, the course of pregnancy, and the state of the newborn, revealed that the risk of premature delivery in spite of tocolytic treatment was highest in young women, women with low bodyweight, women with a history of miscarriages, women with threatened abortion and women with anaemia during pregnancy. In correspondence with prematurity, the development of these children was delayed. The same factors of risk were demonstrated in women with successful tocolytic treatment and delivery after the 37th week of pregnancy, although their neonates were in a markedly better state. Early childhood development in this group did not differ from that in the group of women with deliveries after the 37th week and without tocolytic treatment.
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PMID:[Tocolytic treatment with fenoterol. I. Prospective study of the effect of tocolysis on the condition of the newborn infant and early childhood development up to 4 years of age]. 271 26

This investigation was to evaluated the characteristics and the outcome of pregnancy in young postpubertal girls and in other women of childbearing age. A retrospective analysis of 337 young postpubertal delivered mothers was compared with other parturient women in Sokoto University Teaching Hospital, Nigeria, during a 1-year period. Late booking was identified as the most important factor that directly affects the perinatal outcome in young postpubertal pregnant mothers. The problems of postpubertal pregnancy were highlighted in order to motivate individuals towards family planning. The striking features of the young postpubertal mothers in this study as in other reports were relatively low level of education, low socioeconomic status, and social and psychological immaturity. This analysis revealed a relatively low birth weight and low parity in the young adolescent mothers; this agrees with other studies. The high incidence of maternal and fetal complications contradicts some other reports that indicate that adolescent obstetrics present no greater challenge than obstetrics in general. Anemia and prematurity were common in the young mothers. The cesarean section rate was high and the main indication was cephalopelvic disproportion, with the greatest risk for women under 16, due to bone immaturity. For most developing countries of the world, especially where there is inadequate medical care, pregnancy and delivery in young postpubertal girls appear unsafe and must be discouraged through appropriate reproductive health care in the community.
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PMID:The implications of childbearing in postpubertal girls in Sokoto, Nigeria. 290 3

Intrauterine intravascular transfusion for the treatment of severe erythroblastosis fetalis has resulted in a number of benefits: (a) Direct access to the fetal vasculature allows an accurate assessment and prompt correction of anemia, albeit temporary. In contrast, intraperitoneally transfused blood may be absorbed erratically, especially in the face of ascites. (b) Intravascular treatments can be performed, in general, as early as 17 weeks of gestation, earlier than intraperitoneal approaches permit. (c) Reversal of hydrops along with the correction of anemia and hypoproteinemia has significantly reduced neonatal morbidity and mortality. None of the surviving neonates in our series required either thoracentesis or paracentesis following delivery, and 40% did not require neonatal exchange transfusion. (d) Treatments may be safely performed until pulmonic maturity has been established and/or an EFW of greater than 2,000 g has been reached, reducing problems of prematurity. (e) Central vein and umbilical vein hypertension may be arrested or prevented, thereby allowing fetal liver function to return to normal. While isoimmunization stands as a disease that has been quite successfully reduced in frequency and severity by the careful attention and treatment by obstetricians, cases still occur. Due to the reduced frequency of severe disease, fewer physicians are trained and experienced in performing this difficult procedure. As fewer transfusions are required, the value of regionalized treatment centers will have to be considered carefully, in order to maximize the experience and efficiency of the intravascular intrauterine transfusion treatment teams.
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PMID:Prevention of Rh isoimmunization and treatment of the compromised fetus. 314 12

In our view, three main lessons stem from consideration of the refractory early anemia of prematurity (REAP). These are: (1) Hemoglobin concentration is not enough to describe the anemia. (2) The REAP may be clinically very severe but is often easily missed. It interacts with and worsens other causes of anemia in preterm infants, such as blood losses. Its pathogenesis is multifactorial, but it is generally interrelated with short gestation and its other complications. (3) Prevention, prophylaxis, and if necessary, adequate management are very important.
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PMID:Lessons from the anemia of prematurity. 332 78

The ways in which better prenatal, intrapartum and postpartum care of mothers in Papua New Guinea could decrease perinatal mortality are discussed. Papua New Guinea has a fairly well developed system of rural health care, with teams visiting villages monthly. Emphasis on immunization and acute treatment of children, however, often consumes workers' time so that pregnant women are neglected. Tabulations of perinatal mortality in the Port Moresby General Hospital suggest that 14 to 49% of these deaths could have been prevented. 90% of babies born in the Central Province and National Capital District were delivered in this hospital. There were 132 stillbirths at the hospital in 1985, of which 10 were considered preventable. Prematurity is a common cause of neonatal mortality at the hospital, while infection, often associated with difficult labor, is more common in the rural highlands. There are 3 essential components of good antenatal care: selection of high-risk women for institutional delivery, prophylaxis for anemia, malaria and tetanus, and management of obstetric problems. Often good nutrition, rest from hard physical labor and cleanliness will make a significant impact. Cephalopelvic disproportion frequently complicates delivery, therefore sending all small primigravidae for institutional delivery would be ideal. The most important element of postpartum care is establishment of lactation. In Papua New Guinea, cultural mores regarding sexual abstinence after pregnancy are breaking down, necessitating the introduction of modern family planning.
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PMID:The M of MCH. 347 15

At no other time of life is the decision to transfuse potentially as difficult as in the newborn period. Superimposed upon complex "physiologic" changes in the ability to deliver and release oxygen are varying requirements among infants in terms of oxygen need. These are compounded by changes brought about as a direct consequence of frequent phlebotomy in the most ill of preterm infants. Despite the confusion overlying many of the changes occurring at this time of life, certain principles can be applied. Unlike that of the adult, an infant's ability to make oxygen available in response to a specific demand is almost as dependent upon the modifiers of oxygen uptake and release by hemoglobin as upon the hemoglobin concentration itself. These modifiers are constantly changing, sometimes in a predictable fashion, sometimes not. As discussed, some attention to the status of a particular infant's capability in providing oxygen relative to need will assist in the decision when to transfuse. If specific parameters of these assessments can not be determined, it may be necessary to proceed with transfusion based on the clinical presentation of an infant. With regard to the above, any infant sufficiently ill to require frequent blood sampling should have such blood losses replaced, certainly before ten percent of blood volume has been exceeded. This is particularly true in infants who are unable to maintain adequate arterial oxygen tensions with or without the use of supplemental inspired oxygen. At several weeks of age, when the clinical status of a preterm infant may have stabilized, transfusion may or may not be needed during the nadir of the anemia of prematurity. Infants who had been previously transfused or who had earlier received frequent simple transfusions should be able to tolerate lower levels of hemoglobin. Infants without compromised cardiopulmonary function and in whom no unusual metabolic needs exist are unlikely to be aided by transfusions when the hemoglobin concentration is greater than 10 to 11 g/dl. At lower levels of hemoglobin, simple calculations of "available oxygen" may be helpful when it is difficult to determine whether clinical signs and symptoms of anemia exist. Such signs and symptoms may include poor feeding, dyspnea, tachycardia, tachypnea, diminished activity, and pallor. Apnea has not unequivocably been shown to improve following transfusion. Clearly, our current concepts regarding indications for transfusion, even when based upon known principles of physiology, still represent an art form that is less than completely scientific.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Anemia of prematurity. Current concepts in the issue of when to transfuse. 351 96


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