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Hypotensive obstetric patients with special reference to gestosis
Volume G3 Number
SELECTED
5
1181
ABSTRACTS
fetus could be palpated lying free in the abdomen 10 times. More often, however, the uterus is relatively normal to palpation, though tenderness and tenseness are present. A mistaken diagnosis of abruptio placentae tends to be made for this reason. Signs of peritoneal irritation were reported in 25 per cent of the cases. Abdomen and uterus were entirely normal to palpation in 5 cases. Temperature was elevated only when there was concomitant peritonitis. Gradually developing anemia in patients under observation served as an indication for operation in 30 of the patients. The author emphasizes that the presumptive diagnosis of uterine rupture should be made before the slowly developing anemia has become severe. Review of these cases corroborates the conclusions of numerous authors that rupture of the uterus should be suspected in cases of acute abdominal pain of sudden onset during the latter half of pregnancy, especially after the eighth month. By making use of careful evaluation of physical signs-fetus free in abdominal cavity, tender or tense uterus, absence of fetal heart sounds, anemia, and signs of peritoneal irritationtimely exploratory laparotomy may be performed and the mortality of this obstetric catastrophe may be reduced. DOIJGLAS M. HAYNER
Krueger, Vera I., and Butler, Rildred M.: Antidiuretic Substauce in the Urine During Pregnancy and Its Frequent Association With Bacterial Growth, J. Obst. & Gynaec. Brit.
Emp.
58:
5, 1951.
The authors found that when the specimens of urine were collected over a standard period of time and reduced to a constant volume, a more reliable index of the amount of antidiuretic substance excreted could be obtained. Estimates were made from urine from men, and from nonpregnant, normally pregnant, and toxemic pregnant women, all of which showed the presence of an antidiuretic substance. These findings refute the original contention that the presence of an antidiuretic substance in the urine was characteristic of toxemic pregnancy. Due to the severe toxicity of these urine c0ncentrate.s to mice, often causing death, it was suggested that this toxicity might be due to infection by R. coli and therefore it could not be accepted a,s evidence of the excretion of antidiuretic pituitary substance. This hypothesis was tested out and the conclusion reached that coutamination with bacteria, particularly B. coti, markedly vitiated the results, and unless complete sterility could be maintained throughout the experiment no definite conclusion could be reached. In view of this finding it is doubtful that an antidiuretic substance of pituitary origin can routinely be detected in sterile urine from toxemic patients. HARVFY 1 B . MATTHEWS
Sauramo, obst.
H. :
Hypotensive
et gynec.
Scandinav.
Obstetric
Patients
30:
1951.
351,
With
Special
Reference
to Gestosis, Acta
The patients discussed in this paper were women being followed in the outpatient clinic of the First Women’s Clinic, University of Helsinki. Patients who had a systolic blood-pressure reading of 110 mm. of mercury at any time during pregnancy were included in the study provided that the hypotension was not the expression of an obvious acquired illness such as severe anemia, cardiac insufficiency, long-standing debilitating disease, carcinoma, or posthemorrhagic syndrome. The average incidence of hypotension in pregnant women for the period 1935 to 1948 was 7.2 per cent, with a diminution in incidence during the war years, possibly attributable to continuous strong psychogenic stress. Subjective symptoms probably related to the hypotension were observed in 20 per cent of the hypotensive gravidas. These symptoms include weakness, fatigability, vomiting, palpitation, precordial oppression, indigestion, epigastric distress, and headache. Hypotensive gravidas tend toward an asthenic body build. They were generally found in this series to be less than 40 years of age. The total frequency of toxemia in this group was 9.2 per cent, and the grade of toxemia was, in general, mild. Patients with a consti-
tutional tendency toward hypotension nanc~r and deliver-; when toxemia s~mptoma~o1og.v is not obstetricall~
Swanberg, 0th.
II., and Wiqvist, et gynec.
Rcandinav.
N.:
would appear is superimposed, deleterious.
Rupture 30:
to it
IX excellent tends to be
candidates mild, and
for preg. associated
J)~JI-~:IAs
31. HAYNES
of the TJmbilicaJ Cord During
Pregnancy,
A.ctit
X2.3. 1951.
The authors review the literature on rupture of the umbilical cord, and compile a tattle of etiological factors concerned. To two reported cases of rupture of the umbilical cord during pregnancy they add a third. Ktiologieal factors are divided into traumatic injuries, ana,tomical abnormalities, degenerative changes. inflammatory lesions of bloodvessel walls, and toxic lesions of blood-vessel walls. Traumatic injuries may be due to stress arising from the forces of expulsion; to merhanical compression; to pressure changes during delivery; to sudden escape of large quantit,ies of amniotic fluid; or to injury from operative deliver)-. Anatomical ahnormalities include absolute 0r relative shortness of und varices or tor,+ions. the cord, velamentoun insertion. Among the degenerative changes which may predispose to rupture are unusual looseness of structure of Wharton ‘S jell) deficiency or absence of Whart,on ‘R jelly; au11 connective tissue; deficiencv or absence of the tunica elastica of blood vessels; attenuation of blood-vessel musculature; mucoid de snd hereditary or constitutional weaknesses. The principal inffammator~ generation; disease which may I)e operative is syphilitic involvement of the walls of the cord vessels. the most striking feature was an ahnormal insertion In the case reported by the authors, of the cord in which the vessels separate Irefore joining the placenta, insertio funiculi furcata. E’etal death in utero prior to the onset of labor occurred in this patient following a heavy fall on the 1)uttacks; labor did not ensue until 12 (lays later. The possihilit>that the rupture may have followed motion of thr fetal extremities is considered.
