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The ectocervix during gestation
Volume Srlmber
64 2
SELECTED
2.5 per Type IV, maternal morbidity.
ABSTRACTS
cent. The maternal death The total fetal mortality
463
rate was 2.:; per of this subgroup
cent was
with a 34.6 84 per cent
per cc~l of whic~h
79 per
cent was immediate. Thirty per cent of these infants weighed less than 1,800 grams. There were 14 cases treated by classical section and 14 additional cases in which tllc low cervical section was used. The clinical types treated by classical section were Type I, 23 per c8ent; Type II, 15 per cent; Type III, 38.4 per cent ; and Type IV, 23 per cent. Maternal mortality and morbidity from classical section were 14.2 per cent and 33.3 per cent, respelltively. The over-all fetal mortality by classical section was 7.1 per cent and all infartl deaths were immediate. The distribution of clinical types in 14 cases treated by low cervical sections was: Type I, 14.2 per cent; Type III, 21.4 per cent; and Type IV, 64 per et‘nt. Xaternal mortality and morbidity were 14.2 per cent and 15.3 per cent, respectively, while the infant total mortality was 25.4 per cent, half of which was immediate and half neonatal. Braxton Hicks version and extraction was employed in 17 women with a maternal mortality of 29 per cent and morbidity of 33.3 per cent. All infants delivered by Braxton Hicks met,hod were dead on birth or died soon afterward. In the remaining 32 eases the p1acent.a previa was treatell by bags, embryotonly, tl~stcreetomy, or combinations of these with Simpson forcells delivery. The over-all maternal mortality was 5.9 per cent and the morbidity of the 236 ~nofhr~was 2‘7.0 per cent. The over-all fetal mortality was 5X.4 per cent, of which all bllt 4.6 1le’ czent was immediate. The author observed that the mortality rate of IYll mothers whose systolic h1~1~~*i pressure exceeded 100 mm. Hg was 1.6 per oent; 12.2 per cent of the 41 patients havin: systolic, blood pressures between 100 and 70 mm. Hg; and 40 per cent maternal mortality 1!1 the 15 mothers whose systolic blood pressure was under 70 mm. Hg. The author documents each of ‘2% of the total 243 cases with a concise history. TII*~ hihliograplly is excellent. It is well to recall that in this (“lini8, 1 of every 4 casPs attrntlf~~i rxhibiteG1 definite placenta previa. Cr,arc E. P’or,so>~ /i.
Pregnancy,
Physiology
A., Bromberg, P. M., and Brann, K.: Riboflavin Excretion and Early Lactation, J. I,ab. & C’lin. Med. 39: 54, 195%
Brzezinski,
During
Pregnancy
This interesting study on riboflavin excretion is reported from Jerusalem, Israel. wherry pregnant patients and nonpregnant controls were studied under conditions of dietary restrition and compared with similar groups on an adequat,e diet. These workers noted a distinctly lower riboflavin excretion in pregnant over nonprrcIt was clear that clinical manifestat,ionR nant individuals with a decrease in the last trimester. of riboflavin deficiency occurred frequently in pregnant women lvith low intake? which dill not appear in nonpregnant patients on the same diet. 7’11~ results a’s0 indicate thai tilt> riboflavin requirement is increased during lactation, t)nt is not ps high as that, during pregnancy. 8. R. C:r~sHnli~~.
Nolan, James J., and Pollak, & Obst.
93:
609,
Otakar
J.:
The Ectocervix
During
Gestation,
Hurg., (;yut~.
1951.
Seventy-five patients at various stages of pregnancy were studied with regard to thr morphological appearance of the cervix by means of punch biopsy. No instance of intraepithelial carcinoma or alterations suggesting neoplasm were observed. Two major change? were present in the glands during gestation: one, a papillary intra-acinar hyperplasia characterized by long thin projections of the mucosa, and, two, a multiplicity of nuclear layers, No changes were observed which rowhich can appear in an isolated patch of the mucosa. sembled adenocarcinoma. Hypertrophy of the eetocervical lining was ascribed to mid-zone changes rather than basal-layer activity. Other changes in the squamous lining were, one, irregularity of banal
464 nuclei; two, disturbed polarity of basal cells: threr, varirltir,lr nuclei; four, an increased number of nuclei; fi~rt:, mitotic epithelium; and seven, thickening of the basal-till laycdr.
