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Relation of the size of the eye to the age and length in human ontogenesis
126
Communications
in brief
Amer.
44-
L:
A
D.W., o
40-
nw,
l
J.B. E.G.
m *
36-
2 .
32-
g
28-
d 67
24
1
Relation of the size of the eye to the age and length in human ontogenesis JAROSLAVA Department School
20
1, 1971 Gynec.
ogy, Baltimore, 1967, The Williams & Wilkins Company, Vol. I, p. 88. 4. Klopper, A.: Obstet. Gynec. Surv. 23: 813, 1968. 5. Ranney, H. M.: New Eng. J. Med. 282: 144, 1970. 6. Scommegna, A., and Chattoraj, S. C.: AMER. J. OBSTET. GYNEC. 99: 1087, 1967.
48K.R.
May J. Obstet.
22
24
26
28
30
32
34
36
38
STAFLOVA, of Oghthalmology,
of Medicine,
Milwaukee,
M.D. Marquette Wisconsin
40
WEEK OF PREGNANCY
Fig. 1. Normal and abnormal estriol excretion. The normal range is indicated by the shaded area on the graph. per cent of anemia patients with a hemoglobin level below 10 Gm. per cent. The study of urinary estriol excretion in patients with sickle cell disease enables the clinician to probe the effect of an abnormal maternal hemoglobin upon fetal steroidogenesis and maternal estriol excretion. Hemoglobin S has the characteristic property of crystallizing or gelling under conditions of reduced oxygen tension.ll 5 The exact mechanism by which sickle cell disease can alter fetal steroidogenesis and bring about decreased urinary estriol is unknown. TO what extent the underlying anemia and the intrauterine growth retardation accounted for the decrease in maternal urinary estriol is also unknown. These few cases would suggest that monitoring maternal urinary estriol might enable the clinician to better evaluate fetal outcome in patients with sickle cell disease and possibly other hemoglobinopathies. REFERENCES
1. Beeson, P. B., and McDermott, W.: Textbook of Medicine, ed. 12, Philadelphia, 1968, W. B. Saunders Company, p. 1045. 2. Beischer, N. A., Townsend, L., Holsman, M., Brown, J. B., and Smith, M.: AMER. J. OBSTET. GYNEC. 102: 819, 1968. 3. Beling, C. G.: In Marcus, S., and Marcus, C., editors: Advances in Obstetrics and Gynecol-
T H E M A T T E R of embryonic size and age is of practical as well as theoretical importance. The age of an aborted embryo is first of all important in assessing the duration of pregnancy in reproductive failure and is always of significance to the attending physician. Knowledge of the precise embryonic size in correlation with the duration of pregnancy may also be the means of diagnosing intrauterine death of the fetus, or in certain medical-legal cases, an accurate assessment of age from the fetus may be a crucial point. As the number of induced abortions is constantly increasing, more obstetricians and gynecologists will find discrepancies between the apparent size of the embryo or fetus and the menstrual history or date of conception. Specimens obtained by curettage or suction during the first trimester of pregnancy are usually reduced to fetal and placental fragments that preclude their use for scientific study. Haase’s rule for ascertaining the approximate duration of gestation from the length of the fetus requires the intact embryo or fetus19 2 The present study was undertaken in an effort to determine the correlation of the development and size of the eye of the embryo and the fetus to the duration of pregnancy. This study included the eye measurements of 74 embryos, fetuses, immature newborn infants, This study wan supported in part by an institutional grant from the United States Public Health Services, and in part by a research grant from the National Society for the Prevention of Blindness, Inc., for 1970-1971.
V&me Sumher
110 1
Communications
in brief
Table I. Relation of the size of the eye to the age and length in human ontogenesis ...__ Approximate
Diameter of the eye (mm.)
1 1.5 2.0 3.0 4.0 5.0 6.0 6 11 16 17.7
-11 -14 -17 - 17.9
diameter of the head
Gestational
(mm.)
age
(mm.)
to 3 wks. 4 wks. 6 - 7 wks. 7 - 8 wks. a - 9 wks. 9- 10 wks. 11 - 14 wks. 14- 16 wks. 5th month 6th month 8th month 9th month
-
- 4.5 - 7.5 - 24 - 31 - 45 - 50 - 60 - 120 - 160 -200 -313
- -.- ~.._----
Approximate
crown-rump length 1 4.5 12 25 31 45 50 60 120 160 240 350 480
127
Macroscopic
findings No pigment Pigment Lid adhesions develop
36 6- 10 lo- 15 15- 19 20- 29 30- 50 50 - 70 no - 100 go-110 100 - 117.5
Lid adhesions begin to separate
-540
30 29 28 27 26 25 24 23 22
/
/ /
/ II. IO9.