Pregnancy,
Physiology
of Early Pregnancy Despite Kulseng-Hanssen, K. : Maintenance Corpora Lutea, Acta ohst. et gynec. Scandinav. 30: 420, 1951.
Extirpation
of Three
The clinical protocol of a 3%year-old parous woman who was subjected to explorator) Iapxrot,omy because of vague pain in the hypogastria region and back is present,ed. No amenorrhea or other symptoms or signs of pregnancy were complained of, so when at operation three distinct corpus luteum cysts wer? enczounteretl, these were thought to IN, ‘ ’ disease, ’ ’ and were removed. her primary Three weeks after operation, the patient experienced vomiting and constipation, and was readmitted; at this time, an early pregThe vomiting was controlled, but five weeks later the panancy episode waR diagnosed. Cent became the victim of a serious mental depressi’on, and hysterotomy and sterilization were done on psychiatric recommendation. A viable twin-ovum pregnancy corresponding in size to a conceptus of three months’ gestation was found at operation. The case hiptory illustrates undisturbed continuation of early pregnancy after extirpation of corpora lutea in about the fourth week of pregnancy. The author assumes that even at this early stage the chorion produces sufficient, progest,erone for the maintenance of pregnancy. !rhe pertinent literature is reviewed. 1)or~or.n~
Anzisi,
M.
G., and Vaglio, N.: Serum Concentration and Urinary Excretion Gonadotropins in Pregnancy, Arch. ostet. e ginec. 55: 496, lR5lI
The scope of this paper iti to determine the tropin in the blood serum and urine of pregnant fest var>+g degrees of t,oxemia of pregnancy.
HAYNES
of Chorionic
variation in the levels uf chorionic gonatlowomen in the third trimester who maniThe authors employed the m&le Rana
SELECTED
5
1181
ABSTRACTS
fetus could be palpated lying free in the abdomen 10 times. More often, however, the uterus is relatively normal to palpation, though tenderness and tenseness are present. A mistaken diagnosis of abruptio placentae tends to be made for this reason. Signs of peritoneal irritation were reported in 25 per cent of the cases. Abdomen and uterus were entirely normal to palpation in 5 cases. Temperature was elevated only when there was concomitant peritonitis. Gradually developing anemia in patients under observation served as an indication for operation in 30 of the patients. The author emphasizes that the presumptive diagnosis of uterine rupture should be made before the slowly developing anemia has become severe. Review of these cases corroborates the conclusions of numerous authors that rupture of the uterus should be suspected in cases of acute abdominal pain of sudden onset during the latter half of pregnancy, especially after the eighth month. By making use of careful evaluation of physical signs-fetus free in abdominal cavity, tender or tense uterus, absence of fetal heart sounds, anemia, and signs of peritoneal irritationtimely exploratory laparotomy may be performed and the mortality of this obstetric catastrophe may be reduced. DOIJGLAS M. HAYNER
Krueger, Vera I., and Butler, Rildred M.: Antidiuretic Substauce in the Urine During Pregnancy and Its Frequent Association With Bacterial Growth, J. Obst. & Gynaec. Brit.
Emp.
58:
5, 1951.
The authors found that when the specimens of urine were collected over a standard period of time and reduced to a constant volume, a more reliable index of the amount of antidiuretic substance excreted could be obtained. Estimates were made from urine from men, and from nonpregnant, normally pregnant, and toxemic pregnant women, all of which showed the presence of an antidiuretic substance. These findings refute the original contention that the presence of an antidiuretic substance in the urine was characteristic of toxemic pregnancy. Due to the severe toxicity of these urine c0ncentrate.s to mice, often causing death, it was suggested that this toxicity might be due to infection by R. coli and therefore it could not be accepted a,s evidence of the excretion of antidiuretic pituitary substance. This hypothesis was tested out and the conclusion reached that coutamination with bacteria, particularly B. coti, markedly vitiated the results, and unless complete sterility could be maintained throughout the experiment no definite conclusion could be reached. In view of this finding it is doubtful that an antidiuretic substance of pituitary origin can routinely be detected in sterile urine from toxemic patients. HARVFY 1 B . MATTHEWS
Sauramo, obst.
