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Breech experience reviewed
Breech Experience Reviewed Gimovsky M, Paul R. Singleton breech presentation in labor: Experience in 1980. Am J Obstet Gynecol 143:733, 1982. In a retrospective review of 330 patients presenting in labor with singleton breech presentation the authors have concluded that the liberal use of cesarean section should be continued for infants estimated to weigh less than 2000 g, while term infants of average weight should be allowed a trial of labor. In this series, preventable mortality was limited to infants weighing less than 1300 g (e.g., head entrapment, cord prolapse.) In term, average-sized infants these complications were rarely encountered, and when they were, did not result in neonatal morbidity. The authors stress the fact that the maneuvers used to extract a breech abdominally are the same as for vaginal extraction, and that the risk of birth trauma still exists with cesarean section, in addition to the increased maternal risk of morbidity. In this group of patients, prematurity was the leading factor associated with poor outcome, and congenital anomalies incompatible with life accounted for all the mortality among term infants (74.2% US).
Simple Test for Placental Tissue Munsick R. Clinical test for placenta in 300 consecutive menstrual aspirations. Obstet Gynecol 60:738, 1982. Dr. Munsick describes a simple method of grossly examining tissue for the presence or absence of placental villi. When the initial method proves questionable a sim-
Journal of Nurse-Michuifery Copyright
@ 1983 by the American
??
ple wet mount examination proved to be nearly 100% reliable. This simple method involves rinsing the tissue in tap water until the fluffy villi are apparent. The photograph accompanying the article depicts clearly the difference between placenta and decidua, and the wet mounted microscopic appearance of placental villi is even more clear. In 7 of the initial 200 women curettage was performed due to hemorrhage 3-5 days after the aspiration. All had positive gross tests for placenta, and no villi were identified in the curettings. The bleeding was assumed to be decidual shedding, and the subsequent 100 patients in whom placenta was grossly identified were counseled to remain in bed if worrisome bleeding occurred. Two patients with negative gross and microscopic tests for placenta received rapid treatment of ectopic pregnancies.
Fracture Risk in Postmenopausal Women Williams A, Weiss N, Ure C, et al. Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695, 1982. In order to identify those postmenopausal women most likely to derive skeletal benefits from long-term estrogen use these authors interviewed 353 women aged 50 - 74 who had sustained hip or forearm fractures. Some characteristics that influence fracture risk, both alone and in conjunction with estrogen use, were identified. Significant factors were found to be the woman’s ponderal index, cigarette use,
Vol. 28, No. 2. March/April
College
of Nurse-Midwives
and thyroid hormone use. Among women with little or no estrogen use, the risk of fracture increased steadily with increasing thinness; the risk was 5-6 times greater in thin women than in obese women. Thin women experienced a further increase in risk of hip fracture if they smoked cigarettes. Among estrogen users, the thin women who smoked also experienced a significant increase in risk of hip fracture, though of a smaller magnitude than those women who were not estrogen users. Risk rates for forearm fractures were similar, though not statistically significant. Thin women who had used thyroid hormone for over 8 years experienced a reduction in risk of fractures irrespective of estrogen status. Other factors such as number of live births, age at first birth, duration of lactation, and age at menopause had no effect on risk of fractures. The authors feel this data supports the theory that a factor in cigarette smoke antagonizes the effect of estrogen on skeletal calcium.
Prostaglandins and Herpes Baker D, Thomas J, Epstein J, et al. The effect of prostaglandins on the multiplication and cell-to-cell spread of herpes simplex virus type 2 in vitro. Am J Obstet Gynecol 144346, 1982. Because situations that activate latent herpes are associated with a local or systemic rise in prostaglandins, the authors investigated the effect of prostaglandin Fzu, prostaglandin E,, and ibuprofen, an antiprostaglandin agent, on herpesvirus multiplication and cell-to-cell virus spread in vitro. The prostaglandins enhanced cell-to-
1983
39 0091-2182/83/020039+3$03.00
Simple Test for Placental Tissue Munsick R. Clinical test for placenta in 300 consecutive menstrual aspirations. Obstet Gynecol 60:738, 1982. Dr. Munsick describes a simple method of grossly examining tissue for the presence or absence of placental villi. When the initial method proves questionable a sim-
Journal of Nurse-Michuifery Copyright
@ 1983 by the American
??
ple wet mount examination proved to be nearly 100% reliable. This simple method involves rinsing the tissue in tap water until the fluffy villi are apparent. The photograph accompanying the article depicts clearly the difference between placenta and decidua, and the wet mounted microscopic appearance of placental villi is even more clear. In 7 of the initial 200 women curettage was performed due to hemorrhage 3-5 days after the aspiration. All had positive gross tests for placenta, and no villi were identified in the curettings. The bleeding was assumed to be decidual shedding, and the subsequent 100 patients in whom placenta was grossly identified were counseled to remain in bed if worrisome bleeding occurred. Two patients with negative gross and microscopic tests for placenta received rapid treatment of ectopic pregnancies.
Fracture Risk in Postmenopausal Women Williams A, Weiss N, Ure C, et al. Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695, 1982. In order to identify those postmenopausal women most likely to derive skeletal benefits from long-term estrogen use these authors interviewed 353 women aged 50 - 74 who had sustained hip or forearm fractures. Some characteristics that influence fracture risk, both alone and in conjunction with estrogen use, were identified. Significant factors were found to be the woman’s ponderal index, cigarette use,
Vol. 28, No. 2. March/April
College
of Nurse-Midwives
and thyroid hormone use. Among women with little or no estrogen use, the risk of fracture increased steadily with increasing thinness; the risk was 5-6 times greater in thin women than in obese women. Thin women experienced a further increase in risk of hip fracture if they smoked cigarettes. Among estrogen users, the thin women who smoked also experienced a significant increase in risk of hip fracture, though of a smaller magnitude than those women who were not estrogen users. Risk rates for forearm fractures were similar, though not statistically significant. Thin women who had used thyroid hormone for over 8 years experienced a reduction in risk of fractures irrespective of estrogen status. Other factors such as number of live births, age at first birth, duration of lactation, and age at menopause had no effect on risk of fractures. The authors feel this data supports the theory that a factor in cigarette smoke antagonizes the effect of estrogen on skeletal calcium.
Prostaglandins and Herpes Baker D, Thomas J, Epstein J, et al. The effect of prostaglandins on the multiplication and cell-to-cell spread of herpes simplex virus type 2 in vitro. Am J Obstet Gynecol 144346, 1982. Because situations that activate latent herpes are associated with a local or systemic rise in prostaglandins, the authors investigated the effect of prostaglandin Fzu, prostaglandin E,, and ibuprofen, an antiprostaglandin agent, on herpesvirus multiplication and cell-to-cell virus spread in vitro. The prostaglandins enhanced cell-to-
1983
39 0091-2182/83/020039+3$03.00