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Percutaneous puncture for hydramnios during pregnancy
498
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOQY
DR. ALFRED C. BECK.-1 am interested in knowing entered the tube. Do you think that they entered from the did they cross in the abdomen from the opposite tube?
how side
the spermatozoa of the ectopic
or
DR. WILLIAM F. NELMS.-We have been using this method of sterilization at the Brooklyn Hospital for the last fifteen years. We have done 219 cases and have had no reported cases of pregnancy. Dr. Lull, of Philadelphia, tried it out on 223 eases and states he has had no failures reported from a 72 per cent follow-up. We hands to the and it
believe that one of the reasons why this method has been satisfactory in our is that we do not produce too much trauma. If too much trauma is produced tube either by crushing or the use of nonabsorbable sutures, necrosis results, is much more likely to break down and form a fistula.
There are one or two other points in the technic that we use which might be referred to. We do not make so large a loop that when it is ligated too much tension is exerted on the tube. With a large loop the ligature is liable to slip off or cut through the stump. The same thing applies when the loop is made too close to the uterus. Especially in conjunction with cesarean section where there is a large pregnant uterus, if the loop is made near the uterus, and not in the middle portion of the tube, the weight of the uterus moving from one side to another and in involuting, is likely to cause the ligature to cut through. We testinal opening of the or two
have had but one complication in our 219 obstruction that developed about three the abdomen in that case we found a loop tube, and on freeing the adhesions around drops of pus.
cases and that was a case of inweeks after the operation. On of bowel adherent to the cut ends it, there was an escape of one
DR. WILLIAM SIDNEY SMITH.-In answer to Dr. Welton, I would like to say that Dr. Pomeroy never used black silk as a ligature in his method of sterilizaHe avoided a nonabsorbable suture for the reason that it is liable to leave tion. a fistula. He always used either plain catgut or No. 1 chromic catgut. DR. LUTZ (closing).-Dr. Beck has asked how the spermatozoon reached the ovum to fertilize it. The right tube had a definite separation midway between its proximal and distal portions where part of it had been resected during attempted Pomeroy sterilization. The cut end of the fimbric segment of the tube was apparently closed by an adhesion. Therefore, I believe the spermatozoon must have traveled through the uterine portion of the severed right tube, reached the abdominal cavity and found its way to the ovum and fertilized it near or at the fimbric portion of the tube.
Mayer, A.: Percutaneous f. Geburtsh. u. Gyniik.
Puncture 104: 259,
for Hydramnios 1937.
During
Pregnancy,
Monatschr.
During the last 10 to 12 years, Mayer has punctured the amniotic sac through The indications were pressure symptoms the abdomen in 12 cases of hydramnios. including dyspnea. The technique is simple and the amount of fluid removed varied between 850 and 3,750 C.C. The immediate result was always good because To prevent labor pains morphine the pressure symptoms subsided immediately. and pantopon were given after the puncture. In five cases, however, labor followed in 1, 3, 6, 8, and 10 days respectively. There were no untoward effects encountered, although one patient fainted and vomited. No babies were injured. To avoid the placenta, punctures should not be employed in eases of placenta previa. J.
P.
GREENHILL.
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOQY
DR. ALFRED C. BECK.-1 am interested in knowing entered the tube. Do you think that they entered from the did they cross in the abdomen from the opposite tube?
how side
the spermatozoa of the ectopic
or
DR. WILLIAM F. NELMS.-We have been using this method of sterilization at the Brooklyn Hospital for the last fifteen years. We have done 219 cases and have had no reported cases of pregnancy. Dr. Lull, of Philadelphia, tried it out on 223 eases and states he has had no failures reported from a 72 per cent follow-up. We hands to the and it
believe that one of the reasons why this method has been satisfactory in our is that we do not produce too much trauma. If too much trauma is produced tube either by crushing or the use of nonabsorbable sutures, necrosis results, is much more likely to break down and form a fistula.
There are one or two other points in the technic that we use which might be referred to. We do not make so large a loop that when it is ligated too much tension is exerted on the tube. With a large loop the ligature is liable to slip off or cut through the stump. The same thing applies when the loop is made too close to the uterus. Especially in conjunction with cesarean section where there is a large pregnant uterus, if the loop is made near the uterus, and not in the middle portion of the tube, the weight of the uterus moving from one side to another and in involuting, is likely to cause the ligature to cut through. We testinal opening of the or two
have had but one complication in our 219 obstruction that developed about three the abdomen in that case we found a loop tube, and on freeing the adhesions around drops of pus.
cases and that was a case of inweeks after the operation. On of bowel adherent to the cut ends it, there was an escape of one
DR. WILLIAM SIDNEY SMITH.-In answer to Dr. Welton, I would like to say that Dr. Pomeroy never used black silk as a ligature in his method of sterilizaHe avoided a nonabsorbable suture for the reason that it is liable to leave tion. a fistula. He always used either plain catgut or No. 1 chromic catgut. DR. LUTZ (closing).-Dr. Beck has asked how the spermatozoon reached the ovum to fertilize it. The right tube had a definite separation midway between its proximal and distal portions where part of it had been resected during attempted Pomeroy sterilization. The cut end of the fimbric segment of the tube was apparently closed by an adhesion. Therefore, I believe the spermatozoon must have traveled through the uterine portion of the severed right tube, reached the abdominal cavity and found its way to the ovum and fertilized it near or at the fimbric portion of the tube.
Mayer, A.: Percutaneous f. Geburtsh. u. Gyniik.
Puncture 104: 259,
for Hydramnios 1937.
During
Pregnancy,
Monatschr.
During the last 10 to 12 years, Mayer has punctured the amniotic sac through The indications were pressure symptoms the abdomen in 12 cases of hydramnios. including dyspnea. The technique is simple and the amount of fluid removed varied between 850 and 3,750 C.C. The immediate result was always good because To prevent labor pains morphine the pressure symptoms subsided immediately. and pantopon were given after the puncture. In five cases, however, labor followed in 1, 3, 6, 8, and 10 days respectively. There were no untoward effects encountered, although one patient fainted and vomited. No babies were injured. To avoid the placenta, punctures should not be employed in eases of placenta previa. J.
P.
GREENHILL.