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Fetal deaths from antenatal anticoagulant therapy
464
SELECTED
Am. J. Obst. & Gynec. August, 1956
ABSTRACTS
of quickening, and in retrospect the weight of the baby at birth. Five thousand unselected and essentially consecutive cases were evaluated by one examiner at two Belfast hospitals. The average duration of pregnancy was from two days prior to the estimated date of delivery to one week after the expected date. If the estimated date of delivery was calculated according to Nagele’s rule from the last instead of the first day of the last menses, the actual day of delivery would correspond more closely to the estimated date. The length of the menstrual cycles did not appear to influence the length of the gestation. Fetal mortality was minimal during the forty-first and forty-second weeks, doubled during the forty-third week, and tripled thereafter. The author attempts to explain the reason for this increased fetal mortality in the later weeks. Babies showed no significant weight variations as has been suggested by current investigators. Trauma likewise did not seem to be a factor in increasing the mortality. A considerable number of the fetal deaths did occur either intra partum or through failure to establish respirations in spite of a strong heartbeat after delivery. Anoxia occurs during the first and second stages of labor. In the treatment of prolonged pregnancy induction of labor has been instituted in some clinics after the diagnosis has been made. In the experience of the author, however, medical induction has not been successful unless labor was about to start spontaneously. Conflicting reports have been presented regarding the safety of the surgical approach to induction and the author ardently objects to the current methods. Instead of these, he prefers to examine his patients, and, should the vertex be well engaged and the cervix partially effaced, then assurance of the expectant mother that labor will soon commence naturally should suffice. Should the head not be fixed in the pelvis, stripping the membranes and a hot vinegar douche may be adequate stimulation to induce labor. Once labor has started frequent and careful attendance upon the patient must be the rule and at the first sign of fetal distress delivery either by forceps or cesarean operation should be performed. ARTHUR PERELL, M.D.
Gordon and Dean:
Fetal Deaths From Antenatal
Anticoagulant
Therapy,
p. 719.
Antenatal thrombophlebitis is a rarity. When it does exist, however, treatment or prophylaxis with the standard anticoagulants must be undertaken with the greatest of caution in view of the fetal dangers reported even when prothrombin levels were controlled. A case history of a twin gestation in which there was a clear-cut indication for the use of anticoagulants is reported. One of the infants died in utero and the second at the age of 35 days. Postmortem examinations revealed the cause of the demise in both instances to be secondary to the drug administered to the mother. Other previously reported eases are discussed. After considering the various methods of determining the prothrombin level the authors summarize, with the following conclusions : (1) The maternal mortality associated with thrombophlebitis in pregnancy is not great enough to warrant the routine use of anticoagulant therapy. (2) Should the mother suffer from multiple pulmonary emboii, then the serious fetal risk must be taken into consideration. If the decision to employ anticoagulants is reached, then prothrombin levels should be checked by both the one- and twostage methods of determination. ARTHVR PERELL, M.D.
SELECTED
Am. J. Obst. & Gynec. August, 1956
ABSTRACTS
of quickening, and in retrospect the weight of the baby at birth. Five thousand unselected and essentially consecutive cases were evaluated by one examiner at two Belfast hospitals. The average duration of pregnancy was from two days prior to the estimated date of delivery to one week after the expected date. If the estimated date of delivery was calculated according to Nagele’s rule from the last instead of the first day of the last menses, the actual day of delivery would correspond more closely to the estimated date. The length of the menstrual cycles did not appear to influence the length of the gestation. Fetal mortality was minimal during the forty-first and forty-second weeks, doubled during the forty-third week, and tripled thereafter. The author attempts to explain the reason for this increased fetal mortality in the later weeks. Babies showed no significant weight variations as has been suggested by current investigators. Trauma likewise did not seem to be a factor in increasing the mortality. A considerable number of the fetal deaths did occur either intra partum or through failure to establish respirations in spite of a strong heartbeat after delivery. Anoxia occurs during the first and second stages of labor. In the treatment of prolonged pregnancy induction of labor has been instituted in some clinics after the diagnosis has been made. In the experience of the author, however, medical induction has not been successful unless labor was about to start spontaneously. Conflicting reports have been presented regarding the safety of the surgical approach to induction and the author ardently objects to the current methods. Instead of these, he prefers to examine his patients, and, should the vertex be well engaged and the cervix partially effaced, then assurance of the expectant mother that labor will soon commence naturally should suffice. Should the head not be fixed in the pelvis, stripping the membranes and a hot vinegar douche may be adequate stimulation to induce labor. Once labor has started frequent and careful attendance upon the patient must be the rule and at the first sign of fetal distress delivery either by forceps or cesarean operation should be performed. ARTHUR PERELL, M.D.
Gordon and Dean:
Fetal Deaths From Antenatal
Anticoagulant
Therapy,
p. 719.
Antenatal thrombophlebitis is a rarity. When it does exist, however, treatment or prophylaxis with the standard anticoagulants must be undertaken with the greatest of caution in view of the fetal dangers reported even when prothrombin levels were controlled. A case history of a twin gestation in which there was a clear-cut indication for the use of anticoagulants is reported. One of the infants died in utero and the second at the age of 35 days. Postmortem examinations revealed the cause of the demise in both instances to be secondary to the drug administered to the mother. Other previously reported eases are discussed. After considering the various methods of determining the prothrombin level the authors summarize, with the following conclusions : (1) The maternal mortality associated with thrombophlebitis in pregnancy is not great enough to warrant the routine use of anticoagulant therapy. (2) Should the mother suffer from multiple pulmonary emboii, then the serious fetal risk must be taken into consideration. If the decision to employ anticoagulants is reached, then prothrombin levels should be checked by both the one- and twostage methods of determination. ARTHVR PERELL, M.D.