H. :
Hypotensive
et gynec.
Scandinav.
Obstetric
Patients
30:
1951.
351,
With
Special
Reference
to Gestosis, Acta
The patients discussed in this paper were women being followed in the outpatient clinic of the First Women’s Clinic, University of Helsinki. Patients who had a systolic blood-pressure reading of 110 mm. of mercury at any time during pregnancy were included in the study provided that the hypotension was not the expression of an obvious acquired illness such as severe anemia, cardiac insufficiency, long-standing debilitating disease, carcinoma, or posthemorrhagic syndrome. The average incidence of hypotension in pregnant women for the period 1935 to 1948 was 7.2 per cent, with a diminution in incidence during the war years, possibly attributable to continuous strong psychogenic stress. Subjective symptoms probably related to the hypotension were observed in 20 per cent of the hypotensive gravidas. These symptoms include weakness, fatigability, vomiting, palpitation, precordial oppression, indigestion, epigastric distress, and headache. Hypotensive gravidas tend toward an asthenic body build. They were generally found in this series to be less than 40 years of age. The total frequency of toxemia in this group was 9.2 per cent, and the grade of toxemia was, in general, mild. Patients with a consti-
tutional tendency toward hypotension nanc~r and deliver-; when toxemia s~mptoma~o1og.v is not obstetricall~
Swanberg, 0th.
II., and Wiqvist, et gynec.
Rcandinav.
N.:
would appear is superimposed, deleterious.
Rupture 30:
to it
IX excellent tends to be
candidates mild, and
for preg. associated
J)~JI-~:IAs
31. HAYNES
of the TJmbilicaJ Cord During
Pregnancy,
A.ctit
X2.3. 1951.
The authors review the literature on rupture of the umbilical cord, and compile a tattle of etiological factors concerned. To two reported cases of rupture of the umbilical cord during pregnancy they add a third. Ktiologieal factors are divided into traumatic injuries, ana,tomical abnormalities, degenerative changes. inflammatory lesions of bloodvessel walls, and toxic lesions of blood-vessel walls. Traumatic injuries may be due to stress arising from the forces of expulsion; to merhanical compression; to pressure changes during delivery; to sudden escape of large quantit,ies of amniotic fluid; or to injury from operative deliver)-. Anatomical ahnormalities include absolute 0r relative shortness of und varices or tor,+ions. the cord, velamentoun insertion. Among the degenerative changes which may predispose to rupture are unusual looseness of structure of Wharton ‘S jell) deficiency or absence of Whart,on ‘R jelly; au11 connective tissue; deficiencv or absence of the tunica elastica of blood vessels; attenuation of blood-vessel musculature; mucoid de snd hereditary or constitutional weaknesses. The principal inffammator~ generation; disease which may I)e operative is syphilitic involvement of the walls of the cord vessels. the most striking feature was an ahnormal insertion In the case reported by the authors, of the cord in which the vessels separate Irefore joining the placenta, insertio funiculi furcata. E’etal death in utero prior to the onset of labor occurred in this patient following a heavy fall on the 1)uttacks; labor did not ensue until 12 (lays later. The possihilit>that the rupture may have followed motion of thr fetal extremities is considered.
Pregnancy,
Physiology
of Early Pregnancy Despite Kulseng-Hanssen, K. : Maintenance Corpora Lutea, Acta ohst. et gynec. Scandinav. 30: 420, 1951.
Extirpation
of Three
The clinical protocol of a 3%year-old parous woman who was subjected to explorator) Iapxrot,omy because of vague pain in the hypogastria region and back is present,ed. No amenorrhea or other symptoms or signs of pregnancy were complained of, so when at operation three distinct corpus luteum cysts wer? enczounteretl, these were thought to IN, ‘ ’ disease, ’ ’ and were removed. her primary Three weeks after operation, the patient experienced vomiting and constipation, and was readmitted; at this time, an early pregThe vomiting was controlled, but five weeks later the panancy episode waR diagnosed. Cent became the victim of a serious mental depressi’on, and hysterotomy and sterilization were done on psychiatric recommendation. A viable twin-ovum pregnancy corresponding in size to a conceptus of three months’ gestation was found at operation. The case hiptory illustrates undisturbed continuation of early pregnancy after extirpation of corpora lutea in about the fourth week of pregnancy. The author assumes that even at this early stage the chorion produces sufficient, progest,erone for the maintenance of pregnancy. !rhe pertinent literature is reviewed. 1)or~or.n~
Anzisi,
M.
G., and Vaglio, N.: Serum Concentration and Urinary Excretion Gonadotropins in Pregnancy, Arch. ostet. e ginec. 55: 496, lR5lI
The scope of this paper iti to determine the tropin in the blood serum and urine of pregnant fest var>+g degrees of t,oxemia of pregnancy.
HAYNES
of Chorionic
variation in the levels uf chorionic gonatlowomen in the third trimester who maniThe authors employed the m&le Rana