in
fhc shape of the cclll:: ;tti~l
artiyity:
six,
budding
L. M.
Nesbitt, Robert E. L., Jr., and Hellman, Louis M.: The Histopathology the Cervix in Pregnancy, Surg., Gpnec. g: Obst. 94: 10, 1951.
of HEIJAI
and Cytology
t11(~ IX.
of
This is a study of cervical biopsies and smears from 300 pregnant women. The safe@ of cervical biopsy during pregnancy is attested by the figures given. The authors noted basal-cell hyperactivity in 6.8 per cent, gland hyperplasia in 28.7 per cent, gland epithelial hyperplasia in 47.4 per cent, adcnomatous hyperplasia of the glands in 44.1 per cent, epidermization in 62.7 per cent, basal-cell hyperactivity in epidermization in 10.7 per cent, and intraepithelial carcinoma in 0.66 per cent. Upon study of the smears normal parahasal cells were seen in 92.2 per cent and abnormal parabasal cells in 20.5 per cent of the cases. Therr l\-as a definite correlation between the occurrence of parabasal cells in the smear and hasnlcell hyperactivity of the biopsy. These changes regress within 7 to 12 weeks post partmtr. Caution should be exercised in t.he assessment and treatment of cases diagnosed as intrn~ cpithelial carcinoma during pregnamap. I,. M. ~JELIA~.\s. Braitenberg, H. : Nonpregnant
Effect of Histamine on the Circulatory System During States, Wien. klin. Wchnsc:hr. 63: 943, 1951.
Pregnant
and
Histamine and histamine-related compounds were studied in pregnant and nonpregnant women. When a woman becomes pregnant, the histamine substance in the blood rises rapidly, and reaches its maximal 1cTel at the seventh month. From this time, the level rapidly decreases, so that by the ninth postpartum day it is at the normal nonpregnant level. The rise in early pregnancy is so marked that it is felt that the quantitative determination is as accurate, or more accurate, than the Aschheim-Zondek test for t,he diagnosis of early pregnancy. Ten normal and ten pregnant women were studied. The authors found that in the nonpregnant states, injection of Imido (Roche) given in 1 C.C. doses subcutaneously resulted in a fall in blood pressure of approximately 7 per cent in the lying position and 10 per cent in the standing position. This drop reached its maximum in 70 to SO minutes. On the other hand, during pregnancy the effect had already reached its maximal and had completely disappeared after 30 to 40 minutes. ‘\Vhere a low blood pressure already exists, probably due to increased amounts of histamine, the injection of further histamine may producse collapse in a normal woman. This effect is not noted in pregnant women with hypotension. The interpretation of this difference is thought to be due to the changes in histamine and histaminase compounds in the b!ood. L. B. WINKELSTEIK.
Puerperium Lorenz, Siefried: The Dangers of Partial Placental Retention of Treatment, Zentralbl. f. GynHk. 73: 1337, 1951.
After Delivery
and Methods
In normal delivery the placenta is usually delivered spontaneously or is removed by the Crede maneuver. There is no danger in leaving the placenta in the uterus for a short time following delivery providing no bleeding is present, but it should be removed manually after a reasonable length of time has passed. It often occurs that with too forceful attempts at removing the placenta portions are left in the uterine cavity (3 times more frequent). Other conditions such as changes in the uterine lining, fibroids, eornual implantation, placenta previa, hydramnios, and partial accreta result in nondetachment of portions of placental tissue. Infections such as syphilis, gonorrhea, endometritis, and changes such as decreased hormone function may have something to do with the retention of all or a portion of the afterbirth. Therefore, in all cases, after the third stage of delivery is completed, the placenta should be thoroughly inspected for absent portions. This is especially true when any of the
64 2
SELECTED
2.5 per Type IV, maternal morbidity.
