- Email: [email protected]
Bourke and Whitty: Smallpox Vaccination in Pregnancy: A Prospective Study
288 Selected abstracts
stimulation of the plasma and tissue thromboplastin-generating system which probably controls the level of thrombin. This concept was applied to the study involving 9 patients receiving 5 mg. of norethynodrel plus 0.075 mg. of ethynylestradiol-3-methyl ether for at least 5 months cyclicly. Results were compared to 9 comparable controls. Plasma was drawn and antithrombin assayed. Daily ingestion of the progestin increasf'd the activity of plasma antithrombin by 24.1 per cent when assayed by the clotting time method and by 20.7 per cent when measured by the tosylarginine methyl ester (TAMe) procedure. Edward E. TVallach
Vol. 1, May 9,1964. *Chalmers, J. A.: Five Years' Experience with the Vacuum Extractor, p. 1216. Chalmers: Five Years' Experience with the Vacuum Extractor, p. 1216. Experience with the Malmstrom vacuum extractor in 400 cases is reported. The principal indication for use was uterine inertia with prolonged second stage, although intervention occurred in first stage inertia also. Fetal distress was the second most frequent indication. The instrument was used for various maternal conditions, such as cardiorespiratory disease, toxemia, and uterine scars. Of interest was its application in 5 brow presentations, in 3 of which conversion to vertex presentation was achieved. High arrest of a breech presentation was indication in 4 cases in which the cup was applied to the anterior buttock. Its use in breech presentation, however, has been abandoned. Nine vacuum extraction "failures" were followed by cesarean section. No maternal death occurred in the series. Perinatal mortality was reported in 10 infants (2 stillbirths, 8 neonatal deaths), 2 of whom had intracranial lesions. Xo permanent scalp damage occurred. The author feels that the progressive decline in his perinatal mortality since 1957 is p3rtially attributable to the use of the vacuum extractor, primarily in fetal distress. Edward E. Wallach Vol. 1, June 13, 1964. *Anderson, ]. M., and Benirschke, K.: Maternal Tolerance of Foetal Tissue, p. 1534. *Bourke, G. ]., and Whitty, R. ].: Smallpox Vaccination in Pregnancy: A Prospcctive Study, p. 1544. Anderson and Benirschke: Maternal Tolerance of Foetal Tissue, p. 1534. Experiments involving skin transplants from one
Am.
J.
May 15, 196:; Obs!. & Gynec.
armadillo fetus of a monozygotic quadruplet pregnancy removed at hysterotomy to its mother as We'll as to nonpregnant females and an unrelated gravid female are the basis of this study. Comparisons arc made with the survival times of 3 pairs of skin transplants between 6-month-old offspring and their mothers. The results of the experiments demonstrate: (1) consistent rejection of fetal skin on unrelated hosts; (2) slightly prolonged survival between 6-month-old offspring and their mothers; (3) survival of transplants from fetuses and newborns to their mothers. Since antigenicity of fetal skin was demonstrated (1) antigenic immaturity can be excluded as an explanation for survival. The immunological barrier formed by the trophoblast cannot account for the prolonged survival since the tissue survived without the protection of a layer of trophoblast. The authors propose a mutual tissue-tolerance between mother and fetus, conditioned by the state of pregnancy, which is temporary, as indicated by the rejection of transplants from the 6-monthold offspring. Edward E. Wallach Bourke and Whitty: Smallpox Vaccination in Pregnancy: A Prospective Study, p. 1544. The effects on the fetus of smallpox vaccination during pregnancy were studied prospectively (sec abstracts in AM. J. OBST. & GYNEC. 87: 548, 1963). Over the course of 22 weeks, 112 women registering in a prenatal clinic had been successfully vaccinated during the pregnancy. Fifty-four were vaccinated in the first trimester, 40 at 12 to 24 weeks' duration, and 18 at over 24 weeks. Controls for each vaccinated subject consisted of 4 women who registered in the clinic on the same day. Among the women vaccinated during pregnancy, there were 3 stillbirths with no app3rent abnormality, one abortion at 26 weeks, 3 congenital defects (one stillborn), and 107 normal live births. Abnormalities were hydrocephalus with spina bifida, spina bifida, and Down's syndrome. The mothers of these offspring were vaccinated at 23, 4, and 27 weeks of pregnancy, respectively. The mothers of the stillbirths were all vaccinated during the second trimester. Among the controls there were {) stillbirths with no apparent abnormality, 4 abortions, :~ live births with congenital defects (hydrocephalus with spina bifida, cleft palate, and spina bi1lda alone), and 440 normal live births. The 4 abortions occurred at 6, 7, and 16 weeks of pregnancy. No significant difference occurred in the frequency of these
