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Effect of glucocorticoids on pulmonary edema during terbutallne tocolysis
Volume 141 Number 2
today's standards is unacceptable. This may account for the results being unacceptable to some people. Unfortunately, in the 1980s, in many instances only total abdominal hysterectomy and bilateral salpingo-oophorectomy are performed, without attention to peritoneal cytology and evaluation of the omentum, lymph nodes, and peritoneal surfaces, including the diaphragms. The results of this study do give some indications of subsequent therapy in such a patient. john A. Blessing, Ph.D. Group Statistic.:an Gynecologic Or.cology Group Roswell Park Apartments, R.P.M.I. 666 Elm Street Buffalo, New York 14263
Endocrine pancreas In intrauterine growth retardation To the Editors: Chin-Chu Lin and associates demonstrated low levels of c-peptide in amniotic fluid in intrauterine growth retardation (IUGR) (AM. J. 0BSTET. GYNECOL. 139: 390, 1981). On the basis oftheir hypothesis of the cause of IUGR (low fetal glucose concentration resulting in low fetal insulin secretion), they hope that an effective therapy can be achieved if chronic fetal hypoglycemia and low production of insulin can be corrected. We' have clearly demonstrated that in human neonates with IUGR the amount of pancreatic endocrine tissue and the percentage of insulin-producing B cells are only half of the corresponding values in infants with normal b1:rth weights. We think that the reduced amount of insulin-producing B cells is the morphologic basis of a reduced synthesis and secretion of insulin in IV GR. We have also stressed, in 1977, that the correlation between r.~tal growth retardation and reduced insulin secretion may point the way to a new treatment for fetal growth retardation. In experimental growth retardation, De Prins and Van Assche~ have recently shown that rat fetuses with IUGR have reduced glucose and reduced insulin levels; after birth, a reduced percentage of granulated B cells is noted. This finding of a reduced percentage of granulated B cells in the islets of growth-retarded newborn rats gives a histologic indication that experimental IUGR on a vascular basis (ligation of uterine vessels) finally results in a reduced amount of B cells in the endocrine pancreas, thus supporting the data observed in cases of IUGR in human beings. F. A. Van Assche, M.D. F. A. De Prins, M.D. Department of ObsU!trics and Gynecology Academisch Ziekenhuis St. Rafael Kath. Univ. Le:uven Capucienenvoer 3 5 B-3000 Leuven, Belgium
Correspondence 233
REFERENCES l. Van Assche, F. A., De Prins, F. A., Aerts, L., et al.: The endocrine pancreas in small-for-dates infants, Br. J. Obstet. Gynaecol. 84:751, 1977. 2. De Prins, F. A., and Van Assche, F. A.: Intrauterine growth retardation and development of endocrine pancreas in the experimental rat. Bioi. Neonate. In press.
Effect of glucocorticoids on pulmonary edema during terbutaline tocolysis To the Editors: It recently has been suggested that glucocorticoids, administered to induce fetal lung maturity, may play a role in the pathogenesis of pulmonary edema developing in patients while on terbutaline therapy for preterm labor. 1• 2 After submission of our article concerning this subject to your JoURNAL, we treated two additional patients, who developed pulmonary edema during intravenous terbutaline therapy. However, none of these patients received glucocorticoids. Thus, our incidence of steroid therapy among patients who developed pulmonary edema (4/9, 44%) is comparable to that among the 170 patients treated with intravenous terbutaline (82/177, 52%). Therefore, we would like to further emphasize that, at present, there is no evidence to imply that glucocorticoid therapy is in any way involved in the pathogenesis of pulmonary edema during terbutaline tocolysis. Michael Katz, M.D. Robert K. Creas';, M.D. Department of Obstetrics, Gynecology and Reproductive Sciences Room M-1480 University of California School of Medicine San Francisco, California 94143 REFERENCES I. Jacobs, M. M., Knight, A. B., and Arias, F.: Maternal pulmonary edema resulting from betamimetic and glucocorticoid therapy, Obstet. Gynecol. 56:56, 1980. 2. Katz, M., Robertson, P. A., and Creasy, R. K.: Cardiovascular complications associated with terbutaline treatment for preterm labor, AM. J. 0BSTET. GYNECOL. 139:605, 1981.
