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Anovulatory menstruation
911
CORRESPONDENCE
Treatment should he continued post partum until the symptoms have definitely improved in order to reduce the incidence and severity of post-partum convulsions. Sedatives, intravenous magnesium sulfate injections and intravenous glucose injections, while rational and in some cases helpful, are not essential as part of ante-partum treatment. Patients first seen in labor are usually best delivered from below. Elderly primiparas near term hut not in labor are best delivered by cesarean section because of the danger and uncertainty of delivery by induction of labor. There is no advantage in dividing these cases into eclampsia, low reserve kidney, pre-eclampsia, and eclampsism. Because of the prematurity and toxic condition of the babies in these cases, extra precautions must be taken to insure their safety during labor and in the first days thereafter. J. P.
GREENHIT.I~.
Correspondence Anovulatory Xo the
Menstruation
Editor:
In the article on (‘The Incidence of Anovulatory Menstruation Among Patients of LOW Fertility” which appeared in the January issue of your journal, Drs. Rock, Bartlett and Matson stress the difl’erence in the incidence of the condition in their reported group of casea as compared with those reported by Drs. Mazer, Israel and Kacher in A’urg. Gynec. Obst. 65: 30, 1937. May I call attention to the fact that the discrepancy i.s the result of a difference in the selection of cases. The incidence of anovular menstruation in 9.1 per cent reported by them is based on a study of 398 sterile women with a multiplicity of causative factors; whereas the incidence of 30 per cent of anovular menstruation reported by us is based on a study of 85 sterile women, selected from a much larger group, because in them there was no accountable cause for the existing sterility. We definitely stated in the publication that the study was made on sterile women in whom there was no accountable organic cause for the sterility and whose mates were found to be fertile. This is indeed a restricted group as compared with the all-inclusive type of patient studied by Drs. Rock, Bartlett, and Matson. CHARI‘ES
MAZER,
M.D.
Philadelphia, Pa. January 27, 1939 To the
Editor:
In reply to Dr. Mazer’s letter, I consider his point is well taken, as our respective figures are not exactly comparable. Perhaps mistakenly we thought it unnecessary to extend the discussion, for even if we omitted from the two groups of ovulating and of anovulating women all those whose infertility could be attributed to some other disturbance, we found that among the remainder our incidence of anovulatorv menstruation, as we defined it, and arrording to our indices of progestin effect”in the endometrium, was not materially changed, and was much lower than their figure. I suspect from the photomicrographs accompanying Dr. Mazer’s paper that the discrepancy is at Ieast partly due to differences in cytologic criteria of progestational endometrium. JOHN ROCK, M.D. Boston, Mass. February 15, 1939
CORRESPONDENCE
Treatment should he continued post partum until the symptoms have definitely improved in order to reduce the incidence and severity of post-partum convulsions. Sedatives, intravenous magnesium sulfate injections and intravenous glucose injections, while rational and in some cases helpful, are not essential as part of ante-partum treatment. Patients first seen in labor are usually best delivered from below. Elderly primiparas near term hut not in labor are best delivered by cesarean section because of the danger and uncertainty of delivery by induction of labor. There is no advantage in dividing these cases into eclampsia, low reserve kidney, pre-eclampsia, and eclampsism. Because of the prematurity and toxic condition of the babies in these cases, extra precautions must be taken to insure their safety during labor and in the first days thereafter. J. P.
GREENHIT.I~.
Correspondence Anovulatory Xo the
Menstruation
Editor:
In the article on (‘The Incidence of Anovulatory Menstruation Among Patients of LOW Fertility” which appeared in the January issue of your journal, Drs. Rock, Bartlett and Matson stress the difl’erence in the incidence of the condition in their reported group of casea as compared with those reported by Drs. Mazer, Israel and Kacher in A’urg. Gynec. Obst. 65: 30, 1937. May I call attention to the fact that the discrepancy i.s the result of a difference in the selection of cases. The incidence of anovular menstruation in 9.1 per cent reported by them is based on a study of 398 sterile women with a multiplicity of causative factors; whereas the incidence of 30 per cent of anovular menstruation reported by us is based on a study of 85 sterile women, selected from a much larger group, because in them there was no accountable cause for the existing sterility. We definitely stated in the publication that the study was made on sterile women in whom there was no accountable organic cause for the sterility and whose mates were found to be fertile. This is indeed a restricted group as compared with the all-inclusive type of patient studied by Drs. Rock, Bartlett, and Matson. CHARI‘ES
MAZER,
M.D.
Philadelphia, Pa. January 27, 1939 To the
Editor:
In reply to Dr. Mazer’s letter, I consider his point is well taken, as our respective figures are not exactly comparable. Perhaps mistakenly we thought it unnecessary to extend the discussion, for even if we omitted from the two groups of ovulating and of anovulating women all those whose infertility could be attributed to some other disturbance, we found that among the remainder our incidence of anovulatorv menstruation, as we defined it, and arrording to our indices of progestin effect”in the endometrium, was not materially changed, and was much lower than their figure. I suspect from the photomicrographs accompanying Dr. Mazer’s paper that the discrepancy is at Ieast partly due to differences in cytologic criteria of progestational endometrium. JOHN ROCK, M.D. Boston, Mass. February 15, 1939