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Breast-feeding in prevention of necrotizing enterocolitis
Volume Number
140 4
conclusions from those that appeared in the aforesaid article. The predominant clinical signs in most of our patients were as follows: 1. There was severe pain in the region of the myoma with intense tenderness on superficial palpation. At times there have been exacerbations of this pain, and the tenderness has been so severe as to warrant surgical intervention. According to most textbooks the pain and tenderness are caused by red degeneration of the myoma. In all our cases we were on the verge of surgical intervention but with symptomatic treatment during hospitalization we managed to overcome the severe clinical picture within a few days. All of these women became asymptomatic and their pregnancies went to term. 2. In all our cases the myomas led to premature uterine contractions. As these contractions appeared between weeks 28 and 31 we treated them with beta mimetics, which suppressed contractions, and pregnancy was maintained. All of these women delivered spontaneously except for two who were delivered by cesarean section because of cephalopelvic disproportion; at operation, myomectomy was also carried out. None of our patients presented with either premature rupture of the membranes or hemorrhage, both of which predominated in the article referred to. We also found no link between the location of the myomas in relation to the site of the placenta and the clinical symptomatology. H. Abramovici, M.D. J. H. Faktor, M.D. Department of Obstetrics and Gynecology Lady Davis Carmel Hospital 7 Michal Street Haifa, Israel
Reply to Drs. Abramovici and Faktor To the Editors: We have read with interest the comments of Drs. Abramovici and Faktor and we are pleased to know that other investigators have noted an increased incidence of pregnancy-associated complications in patients in whom myomas of the uterus are present. We have just concluded the prospective study in which 48 pregnant women with myomas were followed up by ultrasonographic examinations throughout the pregnancy and the puerperium. Again we noted an increased incidence of pregnancy-associated complications in patients in whom there was a relationship between the location of the myoma and the placental site. Those were mainly bleeding complications. In response to the comment of Drs. Abramovici and Faktor that bleeding was not a presenting feature in their series, our current prospective study confirms
Correspondence
485
that in our experience bleeding is the most prominent feature. In 10 patients bleeding occurred in the first and second trimesters, and in another three patients postpartum hemorrhage occurred. Five patients complained of pain which was localized to the area of the fibroid. In one of these patients bleeding was also noted. The remaining four had no bleeding whatsoever. Cystic changes in the fibroid were noted on ultrasonographic scanning in two patients. One of these patients did present with extreme pain and tenderness and surgical intervention was contemplated at that time but not performed. In the prospective study we also noted two patients with premature labor, one at 34 and one at 35 weeks’ gestation. In these two cases, there was contact between the myoma and the placental site. We do feel, in view of the increased incidence of complications in patients in whom there is a relationship between the placental site and the location of the myoma, that there may be a cause-effect relationship between the two. In the present study we did not find any patient with premature rupture of the membranes. In reference to the retrospective study it is difficult for us to say whether the patients in whom the diagnosis of premature rupture of the membranes was made were in premature labor. This point needs further elucidation and we thank Drs. Abramovici and Faktor for bringing it to our attention. D. Muram, M.D. M. S. Gillieson, M.D. Department of Obstetrics and Gynecology Ottawa General Hospital University of Ottawa 501 Smyth Road Ottawa, Ontario, Canada
Breast-feeding in prevention of necrotizing enterocolitis To the Editors: In the recent article by Winikoff and Baer,’ wherein they enthusiastically advocate breast-feeding, there is a glaring error of fact which should not be allowed to pass unchallenged. They state that clinical experiments have established breat-feeding to be of value in preventing necrotizing enterocolitis. That is not true. There is no evidence from human studies that permits that statement to be made; there are not even suggestive data. It is unfortunate that their unequivocal misstatement appeared in this highly regarded, refereed JOURNAL, thereby inadvertently tending to give it validity. Neonatal necrotizing enterocolitis is a terrible disease which is now rather well understood.2 It can be prevented3 but not according to the proclamations of un-
486
critical,
Correspondence
albeit
well-meaning
Jwe Am. J. Obstet.
promoters
of
breast-
feeding. Edwin A~wn Dir lition of Nromtolog Drpartment Pediatms Mount Sinai ,Vlrdical Center Fifth Arrenm and 100th Street New York, h’m~ York 10029
of
G. Broum, Y. Sulert,
M.D. M.D.
13. 1981 Gynetol.
REFERENCES 1. Winikoff, B., and Baer, E. C.: The obstetrician’s opportunity: Translating “breast is best” from theory to practice, AM. J. OBSTET. GYNECOL. 138:105, 1980. 2. Brown, E. G., and Sweet, A. Y.: Neonatal Necrotizing Enterocohtis, New York, 1980, Grune & Stratton, Inc. 3. Brown, E. G., and Sweet, A. Y.: Preventing necrotizing enterocohtis in neonates, JAMA 240:2452, 1978.
