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Is the time of rupture of the membranes dependent upon the histologic structure of the membranes?
tment
of Reviews CONDUCTED
BY HUGO
and A
EHRENFEST,
M.D.
Selected Abstracts Labor Freclrikson, H. : The Effect on Deliveries of spontaneous branes, Acta obst. et gynec. Scandinav. 17: 309, 1937.
Rupture
of the Mem-
The author studied 1,290 primiparas and 1,300 multiparas who had normal occipitoanterior presentations in which the babies weighed over 2,500 gm., to determine the effect of spontaneous rupture of the membranes on labor. As “premature rupture” he designates cases in which rupture occurred before or simultaneously with the onset of pains. The term “early rupture” is used to indicate rupture of the bag of waters after the onset of pains but before the cervix is dilated to the size of three fingers. The author found that rupture of the membranes occurred before the onset of pains in 12 per cent of primipnras and in 10.7 per cent of multiparas. Rupture of the bag of waters occurred simultaneously with the onset of pains in i.8 per cent of primiparas and in 5.7 per cent of multiparas. In both primiparas and multiparas the duration of labor was considerably shortened in cases of premature rupture of the membranes. In primiparas, labor was definitely prolonged in cases of early rupture. Genital infections during labor occurred twice as often in cases of premature and early rupture as in the cases of late rupture. The fetal mortality was not increased in cases of premature rupture, but it was higher in cases of early rupture. J. I’.
Apajalahti, A. : Is the Time of Rupture of the Membranes Histologic Structure of the Membranes? Acta obst. et
~P.EENIIII,I,
Dependent Gynrc.
Upon the
Scxndiaar.
18:
57, 1938. This investigation verifies labor bears a definite relation especially to the thickness of pecially the amnion, the more easier it is for the membranes that inflammation produced decidua.
the fact that rupture of bhe bag of waters during to the histologic structure of the fetal membranes the amnion. The thinner the membranes are, espronounced are the degenerative changes, and the to rupture. The author could not find any evidence ally adhesions between the membranes and the J. P. GRVXNIIIIJ.
Wetterdal, Obst.
P. : et Gynec.
Some Notes on the Premature Scandinav.
Rupture
of the Membranes,
Acta
18: 45, 1938.
The author studied a series of 1,022 cases in which liquor amnii was expelled before the onset of labor pains. He found two classes of patients, In the first group labor was short and there were few complications, while in the second group deliver,v was delayed and there were numerous complications. The author believes that the responsible factor for the complications in the second group is not the premature rupture of the bag of waters but the ineffectual labor painn which occur in this series. A vaginal examination in 150 cases of premature rupture of the membranes revealed that in some of these cases a certain amount of labor had occurred without the patient’s knowledge. In a series of 312 cases of premature rupture of the membranes the author not only studied the mothers but also the children 363
364
AMERICAN
JOT’RNAL
OF
ORSTETRICS
AND
GYNECOLOGY
up to twelve years of age. In this series, t,here were 221 and 91 forceps operations. The author found that premature branes affects neither the maternal mortalit>nor the health offspring,
spontaneous deliveries rupture of the memand mentality of the J. Y. GREENHILL
Smythe and Thompson: Induction of Labor by Rupture or High Puncture Membranes, J. Obst. & Gynaec. Brit. Emp. 44: 480, 1937.
of the
The first is by simple rupture of Induction is performed in one of two ways: the membranes at the internal os, and is done with or without anesthesia. A volxellum is employed to tear the membranes, and liquor allowed to drain by slightly pushing up the fetal head. In this way the amount can be roughly controlled. The other method, viz., high puncture of the membranes, is performed as follows: One finger is inserted into the cervix and passed up until the head can be felt. The S-shaped cannula is then passed up the finger until it meets the head and then passed between the membranes and the uterine wall above the head when the membranes are punctured by pressing home the stylet. This can also be done with or without anesthesia, as indicated in each particular case. The special advantage of thiv method is that the chances of infection of the liquor are greatly diminished, which is of great importance should cesarean section become necessary in the course of a trial labor. labors all the eases In the Bristol General Hospital series of 210 consecutive of induction by artificial rupture of the membranes at the OS were successful and only one induction with the cannula failed, Stillbirth rate and the likeThe duration of labor is not appreciably lengthened. lihood of sepsis are not increased. In this series 91.4 per cent, of the cases had unassisted deliveries. J. P. GREENHILL
Thorns, Herbert: 2: 210,
The Obstetrical
Significance
of Pelvic
Variations,
Brit.