8s ?6. 5. 4.
0 I 2 3 4 5 6 7 8 9 10 II 12 13 15
17
Fertilization
19
21
23
25
27
29
31
33
35 36
Age in Weeks
Fig. 1.
or stillbirths. One hundred and thirty-eight separate eyes were used for different procedures, measurements, and histologic and histochemical studies. The eyes were obtained after curettage, suction, hysterotomy, or spontaneous delivery.
Ten contralateral eyes were damaged during evacuation of the uterus. Completely fragmented specimens without intact eyes were excluded from the study and accounted for 20 per cent of the operations. The microscopic measurements
128
Communications
May 1, 1971 Amer. J. Obstet. Gynec.
in brief
of the globe, the head, and where possible, the whole body were performed. The specimens were further utilized for detailed histologic and histochemical studies.5 Measurement of the eye can be very precise using a needle compass. The most remote points at the outer rim of the pigment of the eye should be measured up to the fourth month of gestation; later, the largest diameter at the equator of the globe is required. Enucleation of the globe in older fetuses can be easily performed without mutilation of the lids. Age of gestation was estimated from the history of the last menstruation period and correlated to the histologic findings in the developmental eye according to Mann and Streeter.3j * The microscopic findings, including development of the lens, the ciliary body, ciliary processes and spaces, and the shape of the anterior chamber and pars plana were used in the study for the developmental classification of each specimen.5 Systemic comparison and measurements of specimens were classified (Table I). Our exand histochemical perience in the histologic study of 138 eyes demonstrates a constant relationship of the size of the eyes to the age of embryo and fetus. In comparison to other organs, the development of the eye is very stable and is subject to very few individual variations4 The eyes are also convenient for ascertaining fetal age, because they are intact in about 80 per cent of cases of spontaneous or induced abortion, due to the fact that the sclera serves as a protective barrier for the entire globe from early embryonic stages. From 4 to 6 weeks, the embryo grows approximately a millimeter per day in sitting height. For the remainder of the gestation, the daily increase in growth averages about 1.5 mm. with a maximum of about 2 mm. a day in the fourth month. As shown in Fig. 1, the eye is smaller than 1 mm. up to the fourth week of gestation, then grows approximately 1 mm. a week with the maximum in the fourth and fifth months. In the last trimester, the eye grows less than 1 mm. per month. Commonly employed fetal measurements require the crown-rump length or crown-heel length. In embryonic stages, measurements are unreliable because of the variable degree of flexure and distortion of the products of gestation. Streeter4 explains the differences in organogenesis in classical developmental horizons and shows clearly the variations in individual mea-
surements of the body in ontogenesis. The eye is an organ where precise measurements can be performed as the protective sclera keeps the eye in a very stable round shape from the early stages of development. The histologic changes of the eye will define the gestational age of specimen in hours or in days according to Streeter’s horizons, but this procedure is time-consuming and impractical for clinical application. This study provides the obstetrician and gynecologist, histologist, and embryologist with a practical and precise method of utilizing embryonic and fetal eye size in ascertaining gestational age. REFERENCES 1.
2.
3. 4.
5.
Eastman, N. J., and Hellman, L. M.: Obstetrics, ed. 13, New York, 1966, AppletonCentury-Crofts, Inc., p. 193. Hamilton, W. M., Boyd, J. D., and Mossman, H. W.: Human Embryology, Baltimore, 1962, The Williams & Wilkins Company, pp. 120121. Mann, I.: Development of the Human Eye, ed. 3, New York, 1964, Grune & Stratton, Inc. Streeter, G. L.: Developmental Horizons in Human Embryos, Contributions to Embryology, Washington, D. C., 1942, 1945, 1948, Carnegie Institute, ~01s. XXX, XxX1, XxX11. Staflova, J.: Exp. Eye Res. June, 1971.
Role of spontaneous in Rh immunization
abortion
JOHN T. QUEENAN, M.D. ENRIQUE C. GADOW, M.D. ANTONIO C. LOPES, M.D. Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, New York, New York
THE RI s K 0 F maternal Rh immunization by an unprotected term pregnancy and delivery has been shown in two large prospective studies** 2 to be between 14 and 17 per cent of the patients at risk. This risk is apparently further increased if the fetomaternal hemorrhage is greater than 0.25 ml. as determined by the Kleihauer-Betke technique.3 Fortunately, a Supported in part by the Greenwich Health Association. Reprint requests to: Dr. John T. Queenan, 1 Perry&e Road, Greenwich, Connecticut 06830.
