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Caso, Rogelio and Baez, Juan Jose: Pregnancy, Parturition and Puerperium in Nephrectomized Patients
576
AMERICAN JOURNAL OF OBSTI<~TRICS AND GYNECOLOGY
from two weeks to four months in spite of intensive parenteral liver therapy supplemented by the administration of iron and vitamin concentrates. In the majority of the cases repeated blood transfusions were necessary for the main· tenance of life during the refractory period. J<~ventually complete recovery oc· curred in all cases. Cr,AIR E. FotsoME. Moscoso, Oesa.r Jacome: Eclampsia. in the Quito Ma.ternity, Bol. d. soc. de obst. y ginec. 21: 770-771, 1943. The author reports a statistical study of about 50,000 pregnancies observed at the Quito Maternity since 1910. His figures show a lower incidence of eclampsia than in other reported series. In 22,567 pregnancies during the last five months (the period when eclampsia develops) there were 80 cases of eclampsia, an incidence of 3.54 per 1,000. There was no indication that climate had any effect on development of eclampsia. In the dry season (5 months) there were 38 cases and in the damp season (7 months) 42 cases. Of the 80 cases of eclampsia, 47 were in primiparas (58.25 per cent); 11 in secundiparas; and 20 cases in later pregnancies. The eclampsia occurred during pregnancy in 51 cases, during labor in 17 cases, and during the post-partum period in 12. Eight of the latter occurred within the first 24 hours after delivery, and in the others after 2, 3, 8 and 15 days. In the 80 cases of eclampsia there were 29 maternal deaths (36 per cent). No reference to fetal mortality was noted in 9 cases; in the remaining 71, 30 died either before or after delivery (42 per cent). In this series of cases both medical and surgical treatment was employed. Moscoso comments that since the mortality is higher than in most reported series, better methods of treatment must be found. He feels that improvement can be accomplished only by attention to the social factors and by educational measures. Many of the patients had not been seen prior to the development of severe eclampsia and had had no prenatal care. The method of evacuating the uterus depends on individual cireumstances and the condition of the patient. Other measures recommended include absolute quiet and avoidance of excitement; suppression of the eclamptic attacks by adminis· tration of morphine-chloral; maintenance of circulatory function; and bleeding to bring down arterial pressure. The last is contraindicated in the presence of J p G anemia or imminent delivery. • , REENHILL. Oaso, Rogelio and Baez, Jua.n Jose: Pregnancy, Parturition and Puerperium in Nephrectomized Pa.tients, Bol. d. soc. de obst. y ginee. 21: 816-820, 1943. The authors report six cases. Four of the patients had nephrectomy for tuber· culosis, one for pyonephrosis and one for lithiasis. In four women the pregnancy developed normally and was carried to term, with delivery of live fetuses. Three women had spontaneous deliveries and one required surgical intervention because of dystocia. In the other case, there was abortion of a dead, retained fetus. In one of the patients who ultimately had a spontaneous delivery, pyelitis developed during the second month of pregnancy. This was treated conservatively. The authors conclude that three or four years should elapse after nephrectomy before pregnancy should be allowed, but this only if the remaining kidney is healthy. If the sole kidney is diseased, the pregnancy should be interrupted or sterilization should be carried out. 'fhe patient should have careful observation and study of renal function during the entire period of gestation. If there is any alteration in renal function which threatens the health of the patient, the preg· J p G nancy should be interrupted. •
•
REENHILL.
AMERICAN JOURNAL OF OBSTI<~TRICS AND GYNECOLOGY
from two weeks to four months in spite of intensive parenteral liver therapy supplemented by the administration of iron and vitamin concentrates. In the majority of the cases repeated blood transfusions were necessary for the main· tenance of life during the refractory period. J<~ventually complete recovery oc· curred in all cases. Cr,AIR E. FotsoME. Moscoso, Oesa.r Jacome: Eclampsia. in the Quito Ma.ternity, Bol. d. soc. de obst. y ginec. 21: 770-771, 1943. The author reports a statistical study of about 50,000 pregnancies observed at the Quito Maternity since 1910. His figures show a lower incidence of eclampsia than in other reported series. In 22,567 pregnancies during the last five months (the period when eclampsia develops) there were 80 cases of eclampsia, an incidence of 3.54 per 1,000. There was no indication that climate had any effect on development of eclampsia. In the dry season (5 months) there were 38 cases and in the damp season (7 months) 42 cases. Of the 80 cases of eclampsia, 47 were in primiparas (58.25 per cent); 11 in secundiparas; and 20 cases in later pregnancies. The eclampsia occurred during pregnancy in 51 cases, during labor in 17 cases, and during the post-partum period in 12. Eight of the latter occurred within the first 24 hours after delivery, and in the others after 2, 3, 8 and 15 days. In the 80 cases of eclampsia there were 29 maternal deaths (36 per cent). No reference to fetal mortality was noted in 9 cases; in the remaining 71, 30 died either before or after delivery (42 per cent). In this series of cases both medical and surgical treatment was employed. Moscoso comments that since the mortality is higher than in most reported series, better methods of treatment must be found. He feels that improvement can be accomplished only by attention to the social factors and by educational measures. Many of the patients had not been seen prior to the development of severe eclampsia and had had no prenatal care. The method of evacuating the uterus depends on individual cireumstances and the condition of the patient. Other measures recommended include absolute quiet and avoidance of excitement; suppression of the eclamptic attacks by adminis· tration of morphine-chloral; maintenance of circulatory function; and bleeding to bring down arterial pressure. The last is contraindicated in the presence of J p G anemia or imminent delivery. • , REENHILL. Oaso, Rogelio and Baez, Jua.n Jose: Pregnancy, Parturition and Puerperium in Nephrectomized Pa.tients, Bol. d. soc. de obst. y ginee. 21: 816-820, 1943. The authors report six cases. Four of the patients had nephrectomy for tuber· culosis, one for pyonephrosis and one for lithiasis. In four women the pregnancy developed normally and was carried to term, with delivery of live fetuses. Three women had spontaneous deliveries and one required surgical intervention because of dystocia. In the other case, there was abortion of a dead, retained fetus. In one of the patients who ultimately had a spontaneous delivery, pyelitis developed during the second month of pregnancy. This was treated conservatively. The authors conclude that three or four years should elapse after nephrectomy before pregnancy should be allowed, but this only if the remaining kidney is healthy. If the sole kidney is diseased, the pregnancy should be interrupted or sterilization should be carried out. 'fhe patient should have careful observation and study of renal function during the entire period of gestation. If there is any alteration in renal function which threatens the health of the patient, the preg· J p G nancy should be interrupted. •
•
REENHILL.