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Background and Objectives: Granuloma inguinale (GI) appears to be making a resurgence in South Africa. Local cases were reviewed in order to determine an increasing prevalence and whether differences appeared between pregnant and nonpregnant women. Study Design: Retrospective analysis of clinical records of patients attending a large tertiary teaching hospital, serving an underprivileged population. Results: Sixty-one women with GI were diagnosed over a 3-year period. The most common clinical presentation was genital ulceration in both pregnant (88.5%) and nonpregnant (45.7%) patients. The next most common presentation was genital tract bleeding (19.7%), which occurred mainly among nonpregnant women. The vulva was the most frequent anatomical site involved (54.1%), in both pregnant (88.5%) and nonpregnant (28.6%) women. Multiple sites of infection (vulva, vagina, cervix) occurred only among nonpregnant women. Fourteen of 33 (42.4%) patients whose syphilis serology results were available had reactive tests. Erythromycin and tetracycline were the most common single antimicrobial agents used for therapy and response varied according to site and size of lesion. Conclusions: This study confirms our clinical impression of the increasing prevalence of GI, especially among women in Durban, South Africa. The protean manifestations of the disease are demonstrated with sharp distinctions between pregnant and nonpregnant women and there was a high prevalence of concomitant syphilis., Granuloma inguinale (GI), which causes genital ulcerations and is thought to be a sexually transmitted disease, can be difficult to diagnose since its symptoms can mimic those of other diseases. Of 61 women patients at a South African gynecological and antenatal clinic who were eventually diagnosed with GI, many were initially thought to suffer from a variety of diseases including cervical cancer and pelvic inflammatory disease. Genital ulceration and bleeding were the most common symptoms of GI. Symptoms differed for non-pregnant and pregnant women. Non-pregnant women were more likely to have lesions in more than one site, though pregnant women were more likely to have incidences genital ulceration. Erythromycin was the most popular treatment for GI, but other antimicrobials were also used successfully. Treatment generally lasted from two weeks to three months depending on the size of the lesions.

Eclampsia is a potentially fatal complication of pregnancy associated with seizures, high blood pressure (hypertension), coma, and other physiological changes. Although many deaths of eclamptic women are due to cerebral hemorrhage (bleeding into the brain), other direct causes of death have not been characterized. The possibility that cardiac arrhythmias (irregularities in the heartbeat) accompany eclampsia was investigated in 21 patients who were either eclamptic (convulsions, hypertension, excess protein in the urine) or in a state of imminent eclampsia (stomach pain, blurred vision, headache, and nervous system abnormalities). The women underwent standard treatment, as well as continuous cardiac monitoring for 24-hours. Premature ventricular contractions (extra heartbeats, also called ventricular extrasystoles) were counted and ranked according to their frequency and pattern of occurrence. A control group, consisting of pregnant women with normal blood pressure, were also examined. The eclampsia group was at an earlier stage of pregnancy (average, 32 weeks) than the control group (38 weeks). Results showed that cardiac arrhythmias were present in five control patients, and in all eclamptic or imminent-eclamptic patients. The arrhythmias of all controls and of five eclamptic patients were of the lowest grade, consisting of isolated ventricular extrasystoles. The remaining 15 patients had frequent ventricular extrasystoles and complex arrhythmias ranked as grades III or IV (the highest grades in the ranking scale). These abnormalities decreased during delivery (14 deliveries were by cesarean section under optimal physiologic maintenance), but reappeared afterwards, and disappeared only several hours after blood pressure returned to normal. The results indicate the development of life-threatening ventricular arrhythmias in 71 percent of the patients, but were not a result of electrolyte imbalance or similar physiologic derangement. Drugs that lower blood pressure and control cardiac arrhythmias may be beneficial for pregnant women in hypertensive crises. Complex ventricular arrhythmias may be a cause of sudden death in such cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Eclampsia is a complication of pregnancy marked by maternal high blood pressure, swelling, protein in the urine and convulsions. Although eclampsia is rare, it is the most common cause of maternal death, particularly in developing countries. Since the mechanisms of eclampsia and preeclampsia (a similar condition but not accompanied by convulsions) are not well understood, treatment is aimed at reducing blood pressure with antihypertensive agents and controlling seizures with anticonvulsive agents. Diazepam is a tranquilizing agent that controls seizures rapidly. However, some clinicians believe that high doses of diazepam are dangerous to the mother and fetus. Two reports published in the February 1990 issue of the British Journal of Obstetrics and Gynaecology address the issue of anticonvulsant therapy to treat eclampsia. The most common anticonvulsant for the treatment of eclampsia is magnesium sulfate, which seem to reduce irritability in the brain and temporarily reduce blood pressure. However, convulsions persist in 10 percent of the patients treated with magnesium sulphate. In an effort to find a more effective treatment, the anticonvulsant phenytoin, an agent used to treat epilepsy, was given to a small group of patients with preeclampsia. Phenytoin was not beneficial in preventing recurrent convulsions. Research should focus on preventing the development of preeclampsia by correcting abnormalities in the blood coagulation system. A program studying the effects of low doses of aspirin is currently underway. Until more effective treatment alternatives surface, patients should be managed with intravenous diazepam or dihydralazine (an antihypertensive), increased body fluids and prompt delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)