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Magnesium sulphate is not an effective tocolytic. Magnesium sulphate therapy was also linked to preterm neonatal deaths in one study, which was stopped before completion. Other studies suggest a possible neuroprotective effect of magnesium. Both of these issues require further study. Magnesium sulphate is clearly the drug of choice to prevent recurrent eclampsia and to treat severe pre-eclampsia.

To test the hypothesis that 0.1 mg intrathecal morphine plus NSAIDs provides satisfactory analgesia post-Cesarean section with fewer side effects than 0.25 mg intrathecal morphine.Sixty women, scheduled for elective Cesarean section under spinal anesthesia, were randomized to receive either 0.1 mg or 0.25 mg intrathecal morphine combined with hyperbaric bupivacaine 0.75% and 20 microg fentanyl. All patients received a 100 mg indomethacin suppository at the end of surgery and 500 mg naproxen p.o. b.i.d. was started the evening of surgery and continued until discharge. A blinded researcher recorded the pain, pruritus, and nausea scores, the time to first request for additional analgesics, a visual analogue scale (VAS) satisfaction score, and the use of additional opioids, antipruritics, and/or antiemetics.Of the 60 patients enrolled, two were not included in the data analysis because of protocol violations leaving 30 patients in the 0.1 mg group and 28 in the 0.25 mg group. There were no differences in the VAS pain scores or the number of women requesting an opioid other than codeine between the two groups. The VAS pruritus scores in the 0.1 mg group were lower throughout the 24 hr (P0.001). Fewer women in the 0.1 mg group (4/30 vs 12/28) requested nalbuphine to treat itching (P = 0.018). Nausea scores were lower in the 0.1 mg group (P0.001).The use of 0.1 mg intrathecal morphine plus NSAIDs provides analgesia of similar quality to 0.25 mg but with fewer undesirable side effects following Cesarean section.

A prospective study was carried out to correlate the development of joint symptoms after rubella immunization with pre- and post-immunization rubella-specific immunological responses. Arthralgia or arthritis or both occurred in 10 of 37 adult female volunteers at a mean time of 17.0 days after immunization with the RA 27/3 rubella vaccine. All individuals studied before immunization were seronegative for rubella by either the hemagglutination inhibition or the single radial hemolysis technique. In contrast, rubella enzyme-linked immunosorbent assay or lymphoproliferative responses or both were positive in 27 of 37 (73%) individuals tested before receiving the vaccine. Rubella enzyme-linked immuno-sorbent assays carried out before immunization were positive at high levels (mean E = 0.536) in four individuals who developed recurrent episodes of arthritis after administration of the vaccine while remaining at low levels preimmunization in subjects who developed transient arthralgia (E = 0.238) or no joint manifestations at all (E = 0.288). These data provide preliminary evidence suggesting that rubella vaccine-associated arthritis may occur as a consequence of secondary, rather than primary, infection with rubella virus and that the presence of circulating, nonneutralizing rubella antibody may enhance the development or severity (or both) of the associated postinfection joint manifestations. Assessment of rubella hemagglutination inhibition, hemagglutination inhibition (immunoglobulin M), and enzyme-linked immunosorbent assay serological responses at 6 weeks and 6 months post-immunization revealed no significant differences between patients who developed and those who did not develop joint manifestations. Rubella lymphoproliferative responses were elevated at 6 weeks post-immunization in the group developing arthralgia or arthritis or both, with no difference between the groups observed at 6 months post-immunization.