Communications
in brief
Amer.
44-
L:
A
D.W., o
40-
nw,
l
J.B. E.G.
m *
36-
2 .
32-
g
28-
d 67
24
1
Relation of the size of the eye to the age and length in human ontogenesis JAROSLAVA Department School
20
1, 1971 Gynec.
ogy, Baltimore, 1967, The Williams & Wilkins Company, Vol. I, p. 88. 4. Klopper, A.: Obstet. Gynec. Surv. 23: 813, 1968. 5. Ranney, H. M.: New Eng. J. Med. 282: 144, 1970. 6. Scommegna, A., and Chattoraj, S. C.: AMER. J. OBSTET. GYNEC. 99: 1087, 1967.
48K.R.
May J. Obstet.
22
24
26
28
30
32
34
36
38
STAFLOVA, of Oghthalmology,
of Medicine,
Milwaukee,
M.D. Marquette Wisconsin
40
WEEK OF PREGNANCY
Fig. 1. Normal and abnormal estriol excretion. The normal range is indicated by the shaded area on the graph. per cent of anemia patients with a hemoglobin level below 10 Gm. per cent. The study of urinary estriol excretion in patients with sickle cell disease enables the clinician to probe the effect of an abnormal maternal hemoglobin upon fetal steroidogenesis and maternal estriol excretion. Hemoglobin S has the characteristic property of crystallizing or gelling under conditions of reduced oxygen tension.ll 5 The exact mechanism by which sickle cell disease can alter fetal steroidogenesis and bring about decreased urinary estriol is unknown. TO what extent the underlying anemia and the intrauterine growth retardation accounted for the decrease in maternal urinary estriol is also unknown. These few cases would suggest that monitoring maternal urinary estriol might enable the clinician to better evaluate fetal outcome in patients with sickle cell disease and possibly other hemoglobinopathies. REFERENCES
1. Beeson, P. B., and McDermott, W.: Textbook of Medicine, ed. 12, Philadelphia, 1968, W. B. Saunders Company, p. 1045. 2. Beischer, N. A., Townsend, L., Holsman, M., Brown, J. B., and Smith, M.: AMER. J. OBSTET. GYNEC. 102: 819, 1968. 3. Beling, C. G.: In Marcus, S., and Marcus, C., editors: Advances in Obstetrics and Gynecol-
T H E M A T T E R of embryonic size and age is of practical as well as theoretical importance. The age of an aborted embryo is first of all important in assessing the duration of pregnancy in reproductive failure and is always of significance to the attending physician. Knowledge of the precise embryonic size in correlation with the duration of pregnancy may also be the means of diagnosing intrauterine death of the fetus, or in certain medical-legal cases, an accurate assessment of age from the fetus may be a crucial point. As the number of induced abortions is constantly increasing, more obstetricians and gynecologists will find discrepancies between the apparent size of the embryo or fetus and the menstrual history or date of conception. Specimens obtained by curettage or suction during the first trimester of pregnancy are usually reduced to fetal and placental fragments that preclude their use for scientific study. Haase’s rule for ascertaining the approximate duration of gestation from the length of the fetus requires the intact embryo or fetus19 2 The present study was undertaken in an effort to determine the correlation of the development and size of the eye of the embryo and the fetus to the duration of pregnancy. This study included the eye measurements of 74 embryos, fetuses, immature newborn infants, This study wan supported in part by an institutional grant from the United States Public Health Services, and in part by a research grant from the National Society for the Prevention of Blindness, Inc., for 1970-1971.
V&me Sumher
110 1
Communications
in brief
Table I. Relation of the size of the eye to the age and length in human ontogenesis ...__ Approximate
Diameter of the eye (mm.)
1 1.5 2.0 3.0 4.0 5.0 6.0 6 11 16 17.7
-11 -14 -17 - 17.9
diameter of the head
Gestational
(mm.)
age
(mm.)
to 3 wks. 4 wks. 6 - 7 wks. 7 - 8 wks. a - 9 wks. 9- 10 wks. 11 - 14 wks. 14- 16 wks. 5th month 6th month 8th month 9th month
-
- 4.5 - 7.5 - 24 - 31 - 45 - 50 - 60 - 120 - 160 -200 -313
- -.- ~.._----
Approximate
crown-rump length 1 4.5 12 25 31 45 50 60 120 160 240 350 480
127
Macroscopic
findings No pigment Pigment Lid adhesions develop
36 6- 10 lo- 15 15- 19 20- 29 30- 50 50 - 70 no - 100 go-110 100 - 117.5
Lid adhesions begin to separate
-540
30 29 28 27 26 25 24 23 22
/
/ /
/ II. IO9.
