The birth of a giant fetus

THE JOHN (Prom

BIRTH

E. HOBBS,M.D., the Depm-tment of of Medicine,

AND

Obstetrics St. Louis

OF A GIANT WILLARD

SCRIVNER,

and Gynecology, Maternity and

FE’I’T?ti XD.,

ST.

LOUIS, MO.

Wadimgton UwCvewSy Ramw.?s Rosppitals)

SURVEY of the literature shows comparatively few authentic cases. Duboisl found 28 instances in which the baby wcGghct1 5600 gm. or concluded that fetuses weighing more than six kilograms are very rare. 5;. states that in 30,000 deliveries he has never noted a baby weighing over In 1917, Davisa stated that the largest baby delivered in the Sew York Hospital weighed 15 pounds, although over 100,000 cases had been eonfined

A

Sohod

In 1897, over and Winckel~ till00 gm. Lying-In there.

We have found in the literature nine cases reported by the following observers Beloher4 i,2.S pounds) ; Moss” (24.12 in which the weight exceeded that of our case: pounds) ; Ortega6 (24.82 pounds) ; Neumer and Rachel, tluoted by Williams: (24.8 pounds) ; Beachs (22.75 pounds) ; Robbins (17.5 pounds) ; Brerhini’) (18.37 pounds) ; Trumbullrr (18.25 pounds) ; anti Gordon12 (IS pounds ). L. B., a negress, aged forty, gravids xiii, para xiv, presented herself for the tirst. She had delivered time in the Washington University dispensary on July 27, 19X. spontaneously t,hirteen full-term babies including a set of twins. She estimated the babies to weigh around eleven pounds c:tcTh and collectively for the twins. However, her previous baby born in the St. Louis Maternity Hospital in Narch, 1939, weighed but 4975 gm. Her last menses occurred from January 9 to 13, 1932, with a previous normal period in December. Physieal examination revealed an obese colored woman weighing 208 pounds without any evidenrc of disease. Blood pressure normal. TTrine, blood Wassermann and Kahn were negahive. Pelvic measurements wore normal. The estimated date of confinement was Oct. 16, 1932. She returned in ,4ugust and September, and it was found she bad not gained in weight despite a normal intake of food. In September, the MacDonald measurement was 35 cm. with the head at the spines. The patient did not report until 3:Oir ,$.~t. October 21, 1932, at which time she called the out-patient physician and stated she was in labor. Three hours later, the membranes ruptured spontaneously. The fundus at, this time The patient stuted her abdomen had measured 50 cm. with the head above the spines. increased tremendously in size during the last month. The fetal heartheat, could not, be heard nor had the patient felt movements for the past two days. St six in the evening the head was born spontaneously and attempts to complete the delivery were unsuccessful because of the shoulder impinging on thu symphysis. The patient was brought into the St. Louis Maternity Hospital where tbc delivery was completed by the resident house officer, the child being stillborn. The shoulders were maneuvered so that both were delivered posteriorly. There was considerable amniotic fluid lost in the home and following the extraction of the baby, but it, was not measured. The placenta came away readily, and weighed 1100 gm. h smal1 cervical tear was repaired and the patient ret,urncd to the ward in good condition. The first few days of the puerperium were complicated by a low grade fever and On the sixth day, an intrauterine culture and douche were foul smelling lochia. done and the temperature returned to normal in the next few days. The remainder 902

HOBBS

AND

SCRIVNER:

BIRTH

OF

A

GIANT

of the puerperium was uneventful, except for a vesicovaginal late in the puerperium. The patient was discharged from teenth day in good condition. The

The baby, following

a male, weighed measurements

7700 were

gm. (16.94 made:

fistula, which developed the hospital on the nine-

pounds),

without Cm. 62 38 42 39 21 13.5

Length Length of torso and head Circumference of thorax Circumference of abdomen Bisacromial diameter Bitrochanteric diameter Head Diametevx : 0. F. S. 0. F. S. 0. B. B. P. B. T. 0. M. Head Circumferemws: 0. F. 0. M.

903

FETUS

11 10.5 10 10 9.5 15 36 40

any

malformations. Inches 24.41 14.96 16.53 15.35 8.22 5.31 4.33 4.13 3.93 3.93 3.74 5.90 14.17 15.74

The head was not unusually molded. The sutures and fontanelles were normal for a full-term fetus and the cranial bones showed no increase in density. There The brain was degenerated and very was no evidence of intracranial hemorrhage. friable, the falx and tentorium intact. The sella turcica measured 1.5 by 1.2 cm. The removed pituitary measured 1 by 0.5 by 0.5 cm., no gross abnormalities. On opening the thoraeic cavity, there was a small amount of blood-tinged fluid. The thoracic viscera presented a normal relationship. The lungs combined weighed 137 grams. The heart measured 6 by 8 by 5 cm. and weighed 67 grams, the right ventricle 1 cm. thick, the left 1.5 cm. The foramen ovale was partially occluded. The thymus weighed 35 gm. The thyroid measured 2 by 1 by 1 cm. There was a small amount of blood-tinged fluid in the abdominal cavity, all of the organs in their normal relationship. The ligamentum teres and urachus were quite large. The liver weighed 310 gm. and measured 17.5 by 11 by 3 cm. There was a rupture of The caudate lobe was well developed. the right lobe, most likely traumatic in origin. The spleen weighed 25 gm., measured 7 by 5 by 1 cm. and congested on cut section. The pancreas weighed 10 gm., measured 5 by 2 cm. The kidneys combined weighed 35 gm. and showed the normal fetal lobulations. The adrenals together weighed 22 gm., measured 4 by 5 by 1 cm. and showed no evidence of hemorrhage. The gastrointestinal tract showed no gross abnormalities. The

testes

were

in

the

scrotum,

the

penis

normally

formed.

