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Minamikawa, K.: Manual Dilatation of the Cervical Canal
ABSTRACTS Irving, Frederick c., Berman, Saul, and Nelson, Briatol, H.: The Ba.rbiturates and Other Hypnotics in Labor, Surg. Gynec. Obst. 58: 1, 1934. At the Boston Lying-In Hospital for one y~c·ar an investigation was made into the amnesic, analgesic, and anesthetic properties in labor of drugs in more or Jess common use. Eight types of anesthesia were usefl, and 860 patient~ were sturlied. Pantopon and scopol011nine in combination proved not to be satisfactory hy1•· notics, since only 34 per cent of patients had no memory of their labor and only ;l3 per cent of the infants breathed immediately after birth. There was al~o a prolongation of labor in primiparas, the Ollerative incidence was high, ann tlw ineidence of large blood loss waR the highest encountered in the study, heing 35 per cent. With pantopon and rectal ether there ocr.urred only 18 per cent of complete amnesia, the lowest in the series. Sixteen per cent of th'J patients lost over 300 e.e. of blood, the second highest in the study. There was, however, a low in· cidence of excitement. Pt?rnocton is evanescent in its action and cannot be given until the end of the first stage of labor. It produces a low incidence of amnesia and (Jonsiderahle excitement. Sodi1•m amytal and scopolamine resulted in complete amnesia in 80 per cent L'f eaHeR. No marked effect in delaying the initial respiration of the infants was noticed. There was, however, a fairly high incidence of restlessness and the n•· turn to consciousness was prolonged. Pentobarb·ital and scopolamine produced 86 per cent of complete amnesia, the highest in the study and the greatest percentage of infants, 63, breathed imrne
Minamika.wa, K.: Manual D1la.tat1on of the Cervical Canal, & Gynec. 16: 163, 1933.
Japane~e
,T. Obt~t.
In the opinion of the author a cervix can be completely dilated manually. His average length of time for this procedure was seven minutes, but it never required more tha.:n twenty minutes. He considers eelampsia and abruptio pla· eentae as absolute inilications for thi~ procedure, but he also believes the opera· tion should be used in cases of placenta previa, transverse presentation, cardiac and renal diseases. He mentions that the cases in which the cervix is dilated less than three fingerbreadths at the beginning of the proeedure are fraught with some danger but those with more than this amount of dilatation give no eon· cern. The amount of cervical damage varies inversely with the duration of
306
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
pregnancy. There is no risk of infection if the operator is clean. No instruments are used, only the operator's fingers and since these tire readily they cannot do any great damage to the cervix. After complete dilatation is brought about, delivery is accomplished by version and extraction, hence there must be oo pelvic contraction when eases are chosen for manual dilatation of the cervix. J. P.
GREENHILL.
Bemtt, Leon, a.nd Diradouria.n: Early .A.rWiciaJ. Rupture of the Bag of Water and A.ntt8'pai!Ulod in FunctiOnal Anoma.11es of the Flrst Stage of LabOr, Semana med. 2: 361, 1933. :From a careful study of 31 primiparas and 31 multiparas the authors conclude: In eases of primary or secondary dynamic insufficiency artificial rupture of the membranes, in general, intensifies the contractions. In eases of inertia the combination of small doses of pituitary extract with an antispasmodic gives good results. In the presence of spastic conditions rupture of the membranes is indicated, when their persistence is the cause of the inertia and prolongation of the labor. When it is impossible to determine the cause of the functional abnormality antispasmodics should be administered: If, after the antispasmodics have regulated the contractions, they should cease, the membranes !!hould be ruptured and an antispasmodic with small doses of pituitrin be given. Following such treatment the cervix dilates rapidly and the period of expulsion is short. The best results were obtained. in those patients in whom the cervix was dilated more than 4 em., and especially when the presenting part was high without any disproportion. The administration of large doses of antispasmodics predisposes to a greater amount of bleeding during the third stage. The rupture of the membranes before complete dilatation does not delay puerperal involution. The antispasmodics used were: (1) A combination of pantopon, papaverine and spasmalgine; (2) papaverine and atropine sulphate, and (3) suppositories containing belladonna and scopolamine. JAMES M. PmJWE. Voron, J., a.nd Pegea.ud, H.: The Treatment of Contracted Pelvis at the Lyon Obstetric Clinic Dur1ng 1981 and 1982, Rev. fran<;. de gymk et obst. 29: 481, 1934. The 221 eases of contracted pelves observed were treated in a variety of ways. The greatest number, 108, were delivered through the vagina after a test of labor. In this group were one maternal and 4 fetal deaths. In 21 other eases the test of labor had to be terminated by hysterotomy. In this series one mother and two babies died. In 66 cases the authors induced labor before or near term anrl all of these women delivered spontaneously. In this group there were no maternal or fetal deaths. In 21 eases where labor was induced, operative interference had to be employed and while no mothers died, two babies perished. Five prophylactic cesarean sections were performed with one maternal death. Hence in the entire series of 221 eases there were three maternal and eight fetal deaths. J.P.Gl!.uNHILL.