Voluml~
92
:'\tlmh(~ r
2
Selected abstracts
abnormalities among the vaccinated and unvaccinated women. There were no significant differences either in duration of pregnancy, weight at birth, or sex of the infants. Although these rcsuits do not indicate a harmful influence of vaccination on the fetus, the authors warn against routine primary smallpox vaccination of the pregnant woman to avoid the rare condition of prenatal vaccinia. I~'dward E. Wallach Vol. 1, June 20,1964. *Crrgan, J. C. F., and Burslem, R . W.: Pregnancy and Successful Caesarean Section After Hemipelvectomy for Malignant Disease, p. 1611. Cregan and Burslem: Pregnancy and Successful Caesarean Section After Hemipelvectomy for Malignant Disease, p. 1614. A patient, at the age of J 9, had a hemipelvectomy for an osteogenic sarcoma arising from the ilium and measuring 4 incht's in greatest diameter. Four years later her first pregnancy was terminat('d by cesarean section with the delivery of a 3,100 gram live infant. The postpartum course was uneventful, and at the time of reporting, 8 y(~a rs after her original operation, she was pregnant for the second time. Edward E. Wallach Vol. 2, July 4, 1964. *Editorial: Syndrome in Hydrops Foetalis, p. 3. Editorial: Syndrome in Hydrops Foetalis, p. 3. About half the mothers carrying a fNUS affected by hydrops £CtaUs develop toxemia-like signs which are f('1t to be rdated to the existence of hemolytic disease. The syndrome arises at the seventh or eighth month when there is a sudden increase in weight, accumulation of edema, appearance of proteinuria and, in about half the cases, hypertension. Pruritus, hydramnios, and, occasionally, antepartulll hemorrhage have also ht'en reported. The fetus usually dies after the onset of maternal symptoms. The cause of the syndronw is not known. II ypotheses include: ( 1) allergy to toxin produced by the hydropic fetus, and ~ 2 ~ fetal bleeding into the maternal circulation with production of an antigen-antibody reaction. The most provocative hypothesis concerns ahnormal activity of the placenta, as suggested by the increase in ratio of plaCt~ntal to fetal weight, and an increased production of chorionic .~onadotropin in hydrops fetalis. An imbalance between the activity of the Langhans layer and steroid producing syn('ytiotrophoblast is suggested. I~'d ZL'ar d
g Wallach
289
Vol. 2, September 19, 1964. L('ading Article: Buccal Oxytocin, p. 70:). Vol. 2, October 3,1964. Leading Articles: Test-tube Embryos, p. 836.
Bulletin of the Sloane Hospital for Women Vol. X , No . 3, Fall, 1964. Kin~, T . M.. and D'Esopo, D. A.: Brain Tumors in Pregnancy, p. 7:t The Canadian Medical Association Journal Vol. 91, No. 15, October 10,1964. Krisman, A. : The Fern Reaction of Cervical Mucus: Part I. The Effect of the Xormal Ovarian Cycle and of Pregnancy. Part II. A Guide to th(' Early Diagnosis of Prqrnancy, p. 8m. Vol. 91, No . 17, October 24,1964. Morgan , J., and Cadger, D.: Arteriovenous Fistula of the Internal Iliac Artery and Vein, Related to Trauma at Childbirth, p. 920. Cancer Vol. 17, August 1964. *Allen, A. C.: Grading of Carcinoma-in-Situ of the Cervix, p. 979. Allen: Grading of Carcinoma-in-Situ of the Cervix, p. 979. A system for grading carcinoma in situ of the cervix is presented . Thc systcm consists of grading the de,l!rer of cellular atypia from I to IV as in Broder's classification and estimating the degree of extension of the carcinoma in radial sections of the cone. Thc degree of extension is graded A, B, or C. "Roughly, 'A' rders to a lesion involving about one third of the length of the ectocervical squamous epithelium of the average cone, or approximately 5 mm.; 'Jr, two thirds of the length, or 10 mm.; and 'C', the entire length of the squamous epithelium , or approximately 15 mm." Thus cases graded as IVe an' in the author's opinion more lik('jy to yield residual neoplastic cells in the n~s('ctc d uterus than cases graded 11'1.. Xo statistics are given. The system is suggested as a possihle means of individualizing treatment in carcinoma in situ. This is felt desirahle by the author because he feels some are overtreatrd by hysterectomy ann sonH' may rc('(,ivr inadequate therapy. James ll. N elson , Jr. Current Medical Digest Vol. XXXI, No. 10, October, 1964 . Eastman, ~. J.: Chrolllosomal Ahnormalities In Ahortuses or Stillborn Infants, p. 941.