M.
J.
1937.
The report is given of an x-ray study of 150 primiparous white women delivered at term in the New Haven Hospital. The “grid method” of pelvimetry originally developed by Thorns was used. In addition, lateral aspects of pelvic roentgenometry were employed, as well as a newly modified technique for lateral viewing. The author classifies the pelvis into four types: 1. Dolichopellic or anthropoid type. The anteroposterior diameter is longer than the transverse. The anteroposterior diameter is equal to or 2. Mesatipellie or round type. slightly less than the transverse (never more than 1 cm.). 3. Brachypellic or oval type. The anteroposterior diameter is between 1 and 3 cm. shorter than the transverse. 4. Platypellic or flat type. The anteroposterior diameter is excessively shorter than the transverse, 3 cm. or more. On the basis of the length of the anteropost,erior diameter, the first three groups may be divided for clinical use into large, average, and small pelves which classification serves to depict the shape of the superior strait. The external measurements bear no relation to those of the superior strait by roentgenometry. The aut.hor finds that the The incidence of the various types is recorded. round type predominates. This study calls for a reconstruction of views regarding normal white female pelves, as evidenced by the presence of the oval or brachypellic type in only 35 The chief value of roentgenometry is in cases of suspected per cent of cases. disproportion. Here the lateral technique is of great importance. Routine use of x-ray in primiparous women is justified and serviceable. F. L. ADAIR
AND 8. A. PEARL
of Reviews CONDUCTED
BY HUGO
and A
EHRENFEST,
M.D.
Selected Abstracts Labor Freclrikson, H. : The Effect on Deliveries of spontaneous branes, Acta obst. et gynec. Scandinav. 17: 309, 1937.
Rupture
of the Mem-
The author studied 1,290 primiparas and 1,300 multiparas who had normal occipitoanterior presentations in which the babies weighed over 2,500 gm., to determine the effect of spontaneous rupture of the membranes on labor. As “premature rupture” he designates cases in which rupture occurred before or simultaneously with the onset of pains. The term “early rupture” is used to indicate rupture of the bag of waters after the onset of pains but before the cervix is dilated to the size of three fingers. The author found that rupture of the membranes occurred before the onset of pains in 12 per cent of primipnras and in 10.7 per cent of multiparas. Rupture of the bag of waters occurred simultaneously with the onset of pains in i.8 per cent of primiparas and in 5.7 per cent of multiparas. In both primiparas and multiparas the duration of labor was considerably shortened in cases of premature rupture of the membranes. In primiparas, labor was definitely prolonged in cases of early rupture. Genital infections during labor occurred twice as often in cases of premature and early rupture as in the cases of late rupture. The fetal mortality was not increased in cases of premature rupture, but it was higher in cases of early rupture. J. I’.
Apajalahti, A. : Is the Time of Rupture of the Membranes Histologic Structure of the Membranes? Acta obst. et
~P.EENIIII,I,
Dependent Gynrc.
Upon the
Scxndiaar.
18:
57, 1938. This investigation verifies labor bears a definite relation especially to the thickness of pecially the amnion, the more easier it is for the membranes that inflammation produced decidua.
the fact that rupture of bhe bag of waters during to the histologic structure of the fetal membranes the amnion. The thinner the membranes are, espronounced are the degenerative changes, and the to rupture. The author could not find any evidence ally adhesions between the membranes and the J. P. GRVXNIIIIJ.