Hanson, &amuel: Th• Narrow Blaptnoue l)iameter aad the Per&istellt Occ1p1toposterior Position, Burg. Gynee. Obst. 59: 102, 1934. The object of this study is to determine what in1luence, if any, the narrow bispinous diameter may exert on the mechanism of labor, particularly so far
Minamika.wa, K.: Manual D1la.tat1on of the Cervical Canal, & Gynec. 16: 163, 1933.
Japane~e
,T. Obt~t.
In the opinion of the author a cervix can be completely dilated manually. His average length of time for this procedure was seven minutes, but it never required more tha.:n twenty minutes. He considers eelampsia and abruptio pla· eentae as absolute inilications for thi~ procedure, but he also believes the opera· tion should be used in cases of placenta previa, transverse presentation, cardiac and renal diseases. He mentions that the cases in which the cervix is dilated less than three fingerbreadths at the beginning of the proeedure are fraught with some danger but those with more than this amount of dilatation give no eon· cern. The amount of cervical damage varies inversely with the duration of
306
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
pregnancy. There is no risk of infection if the operator is clean. No instruments are used, only the operator's fingers and since these tire readily they cannot do any great damage to the cervix. After complete dilatation is brought about, delivery is accomplished by version and extraction, hence there must be oo pelvic contraction when eases are chosen for manual dilatation of the cervix. J. P.
GREENHILL.
Bemtt, Leon, a.nd Diradouria.n: Early .A.rWiciaJ. Rupture of the Bag of Water and A.ntt8'pai!Ulod in FunctiOnal Anoma.11es of the Flrst Stage of LabOr, Semana med. 2: 361, 1933. :From a careful study of 31 primiparas and 31 multiparas the authors conclude: In eases of primary or secondary dynamic insufficiency artificial rupture of the membranes, in general, intensifies the contractions. In eases of inertia the combination of small doses of pituitary extract with an antispasmodic gives good results. In the presence of spastic conditions rupture of the membranes is indicated, when their persistence is the cause of the inertia and prolongation of the labor. When it is impossible to determine the cause of the functional abnormality antispasmodics should be administered: If, after the antispasmodics have regulated the contractions, they should cease, the membranes !!hould be ruptured and an antispasmodic with small doses of pituitrin be given. Following such treatment the cervix dilates rapidly and the period of expulsion is short. The best results were obtained. in those patients in whom the cervix was dilated more than 4 em., and especially when the presenting part was high without any disproportion. The administration of large doses of antispasmodics predisposes to a greater amount of bleeding during the third stage. The rupture of the membranes before complete dilatation does not delay puerperal involution. The antispasmodics used were: (1) A combination of pantopon, papaverine and spasmalgine; (2) papaverine and atropine sulphate, and (3) suppositories containing belladonna and scopolamine. JAMES M. PmJWE. Voron, J., a.nd Pegea.ud, H.: The Treatment of Contracted Pelvis at the Lyon Obstetric Clinic Dur1ng 1981 and 1982, Rev. fran<;. de gymk et obst. 29: 481, 1934. The 221 eases of contracted pelves observed were treated in a variety of ways. The greatest number, 108, were delivered through the vagina after a test of labor. In this group were one maternal and 4 fetal deaths. In 21 other eases the test of labor had to be terminated by hysterotomy. In this series one mother and two babies died. In 66 cases the authors induced labor before or near term anrl all of these women delivered spontaneously. In this group there were no maternal or fetal deaths. In 21 eases where labor was induced, operative interference had to be employed and while no mothers died, two babies perished. Five prophylactic cesarean sections were performed with one maternal death. Hence in the entire series of 221 eases there were three maternal and eight fetal deaths. J.P.Gl!.uNHILL.
Hanson, &amuel: Th• Narrow Blaptnoue l)iameter aad the Per&istellt Occ1p1toposterior Position, Burg. Gynee. Obst. 59: 102, 1934. The object of this study is to determine what in1luence, if any, the narrow bispinous diameter may exert on the mechanism of labor, particularly so far