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OBJECTIVE: The purpose of this study was to compare the following outcome variables in pregnant patients with sickle cell trait and matched pregnant control patients: asymptomatic bacteriuria, acute cystitis, urinary pathogens that were present, and pyelonephritis. STUDY DESIGN: This was a retrospective cohort study that was conducted at a university clinic. Pregnant patients with sickle cell trait (n = 455) were matched with control patients (n = 448) for race, age, gestational age at entry into prenatal care, and number of prenatal visits. RESULTS: Women with sickle cell trait received urine testing significantly more often. There was no difference in the incidence of positive urine cultures, urinary pathogens, or asymptomatic bacteriuria among the comparison groups. Sickle cell trait carriers had significantly higher rates of pyelonephritis, but many affected patients had risk factors, such as previous pyelonephritis or noncompliance with therapy. CONCLUSION: Sickle cell trait carriers were no more susceptible to acute cystitis and asymptomatic bacteriuria than were the control patients. On the basis of these data, we outline recommendations for urinary screening and pyelonephritis prevention in pregnant patients with sickle cell trait.

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OBJECTIVE: Our aim was to determine the prevalence of thrombocytopenia in pregnant patients who did and did not use cocaine. STUDY DESIGN: A 1:1 case-control study of 326 patients attending an inner-city, neighborhood-based antenatal program between January 1992 and December 1998 is presented. Data concerning cocaine use (history and urine toxicology study) and platelet count, along with gestational age, were compared by nonparametric techniques (chi2 test, Fisher exact test, Wilcoxon rank sums, and receiver operating characteristic curve). RESULTS: The prevalence of thrombocytopenia during pregnancy was not different between cocaine-using patients (13/160; 8.1%) and nonusing patients (11/160; 6.9%; difference not significant). In patients who abused cocaine and for whom both positive and negative urine screening results were obtained concomitantly with platelet levels, no difference in platelet counts was evident. Overall, thrombocytopenia occurred more often in the third trimester than earlier in pregnancy for both control and cocaine-using pregnant women. CONCLUSION: Cocaine use among pregnant women was not associated with thrombocytopenia. A low platelet count was found more often later in pregnancy.

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In this report, the maternal and fetal risks in a patient with paroxysmal nocturnal hemoglobinuria (PNH) were evaluated. A patient with PNH carried a pregnancy to successful delivery, with a healthy male infant, and suffered from postpartum cerebral subcortical thrombosis followed by recovery. An elevated level of serum lactate dehydrogenase isoenzyme (alpha-hydroxybutyrate dehydrogenase) was observed during pregnancy; the level returned to normal by delivery. However, the hemoglobin concentration during pregnancy and post-partum was kept at 8 g/dl. This is the first report of a relation between the onset of hemolysis and pregnancy. The management of pregnancy in such patients is discussed.

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An anemic pregnant black primigravida with hemoglobin SD disease was studied throughout pregnancy and parturition. Hemoglobin SD disease was established by agar gel electrophoresis at pH 6.2. The patient carried to term a healthy femlae infant, an unusual occurrence in a patient homozygous for hemoglobin SD disease. The increase in the red cell concentration of 2,3 disphosphoglycerate (2,3 DPG) of 18--21 micrometer/g Hb (normal 12 +/- 2 micrometer/g Hb) was associated with a decrease in red cell oxygen affinity. The patient's in vitro P50 value ranged between 35 and 45 mm Hg (normal 28 +/- 1 mmHg). The function of red cells with increased 2,3 DPG levels and decreased affinity for oxygen in a pregnant woman with hemoglobin SD disease is discussed.

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The estriol 16-glucuronid excretion was determined in 186 urine samples in cases with preeclampsia, post maturity, pregnancies past the expected date of confinement, intra-uterine fetal deaths, congenital anomalies, Rhesus incompatability and diabetes mellitus. In groups with mild dystrophy, severe dystrophy, and intra-uterine fetal death, three zones of estriol 16-glucuronid excretion were determined. Zone 1 is suggestive of a possible fetal impairment. Zone 2 shows a high probability of fetal impairment and Zone 3 was considered as lethal zone suggestive of imminent intra-uterine fetal death. The degree of rhesus incompatability, disease of the fetus or of diabetogenic fetopathy was not recognizable by the estriol 16-glucuronid excretion.

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Urinary estrogen determinations have simplified the care of pregnant patients with certain metabolic disorders known to adversely affect the fetus. This report demonstrates that erroneously low values for urinary estrogens may be obtained if colorimetric assay methods are used for patients with congenital hemolytic anemias during an acute hemolytic crisis. This appears to be due to the interference of the large amounts of urobilin present in the urine of these patients.

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