Wetterdal, Obst.
P. : et Gynec.
Some Notes on the Premature Scandinav.
Rupture
of the Membranes,
Acta
18: 45, 1938.
The author studied a series of 1,022 cases in which liquor amnii was expelled before the onset of labor pains. He found two classes of patients, In the first group labor was short and there were few complications, while in the second group deliver,v was delayed and there were numerous complications. The author believes that the responsible factor for the complications in the second group is not the premature rupture of the bag of waters but the ineffectual labor painn which occur in this series. A vaginal examination in 150 cases of premature rupture of the membranes revealed that in some of these cases a certain amount of labor had occurred without the patient’s knowledge. In a series of 312 cases of premature rupture of the membranes the author not only studied the mothers but also the children 363
364
AMERICAN
JOT’RNAL
OF
ORSTETRICS
AND
GYNECOLOGY
up to twelve years of age. In this series, t,here were 221 and 91 forceps operations. The author found that premature branes affects neither the maternal mortalit>nor the health offspring,
spontaneous deliveries rupture of the memand mentality of the J. Y. GREENHILL
Smythe and Thompson: Induction of Labor by Rupture or High Puncture Membranes, J. Obst. & Gynaec. Brit. Emp. 44: 480, 1937.
of the
The first is by simple rupture of Induction is performed in one of two ways: the membranes at the internal os, and is done with or without anesthesia. A volxellum is employed to tear the membranes, and liquor allowed to drain by slightly pushing up the fetal head. In this way the amount can be roughly controlled. The other method, viz., high puncture of the membranes, is performed as follows: One finger is inserted into the cervix and passed up until the head can be felt. The S-shaped cannula is then passed up the finger until it meets the head and then passed between the membranes and the uterine wall above the head when the membranes are punctured by pressing home the stylet. This can also be done with or without anesthesia, as indicated in each particular case. The special advantage of thiv method is that the chances of infection of the liquor are greatly diminished, which is of great importance should cesarean section become necessary in the course of a trial labor. labors all the eases In the Bristol General Hospital series of 210 consecutive of induction by artificial rupture of the membranes at the OS were successful and only one induction with the cannula failed, Stillbirth rate and the likeThe duration of labor is not appreciably lengthened. lihood of sepsis are not increased. In this series 91.4 per cent, of the cases had unassisted deliveries. J. P. GREENHILL
Thorns, Herbert: 2: 210,
The Obstetrical
Significance
of Pelvic
Variations,
Brit.
M.
J.
1937.
The report is given of an x-ray study of 150 primiparous white women delivered at term in the New Haven Hospital. The “grid method” of pelvimetry originally developed by Thorns was used. In addition, lateral aspects of pelvic roentgenometry were employed, as well as a newly modified technique for lateral viewing. The author classifies the pelvis into four types: 1. Dolichopellic or anthropoid type. The anteroposterior diameter is longer than the transverse. The anteroposterior diameter is equal to or 2. Mesatipellie or round type. slightly less than the transverse (never more than 1 cm.). 3. Brachypellic or oval type. The anteroposterior diameter is between 1 and 3 cm. shorter than the transverse. 4. Platypellic or flat type. The anteroposterior diameter is excessively shorter than the transverse, 3 cm. or more. On the basis of the length of the anteropost,erior diameter, the first three groups may be divided for clinical use into large, average, and small pelves which classification serves to depict the shape of the superior strait. The external measurements bear no relation to those of the superior strait by roentgenometry. The aut.hor finds that the The incidence of the various types is recorded. round type predominates. This study calls for a reconstruction of views regarding normal white female pelves, as evidenced by the presence of the oval or brachypellic type in only 35 The chief value of roentgenometry is in cases of suspected per cent of cases. disproportion. Here the lateral technique is of great importance. Routine use of x-ray in primiparous women is justified and serviceable. F. L. ADAIR
AND 8. A. PEARL