stimulation of the plasma and tissue thromboplastin-generating system which probably controls the level of thrombin. This concept was applied to the study involving 9 patients receiving 5 mg. of norethynodrel plus 0.075 mg. of ethynylestradiol-3-methyl ether for at least 5 months cyclicly. Results were compared to 9 comparable controls. Plasma was drawn and antithrombin assayed. Daily ingestion of the progestin increasf'd the activity of plasma antithrombin by 24.1 per cent when assayed by the clotting time method and by 20.7 per cent when measured by the tosylarginine methyl ester (TAMe) procedure. Edward E. TVallach
Vol. 1, May 9,1964. *Chalmers, J. A.: Five Years' Experience with the Vacuum Extractor, p. 1216. Chalmers: Five Years' Experience with the Vacuum Extractor, p. 1216. Experience with the Malmstrom vacuum extractor in 400 cases is reported. The principal indication for use was uterine inertia with prolonged second stage, although intervention occurred in first stage inertia also. Fetal distress was the second most frequent indication. The instrument was used for various maternal conditions, such as cardiorespiratory disease, toxemia, and uterine scars. Of interest was its application in 5 brow presentations, in 3 of which conversion to vertex presentation was achieved. High arrest of a breech presentation was indication in 4 cases in which the cup was applied to the anterior buttock. Its use in breech presentation, however, has been abandoned. Nine vacuum extraction "failures" were followed by cesarean section. No maternal death occurred in the series. Perinatal mortality was reported in 10 infants (2 stillbirths, 8 neonatal deaths), 2 of whom had intracranial lesions. Xo permanent scalp damage occurred. The author feels that the progressive decline in his perinatal mortality since 1957 is p3rtially attributable to the use of the vacuum extractor, primarily in fetal distress. Edward E. Wallach Vol. 1, June 13, 1964. *Anderson, ]. M., and Benirschke, K.: Maternal Tolerance of Foetal Tissue, p. 1534. *Bourke, G. ]., and Whitty, R. ].: Smallpox Vaccination in Pregnancy: A Prospcctive Study, p. 1544. Anderson and Benirschke: Maternal Tolerance of Foetal Tissue, p. 1534. Experiments involving skin transplants from one
Am.
J.
May 15, 196:; Obs!. & Gynec.
armadillo fetus of a monozygotic quadruplet pregnancy removed at hysterotomy to its mother as We'll as to nonpregnant females and an unrelated gravid female are the basis of this study. Comparisons arc made with the survival times of 3 pairs of skin transplants between 6-month-old offspring and their mothers. The results of the experiments demonstrate: (1) consistent rejection of fetal skin on unrelated hosts; (2) slightly prolonged survival between 6-month-old offspring and their mothers; (3) survival of transplants from fetuses and newborns to their mothers. Since antigenicity of fetal skin was demonstrated (1) antigenic immaturity can be excluded as an explanation for survival. The immunological barrier formed by the trophoblast cannot account for the prolonged survival since the tissue survived without the protection of a layer of trophoblast. The authors propose a mutual tissue-tolerance between mother and fetus, conditioned by the state of pregnancy, which is temporary, as indicated by the rejection of transplants from the 6-monthold offspring. Edward E. Wallach Bourke and Whitty: Smallpox Vaccination in Pregnancy: A Prospective Study, p. 1544. The effects on the fetus of smallpox vaccination during pregnancy were studied prospectively (sec abstracts in AM. J. OBST. & GYNEC. 87: 548, 1963). Over the course of 22 weeks, 112 women registering in a prenatal clinic had been successfully vaccinated during the pregnancy. Fifty-four were vaccinated in the first trimester, 40 at 12 to 24 weeks' duration, and 18 at over 24 weeks. Controls for each vaccinated subject consisted of 4 women who registered in the clinic on the same day. Among the women vaccinated during pregnancy, there were 3 stillbirths with no app3rent abnormality, one abortion at 26 weeks, 3 congenital defects (one stillborn), and 107 normal live births. Abnormalities were hydrocephalus with spina bifida, spina bifida, and Down's syndrome. The mothers of these offspring were vaccinated at 23, 4, and 27 weeks of pregnancy, respectively. The mothers of the stillbirths were all vaccinated during the second trimester. Among the controls there were {) stillbirths with no apparent abnormality, 4 abortions, :~ live births with congenital defects (hydrocephalus with spina bifida, cleft palate, and spina bi1lda alone), and 440 normal live births. The 4 abortions occurred at 6, 7, and 16 weeks of pregnancy. No significant difference occurred in the frequency of these