140 4
conclusions from those that appeared in the aforesaid article. The predominant clinical signs in most of our patients were as follows: 1. There was severe pain in the region of the myoma with intense tenderness on superficial palpation. At times there have been exacerbations of this pain, and the tenderness has been so severe as to warrant surgical intervention. According to most textbooks the pain and tenderness are caused by red degeneration of the myoma. In all our cases we were on the verge of surgical intervention but with symptomatic treatment during hospitalization we managed to overcome the severe clinical picture within a few days. All of these women became asymptomatic and their pregnancies went to term. 2. In all our cases the myomas led to premature uterine contractions. As these contractions appeared between weeks 28 and 31 we treated them with beta mimetics, which suppressed contractions, and pregnancy was maintained. All of these women delivered spontaneously except for two who were delivered by cesarean section because of cephalopelvic disproportion; at operation, myomectomy was also carried out. None of our patients presented with either premature rupture of the membranes or hemorrhage, both of which predominated in the article referred to. We also found no link between the location of the myomas in relation to the site of the placenta and the clinical symptomatology. H. Abramovici, M.D. J. H. Faktor, M.D. Department of Obstetrics and Gynecology Lady Davis Carmel Hospital 7 Michal Street Haifa, Israel
Reply to Drs. Abramovici and Faktor To the Editors: We have read with interest the comments of Drs. Abramovici and Faktor and we are pleased to know that other investigators have noted an increased incidence of pregnancy-associated complications in patients in whom myomas of the uterus are present. We have just concluded the prospective study in which 48 pregnant women with myomas were followed up by ultrasonographic examinations throughout the pregnancy and the puerperium. Again we noted an increased incidence of pregnancy-associated complications in patients in whom there was a relationship between the location of the myoma and the placental site. Those were mainly bleeding complications. In response to the comment of Drs. Abramovici and Faktor that bleeding was not a presenting feature in their series, our current prospective study confirms
Correspondence
485
that in our experience bleeding is the most prominent feature. In 10 patients bleeding occurred in the first and second trimesters, and in another three patients postpartum hemorrhage occurred. Five patients complained of pain which was localized to the area of the fibroid. In one of these patients bleeding was also noted. The remaining four had no bleeding whatsoever. Cystic changes in the fibroid were noted on ultrasonographic scanning in two patients. One of these patients did present with extreme pain and tenderness and surgical intervention was contemplated at that time but not performed. In the prospective study we also noted two patients with premature labor, one at 34 and one at 35 weeks’ gestation. In these two cases, there was contact between the myoma and the placental site. We do feel, in view of the increased incidence of complications in patients in whom there is a relationship between the placental site and the location of the myoma, that there may be a cause-effect relationship between the two. In the present study we did not find any patient with premature rupture of the membranes. In reference to the retrospective study it is difficult for us to say whether the patients in whom the diagnosis of premature rupture of the membranes was made were in premature labor. This point needs further elucidation and we thank Drs. Abramovici and Faktor for bringing it to our attention. D. Muram, M.D. M. S. Gillieson, M.D. Department of Obstetrics and Gynecology Ottawa General Hospital University of Ottawa 501 Smyth Road Ottawa, Ontario, Canada
Breast-feeding in prevention of necrotizing enterocolitis To the Editors: In the recent article by Winikoff and Baer,’ wherein they enthusiastically advocate breast-feeding, there is a glaring error of fact which should not be allowed to pass unchallenged. They state that clinical experiments have established breat-feeding to be of value in preventing necrotizing enterocolitis. That is not true. There is no evidence from human studies that permits that statement to be made; there are not even suggestive data. It is unfortunate that their unequivocal misstatement appeared in this highly regarded, refereed JOURNAL, thereby inadvertently tending to give it validity. Neonatal necrotizing enterocolitis is a terrible disease which is now rather well understood.2 It can be prevented3 but not according to the proclamations of un-
486
critical,
Correspondence
albeit
well-meaning
Jwe Am. J. Obstet.
promoters
of
breast-
feeding. Edwin A~wn Dir lition of Nromtolog Drpartment Pediatms Mount Sinai ,Vlrdical Center Fifth Arrenm and 100th Street New York, h’m~ York 10029
of
G. Broum, Y. Sulert,
M.D. M.D.
13. 1981 Gynetol.
REFERENCES 1. Winikoff, B., and Baer, E. C.: The obstetrician’s opportunity: Translating “breast is best” from theory to practice, AM. J. OBSTET. GYNECOL. 138:105, 1980. 2. Brown, E. G., and Sweet, A. Y.: Neonatal Necrotizing Enterocohtis, New York, 1980, Grune & Stratton, Inc. 3. Brown, E. G., and Sweet, A. Y.: Preventing necrotizing enterocohtis in neonates, JAMA 240:2452, 1978.