Pregnancy and parturition in myomectomized women

ABSTRACTS

897

Gavioli presents two cases, one of each type. The cervical condition disappeared during the puerperium. J. P. GREENHILL Winzeler, H.: The Question of Oxytoxic Action in the Animal and Human Uteri: Basergin in the Placental Period, Monatschr. f. Geburtsh. u. Gynak. 113: 289, 1942. The author observed that the human uterus does not react to oxytoxics in the same manner as the uterus of small animals. Hence, clinical tests in women are essential. The author maintains that basergin is the best drug for the control of post-partum hemorrhage. J. P. GREENHILL Westerman: 1942.

Spontaneous Detachment of Cervix in Labor:

Brit. M. J. 4: 272,

The author reports the case of a primipara with a flat type of pelvis. She was due February 10, 1942. The membranes ruptured naturally at 10:15 P.M. on February 26, and labor began. Progress was slow. She was given morphine for. rest. Her pulse rate rose to 130. The blood pressure was 150/100. Head was visible at 5:30 P.M. on February 28, but recedM and reappeared ai: 6:30P.M. but there was no progress. She was anesthetized, .and on examination, a transverse rent was found in the anterior portion of the cervix. The head was rotated and forceps delivery accomplished by delivering the stillborn fetus through the rent on Februa~y 28 after. 7:30P.M. The cord was around the neck. A ring of cervix crowning the head was delivered with it. The author asks, "Had the nature of the condition been recognized earlier, would interference have been indicated or justi:fiablef" One hesitates to comment in print on a ease of this type. Fortunately the mother recovered minus the lower portion of the cervix uteri. FRED L. ADAIR Ollvalla., Jos6 Ramirez: Retroplacental Hematoma. of Pregnancy (Statistic Study, Municipal Maternity ''America Arias,'' Havana, 1933-1941), Rev. eubana de obst. y ginee. 4: 186, 1942. Jose Ramirez Olivalla states that this accident has occurred 62 times in 34,203 labors, or 0.18 per cent. The uncorrected maternal mortality due to the accident was 1.61 per cent. The best results were given by conservative treatment. The systematic use of abdominal surgical treatment is condemned as highly aggressive, and no case of retroplaeental hematoma has been treated by the abdominal route during the last three years. Post-partum hemorrhage in retroplacental hematoma has been frequently observed; but all cases were successfully treated by the usual measures. Of the nine eases treated by abdominal Rurgery, four had hysterectomies. The medical treatment of the accident has avoided a considerable number of abdominal interventions which would have added an operative wound to the lesion of the uterine tissues. The author regards retroplaeental hematoma as belonging to the gestoses, excluding those of mechanical origin which are exceptional. J. P. GREENHILL Monti, Ricardo Lopez: Pregnancy and Parturition in Myomectomized Women, An. Inst. de Mat. y Asist. Soc. 2: 85-104, 1940. Ricardo Lopez Monti reports 31 eases on whom myomectomies were performed during the first months of pregnancy. He draws the following conclusions: 1. Pregnancy and parturition in women operated on for uterine :fibroma progress as in nor-

898

AMERICAN ,JOt:RNAL Of<' OBS'rETRICS AND GYNECOU)GY

mal women. 2. Prophylaetic forcep:< at thP end of the HE>eond stage, although not necessary in most case8, should be used wht>u labor is lung, when the nt<>rine cavity was opened to remove the fibroma, or wlwn a number of fihroids werf' extirpated. ::. The puerperium pr·ogres~ed unewntfully. 4. '!'he operation doe,; not interfere with fetal development. 5. Reeurrence of myoma,; i>< extremp]_v ran· and does not in· validate the con~ervative tretttment. ll. The experieuo·e nl· the ohstetrk fut uri' myomect.omized women is O!IC' more argument on bPhalf of' •·oruervativt> ~urger;• of the uterus. .r. P. GR~;~;NmLr. Bravo, Rogelio Rodriguez: Experience With Zarate's Partial Subcutaneous Symphysiotomy, An. Inst. de Mat. y Asist. Soc. 2: 14J, 1\140. Rogelio Rodriguez Bravo review!' 63 cases observed betweE'n Hl2H and Hl::l9, an correctly used according to Zarate'~ technique when it i~ possible to rel,\· on good dynamics and amplitude of the soft parts to obtain spontaneouR parturition; in many •:a~e~ it gives the patient a dilatation that permanently solves O!ia . .T. P. GREENHILL Beruti, Josue A.: Chloral Hydrate in Labor, Arch. Clin. ohst. y ginec. Eliseo Canton 1: 58, 1942. Josue A. Beruti state~ that his experience of 10 years with thi8 drug shows that it fails in many cases; however, the failures must be largely attributed to incorrect indication and insufficient dosage. In correct dosage and provided that the enemas do not contain more than 3 Gm. of thP drug and arc not repeated too frequently, it has no disturbing effects on the evolution of labor, preHPnts no risks for mother or fetus and has no unfavorable action on placental delivery or post-partum. Often the association of chloral hydrate and ~pasmalgin has an excellent effect on dilatation of the cervix. ,J. P. GREENHJI,f,

Sala, Silvestre Luis: Value of Rectal Examination in Obstetrics, Arch. Clin. obst. y ginec. Eliseo Canton 1: 118, J!l42. From an exten~ve review of the literature and a statistic of 2,000 observations, Silvestre Luis Sala concludes that rectal examination during labor decreases puer· peral morbidity, but gives les;;; exact diagnostic information than vaginal examina· tion. This is due to the frequently unavoidable uiffic•.ulties peculiar to the method and depending on the height of the pre~entation. However, the> index of inacc>uracy in the diagno;;is of the uilatation and the height of the ptesentation are not consider" able, while vaginal examination made under aHeptie conditions is not as dangerous as has been claimed. Therefore, the author recommends that rectal examination be used only to verify the progress of labor and that vaginal exarnination be made in the beginnipg and be resorted to in ease of the sligMest douht, or if a more accurate diagnosis becomes necessary. .r. P. GREE!'<'HII,L