Voluml~
92
:'\tlmh(~ r
2
Selected abstracts
abnormalities among the vaccinated and unvaccinated women. There were no significant differences either in duration of pregnancy, weight at birth, or sex of the infants. Although these rcsuits do not indicate a harmful influence of vaccination on the fetus, the authors warn against routine primary smallpox vaccination of the pregnant woman to avoid the rare condition of prenatal vaccinia. I~'dward E. Wallach Vol. 1, June 20,1964. *Crrgan, J. C. F., and Burslem, R . W.: Pregnancy and Successful Caesarean Section After Hemipelvectomy for Malignant Disease, p. 1611. Cregan and Burslem: Pregnancy and Successful Caesarean Section After Hemipelvectomy for Malignant Disease, p. 1614. A patient, at the age of J 9, had a hemipelvectomy for an osteogenic sarcoma arising from the ilium and measuring 4 incht's in greatest diameter. Four years later her first pregnancy was terminat('d by cesarean section with the delivery of a 3,100 gram live infant. The postpartum course was uneventful, and at the time of reporting, 8 y(~a rs after her original operation, she was pregnant for the second time. Edward E. Wallach Vol. 2, July 4, 1964. *Editorial: Syndrome in Hydrops Foetalis, p. 3. Editorial: Syndrome in Hydrops Foetalis, p. 3. About half the mothers carrying a fNUS affected by hydrops £CtaUs develop toxemia-like signs which are f('1t to be rdated to the existence of hemolytic disease. The syndrome arises at the seventh or eighth month when there is a sudden increase in weight, accumulation of edema, appearance of proteinuria and, in about half the cases, hypertension. Pruritus, hydramnios, and, occasionally, antepartulll hemorrhage have also ht'en reported. The fetus usually dies after the onset of maternal symptoms. The cause of the syndronw is not known. II ypotheses include: ( 1) allergy to toxin produced by the hydropic fetus, and ~ 2 ~ fetal bleeding into the maternal circulation with production of an antigen-antibody reaction. The most provocative hypothesis concerns ahnormal activity of the placenta, as suggested by the increase in ratio of plaCt~ntal to fetal weight, and an increased production of chorionic .~onadotropin in hydrops fetalis. An imbalance between the activity of the Langhans layer and steroid producing syn('ytiotrophoblast is suggested. I~'d ZL'ar d
g Wallach
289
Vol. 2, September 19, 1964. L('ading Article: Buccal Oxytocin, p. 70:). Vol. 2, October 3,1964. Leading Articles: Test-tube Embryos, p. 836.
Bulletin of the Sloane Hospital for Women Vol. X , No . 3, Fall, 1964. Kin~, T . M.. and D'Esopo, D. A.: Brain Tumors in Pregnancy, p. 7:t The Canadian Medical Association Journal Vol. 91, No. 15, October 10,1964. Krisman, A. : The Fern Reaction of Cervical Mucus: Part I. The Effect of the Xormal Ovarian Cycle and of Pregnancy. Part II. A Guide to th(' Early Diagnosis of Prqrnancy, p. 8m. Vol. 91, No . 17, October 24,1964. Morgan , J., and Cadger, D.: Arteriovenous Fistula of the Internal Iliac Artery and Vein, Related to Trauma at Childbirth, p. 920. Cancer Vol. 17, August 1964. *Allen, A. C.: Grading of Carcinoma-in-Situ of the Cervix, p. 979. Allen: Grading of Carcinoma-in-Situ of the Cervix, p. 979. A system for grading carcinoma in situ of the cervix is presented . Thc systcm consists of grading the de,l!rer of cellular atypia from I to IV as in Broder's classification and estimating the degree of extension of the carcinoma in radial sections of the cone. Thc degree of extension is graded A, B, or C. "Roughly, 'A' rders to a lesion involving about one third of the length of the ectocervical squamous epithelium of the average cone, or approximately 5 mm.; 'Jr, two thirds of the length, or 10 mm.; and 'C', the entire length of the squamous epithelium , or approximately 15 mm." Thus cases graded as IVe an' in the author's opinion more lik('jy to yield residual neoplastic cells in the n~s('ctc d uterus than cases graded 11'1.. Xo statistics are given. The system is suggested as a possihle means of individualizing treatment in carcinoma in situ. This is felt desirahle by the author because he feels some are overtreatrd by hysterectomy ann sonH' may rc('(,ivr inadequate therapy. James ll. N elson , Jr. Current Medical Digest Vol. XXXI, No. 10, October, 1964 . Eastman, ~. J.: Chrolllosomal Ahnormalities In Ahortuses or Stillborn Infants, p. 941.