Prenatal care and pregnancy outcome To the Editors: Ryan, Sweeney, and Solola have demonstrated that women with fewer prenatal visits have poorer pregnancy outcome.' They further show that the excess of perinatal deaths among offspring of those women is explained by higher rates of low birth weight and, by inference, prematurity. What they fail to point out is that women who undergo delivery prematurely by the very nature of their early delivery cannot have as many prenatal visits as women who undergo delivery at term. The more relevant information not included in their
today's standards is unacceptable. This may account for the results being unacceptable to some people. Unfortunately, in the 1980s, in many instances only total abdominal hysterectomy and bilateral salpingo-oophorectomy are performed, without attention to peritoneal cytology and evaluation of the omentum, lymph nodes, and peritoneal surfaces, including the diaphragms. The results of this study do give some indications of subsequent therapy in such a patient. john A. Blessing, Ph.D. Group Statistic.:an Gynecologic Or.cology Group Roswell Park Apartments, R.P.M.I. 666 Elm Street Buffalo, New York 14263
Endocrine pancreas In intrauterine growth retardation To the Editors: Chin-Chu Lin and associates demonstrated low levels of c-peptide in amniotic fluid in intrauterine growth retardation (IUGR) (AM. J. 0BSTET. GYNECOL. 139: 390, 1981). On the basis oftheir hypothesis of the cause of IUGR (low fetal glucose concentration resulting in low fetal insulin secretion), they hope that an effective therapy can be achieved if chronic fetal hypoglycemia and low production of insulin can be corrected. We' have clearly demonstrated that in human neonates with IUGR the amount of pancreatic endocrine tissue and the percentage of insulin-producing B cells are only half of the corresponding values in infants with normal b1:rth weights. We think that the reduced amount of insulin-producing B cells is the morphologic basis of a reduced synthesis and secretion of insulin in IV GR. We have also stressed, in 1977, that the correlation between r.~tal growth retardation and reduced insulin secretion may point the way to a new treatment for fetal growth retardation. In experimental growth retardation, De Prins and Van Assche~ have recently shown that rat fetuses with IUGR have reduced glucose and reduced insulin levels; after birth, a reduced percentage of granulated B cells is noted. This finding of a reduced percentage of granulated B cells in the islets of growth-retarded newborn rats gives a histologic indication that experimental IUGR on a vascular basis (ligation of uterine vessels) finally results in a reduced amount of B cells in the endocrine pancreas, thus supporting the data observed in cases of IUGR in human beings. F. A. Van Assche, M.D. F. A. De Prins, M.D. Department of ObsU!trics and Gynecology Academisch Ziekenhuis St. Rafael Kath. Univ. Le:uven Capucienenvoer 3 5 B-3000 Leuven, Belgium
Correspondence 233
REFERENCES l. Van Assche, F. A., De Prins, F. A., Aerts, L., et al.: The endocrine pancreas in small-for-dates infants, Br. J. Obstet. Gynaecol. 84:751, 1977. 2. De Prins, F. A., and Van Assche, F. A.: Intrauterine growth retardation and development of endocrine pancreas in the experimental rat. Bioi. Neonate. In press.
Effect of glucocorticoids on pulmonary edema during terbutaline tocolysis To the Editors: It recently has been suggested that glucocorticoids, administered to induce fetal lung maturity, may play a role in the pathogenesis of pulmonary edema developing in patients while on terbutaline therapy for preterm labor. 1• 2 After submission of our article concerning this subject to your JoURNAL, we treated two additional patients, who developed pulmonary edema during intravenous terbutaline therapy. However, none of these patients received glucocorticoids. Thus, our incidence of steroid therapy among patients who developed pulmonary edema (4/9, 44%) is comparable to that among the 170 patients treated with intravenous terbutaline (82/177, 52%). Therefore, we would like to further emphasize that, at present, there is no evidence to imply that glucocorticoid therapy is in any way involved in the pathogenesis of pulmonary edema during terbutaline tocolysis. Michael Katz, M.D. Robert K. Creas';, M.D. Department of Obstetrics, Gynecology and Reproductive Sciences Room M-1480 University of California School of Medicine San Francisco, California 94143 REFERENCES I. Jacobs, M. M., Knight, A. B., and Arias, F.: Maternal pulmonary edema resulting from betamimetic and glucocorticoid therapy, Obstet. Gynecol. 56:56, 1980. 2. Katz, M., Robertson, P. A., and Creasy, R. K.: Cardiovascular complications associated with terbutaline treatment for preterm labor, AM. J. 0BSTET. GYNECOL. 139:605, 1981.
Prenatal care and pregnancy outcome To the Editors: Ryan, Sweeney, and Solola have demonstrated that women with fewer prenatal visits have poorer pregnancy outcome.' They further show that the excess of perinatal deaths among offspring of those women is explained by higher rates of low birth weight and, by inference, prematurity. What they fail to point out is that women who undergo delivery prematurely by the very nature of their early delivery cannot have as many prenatal visits as women who undergo delivery at term. The more relevant information not included in their