8s ?6. 5. 4.
0 I 2 3 4 5 6 7 8 9 10 II 12 13 15
17
Fertilization
19
21
23
25
27
29
31
33
35 36
Age in Weeks
Fig. 1.
or stillbirths. One hundred and thirty-eight separate eyes were used for different procedures, measurements, and histologic and histochemical studies. The eyes were obtained after curettage, suction, hysterotomy, or spontaneous delivery.
Ten contralateral eyes were damaged during evacuation of the uterus. Completely fragmented specimens without intact eyes were excluded from the study and accounted for 20 per cent of the operations. The microscopic measurements
128
Communications
May 1, 1971 Amer. J. Obstet. Gynec.
in brief
of the globe, the head, and where possible, the whole body were performed. The specimens were further utilized for detailed histologic and histochemical studies.5 Measurement of the eye can be very precise using a needle compass. The most remote points at the outer rim of the pigment of the eye should be measured up to the fourth month of gestation; later, the largest diameter at the equator of the globe is required. Enucleation of the globe in older fetuses can be easily performed without mutilation of the lids. Age of gestation was estimated from the history of the last menstruation period and correlated to the histologic findings in the developmental eye according to Mann and Streeter.3j * The microscopic findings, including development of the lens, the ciliary body, ciliary processes and spaces, and the shape of the anterior chamber and pars plana were used in the study for the developmental classification of each specimen.5 Systemic comparison and measurements of specimens were classified (Table I). Our exand histochemical perience in the histologic study of 138 eyes demonstrates a constant relationship of the size of the eyes to the age of embryo and fetus. In comparison to other organs, the development of the eye is very stable and is subject to very few individual variations4 The eyes are also convenient for ascertaining fetal age, because they are intact in about 80 per cent of cases of spontaneous or induced abortion, due to the fact that the sclera serves as a protective barrier for the entire globe from early embryonic stages. From 4 to 6 weeks, the embryo grows approximately a millimeter per day in sitting height. For the remainder of the gestation, the daily increase in growth averages about 1.5 mm. with a maximum of about 2 mm. a day in the fourth month. As shown in Fig. 1, the eye is smaller than 1 mm. up to the fourth week of gestation, then grows approximately 1 mm. a week with the maximum in the fourth and fifth months. In the last trimester, the eye grows less than 1 mm. per month. Commonly employed fetal measurements require the crown-rump length or crown-heel length. In embryonic stages, measurements are unreliable because of the variable degree of flexure and distortion of the products of gestation. Streeter4 explains the differences in organogenesis in classical developmental horizons and shows clearly the variations in individual mea-
surements of the body in ontogenesis. The eye is an organ where precise measurements can be performed as the protective sclera keeps the eye in a very stable round shape from the early stages of development. The histologic changes of the eye will define the gestational age of specimen in hours or in days according to Streeter’s horizons, but this procedure is time-consuming and impractical for clinical application. This study provides the obstetrician and gynecologist, histologist, and embryologist with a practical and precise method of utilizing embryonic and fetal eye size in ascertaining gestational age. REFERENCES 1.
2.
3. 4.
5.
Eastman, N. J., and Hellman, L. M.: Obstetrics, ed. 13, New York, 1966, AppletonCentury-Crofts, Inc., p. 193. Hamilton, W. M., Boyd, J. D., and Mossman, H. W.: Human Embryology, Baltimore, 1962, The Williams & Wilkins Company, pp. 120121. Mann, I.: Development of the Human Eye, ed. 3, New York, 1964, Grune & Stratton, Inc. Streeter, G. L.: Developmental Horizons in Human Embryos, Contributions to Embryology, Washington, D. C., 1942, 1945, 1948, Carnegie Institute, ~01s. XXX, XxX1, XxX11. Staflova, J.: Exp. Eye Res. June, 1971.
Role of spontaneous in Rh immunization
abortion
JOHN T. QUEENAN, M.D. ENRIQUE C. GADOW, M.D. ANTONIO C. LOPES, M.D. Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, New York, New York
THE RI s K 0 F maternal Rh immunization by an unprotected term pregnancy and delivery has been shown in two large prospective studies** 2 to be between 14 and 17 per cent of the patients at risk. This risk is apparently further increased if the fetomaternal hemorrhage is greater than 0.25 ml. as determined by the Kleihauer-Betke technique.3 Fortunately, a Supported in part by the Greenwich Health Association. Reprint requests to: Dr. John T. Queenan, 1 Perry&e Road, Greenwich, Connecticut 06830.