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OBJECTIVE: To assess the efficacy of doubling the 30 mg dose of iron in women with iron deficiency anemia (IDA) in singleton pregnancies. STUDY DESIGN: Prospective randomized controlled trial. Iron-deficient women were randomized during the second trimester to receive one or two capsules of daily iron supplement, containing 34 mg of ferrous sulfate, from 17 weeks until 6 weeks postpartum. The primary outcome was hemoglobin (Hgb) at 35 weeks. Secondary outcomes included ferritin at 35 weeks, Hgb during pregnancy and postpartum, birth weights, preterm birth rate, gastrointestinal side effects, intravenous iron administration and compliance. RESULTS: In all, 160 women were randomized to receive one capsule and 164 received two capsules. Both groups had similar Hgb (10.1 g dl-1) and ferritin (9.3 and 9.4 ng l-1) at allocation. Hgb concentration in both groups was similar at 35 weeks (10.8 g dl-1). There were no significant differences in any of the secondary outcomes. CONCLUSION: In IDA pregnant women, a single dose of iron is as effective as a double dose.

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OBJECTIVE: To assess the effect of maternal glucose administration on perceived fetal movements. STUDY DESIGN: This was a randomized, double-blinded placebo-controlled trial. Patients 28-41 weeks singleton gestation complaining of decreased fetal movements (DFM) were assigned to receive either 500 cc dextrose 5% (group A) or 500 cc normal saline (group B) intravenously. Primary outcome was number of fetal movements recorded during the following 30 min. Secondary outcomes included need for admission or induction of labor owing to persistent DFM. Maternal glucose levels were taken before and after intervention. A sample size of 50 patients was planned in order to detect a 30% increase in fetal movements in group A. RESULTS: Between February 2011 and April 2013, 50 patients were recruited. Demographic characteristics were similar among groups. There was no difference in the number of fetal movements recorded (7±6 vs 8.8±6 movements/30 min, group A and B, respectively, P=0.39). Similar number of patients had persistent DFM that required admission (8 vs 10 patients, P=0.77, OR 1.4, confidence interval (CI) 0.38-5.3); of those admitted, similar number of patients had induction of labor (3 vs 6 patients, P=0.64, OR 0.4, CI 0.03-3.8). Maternal glucose levels were similar at recruitment (88±19 vs 83±15 mg dl(-1) P=0.36) but were significantly higher in group A (161±37 vs 75±15 mg dl(-1) P<0.0001) after intervention. CONCLUSION: In women with DFM, maternal glucose administration has no effect on perceived fetal movement and its clinical use is questionable.

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OBJECTIVE: To investigate prematurity rate in women aged ≥45 carrying a twin pregnancy. Other maternal and neonatal outcomes are also described. DESIGN: Retrospective cohort study. SETTING: Women delivering a twin pregnancy at a single tertiary medical center. POPULATION: The study included all women aged 45 years and over carrying a twin pregnancy who delivered at 20 weeks gestation or beyond over a 9-year period from May 2000 to May 2009. METHODS: Women aged 45 years and over were identified, all conceived by in vitro fertilization with ovum donation. The study group was compared to a control group of women <40 years with twin pregnancies conceived by IVF who delivered during the same time period. MAIN OUTCOME MEASURE(S): Maternal complications during pregnancy and neonatal outcome. RESULTS: During the study period 32 women ≥45 years delivered twins. The control group included 109 women. The rate of delivery before 37 weeks as well as before 32 weeks were very high in our study group (65% versus 40%, p = 0.01 and 15% versus 5.0%, p = 0.05, respectively). The rate of maternal life-threatening complications including blood product transfusion and maternal admission to the intensive care unit were also significantly higher in our study group compared to the control group (18% versus 2%, p = 0.018 and 6.3% versus none, p = 0.05). CONCLUSIONS: Women ≥45 years old with twin pregnancy carry a higher risk of maternal and perinatal complications.

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Hepatitis A virus has been recognized as an etiologic factor of cutaneous necrotizing vasculitis in only 2 adult cases. We describe a 2-year-old Bedouin girl who developed cutaneous necrotizing vasculitis during the acute phase of hepatitis A infection. The cutaneous punch biopsy from an ecchymotic lesion revealed microscopic findings of a necrotizing vasculitis process involving the superficial and deep blood vessel plexuses. Fibrin thrombi were present in the lumen of a few blood vessels. She was treated with 2 mg/kg/day, tapered during 5 weeks. Serum liver enzymes returned to the normal range within 6 weeks of the first presenting symptom. A few skin scars were noted in previously necrotic areas. Hepatitis A is one of many viruses that may be an etiologic factor in development of cutaneous necrotizing vasculitis in children.

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