Microscopically the pituitary showed considerable degenerative changes with increased vascularity. Heidenhain ‘s iron hematoxylin stain showed the eosinophile to be the predominating cell. The lungs showed ateleetasis with some meconiumlike material in a few of the alveoli and considerable degeneration. The other organs showed a normal picture of fetal tissue with considerable postmortem degeneration. A roentgenologic pected in a full-term,

study showed nonpostmature

normal child.

centers

of

ossification

as would

be

ex-

Babies at birth weighing over 6000 gm. are extremely rare and one should be very skeptical of reports of excessively large fetuses without absolute evidence. Nine cases have been reported in which the weight of the newborn has surpassed the weight of our ease, but none of these cases haa a complete necropsy and

(1) Dubois: Lcs Gros Enfants a~1 Point do Vuc Obstetrical, 1897. (2) c-. Winolcel, F. : Klinische Vortriige, X. F. 292-293, p. 175, 1901. (3) Dazriu, gwted by Bro&md, G. L.: Am. J. Obst. 75: 993, 1.917. (4) Beldwr, D. P.: J. A. X. A. 67: 950, 1916. (5) MOSS, E. L.: Brit. Ivl. J. p. 643, 1922. (6) Ortega, F. : Nouvelles Arch. d’obst. et de gynee. p. 481, 1891. (7) Williamts, J. W.: Ed. 6, 1930, p. 168. (8) Beach, A. P.: Med. Rec. 15: 271, 1879. (9) Ilobbi,?~, L. IT.: Trans. A. N. A. 33: 231, 1882. (10) Brechin, W. P.: Med. Rec. 24: 707, 1883. (11) !l’ruznbdZ, J. : Med. Record 35: 656, 1889. (12) Gonlom, E.: Brit. M. J. 1: 664, 1884. (13) Ad&, F. L., aad Sm~m~on, R. E.: AK J. OBST. & GYNEC. 2: 35, 1921. (14) Brothers, A.: Am. J. Obst. 33: 528, 1896. (15) DcLee, J. B.: Principles and Practice of Obstetrics, Chap. LI, 1928, p. 682. (16) O~lc~mnda, 1K.: Beitr. z. Geburtsh. u. Gyniik. 17: 93, 1911. (17) Bkfeld: Arch. f. Gynlk. 4: 510, 1872. (18) Lewis, E. B.: Boston M. & S. .J. 119: 543, 188S (19) E&toricrZ: 5. A. M. A. 62: 383, 1914.

SPONTANEOUS RUPTURE OF UTERUS WITH A SEVEN MONTHS' PREGNANCY" A.

ALFRED (From

the

SCHENONE,

Obstetrical

T

HIS case is reported of the uterus without in its causation.

Ren>ioc

because labor,

M.D., BROOKLYN, of

St.

Catherine’s

of the relative infrequency and also because of the

N. Y. Hosph.l)

of spontaneons possible etiologio

rupture factors

Mrs. M. K., white, aged thirty-one, gravida, v, para ii, admitted to St. Ca.therine’s Rospital July 25, 1929, in the seventh month of her pregnancy, complaining of mild lower abdominal pain. She believed herself in labor. She had been married I;en years, had 2 spontaneous abortions, 2 full-term pregnancies, both labors instrumental, one a stillbirth. Appendectomy had been done fourteen years previousily, Another laparotonly with a midline incision was done six years previously to above admission for what patient described as “cyst on left. ovary. ” Husband later claimed this was for a tubal pregnancy. No hospital record of this operation was obtainable. A curettage for incomplete abortion was done in 1926. Last menstrual period Dec. 19, 1928, estimated labor Sept. 25, 1929. Pregnancy proceeded normally except for moderate headaches at third month. Patient was first seen in early part of July, 1929, three weeks prior to admission, when she eemplained of more or less constant, though vague pain transversely aerosa lower abdomen. Patient, however, was up and about at this time. Physical exalliinstian revealed two well-healed operative scars on abdomen, whi& was enlarged to sire of a six or seven months’ pregnancy. There was slight tenderness in the left lower quadrant midway between umbilicus and left anterior superior spine. P*n had oxisted for the past two weeks. Blood pressure was 120/78; pulse, 80. Fetal heart was audible in right lower quadrant, rate about 140. Patient was seen &gain one week later, complaining of same pain in lower abdamen especially on l&t &de. *Presented

at a meeting

of

the

Rrooklyn

Gynecological

Society,

December

2, 193%