ABSTRACTS
cent. The maternal death The total fetal mortality
463
rate was 2.:; per of this subgroup
cent was
with a 34.6 84 per cent
per cc~l of whic~h
79 per
cent was immediate. Thirty per cent of these infants weighed less than 1,800 grams. There were 14 cases treated by classical section and 14 additional cases in which tllc low cervical section was used. The clinical types treated by classical section were Type I, 23 per c8ent; Type II, 15 per cent; Type III, 38.4 per cent ; and Type IV, 23 per cent. Maternal mortality and morbidity from classical section were 14.2 per cent and 33.3 per cent, respelltively. The over-all fetal mortality by classical section was 7.1 per cent and all infartl deaths were immediate. The distribution of clinical types in 14 cases treated by low cervical sections was: Type I, 14.2 per cent; Type III, 21.4 per cent; and Type IV, 64 per et‘nt. Xaternal mortality and morbidity were 14.2 per cent and 15.3 per cent, respectively, while the infant total mortality was 25.4 per cent, half of which was immediate and half neonatal. Braxton Hicks version and extraction was employed in 17 women with a maternal mortality of 29 per cent and morbidity of 33.3 per cent. All infants delivered by Braxton Hicks met,hod were dead on birth or died soon afterward. In the remaining 32 eases the p1acent.a previa was treatell by bags, embryotonly, tl~stcreetomy, or combinations of these with Simpson forcells delivery. The over-all maternal mortality was 5.9 per cent and the morbidity of the 236 ~nofhr~was 2‘7.0 per cent. The over-all fetal mortality was 5X.4 per cent, of which all bllt 4.6 1le’ czent was immediate. The author observed that the mortality rate of IYll mothers whose systolic h1~1~~*i pressure exceeded 100 mm. Hg was 1.6 per oent; 12.2 per cent of the 41 patients havin: systolic, blood pressures between 100 and 70 mm. Hg; and 40 per cent maternal mortality 1!1 the 15 mothers whose systolic blood pressure was under 70 mm. Hg. The author documents each of ‘2% of the total 243 cases with a concise history. TII*~ hihliograplly is excellent. It is well to recall that in this (“lini8, 1 of every 4 casPs attrntlf~~i rxhibiteG1 definite placenta previa. Cr,arc E. P’or,so>~ /i.
Pregnancy,
Physiology
A., Bromberg, P. M., and Brann, K.: Riboflavin Excretion and Early Lactation, J. I,ab. & C’lin. Med. 39: 54, 195%
Brzezinski,
During
Pregnancy
This interesting study on riboflavin excretion is reported from Jerusalem, Israel. wherry pregnant patients and nonpregnant controls were studied under conditions of dietary restrition and compared with similar groups on an adequat,e diet. These workers noted a distinctly lower riboflavin excretion in pregnant over nonprrcIt was clear that clinical manifestat,ionR nant individuals with a decrease in the last trimester. of riboflavin deficiency occurred frequently in pregnant women lvith low intake? which dill not appear in nonpregnant patients on the same diet. 7’11~ results a’s0 indicate thai tilt> riboflavin requirement is increased during lactation, t)nt is not ps high as that, during pregnancy. 8. R. C:r~sHnli~~.
Nolan, James J., and Pollak, & Obst.
93:
609,
Otakar
J.:
The Ectocervix
During
Gestation,
Hurg., (;yut~.
1951.
Seventy-five patients at various stages of pregnancy were studied with regard to thr morphological appearance of the cervix by means of punch biopsy. No instance of intraepithelial carcinoma or alterations suggesting neoplasm were observed. Two major change? were present in the glands during gestation: one, a papillary intra-acinar hyperplasia characterized by long thin projections of the mucosa, and, two, a multiplicity of nuclear layers, No changes were observed which rowhich can appear in an isolated patch of the mucosa. sembled adenocarcinoma. Hypertrophy of the eetocervical lining was ascribed to mid-zone changes rather than basal-layer activity. Other changes in the squamous lining were, one, irregularity of banal
464 nuclei; two, disturbed polarity of basal cells: threr, varirltir,lr nuclei; four, an increased number of nuclei; fi~rt:, mitotic epithelium; and seven, thickening of the basal-till laycdr.
in
fhc shape of the cclll:: ;tti~l
artiyity:
six,
budding
L. M.
Nesbitt, Robert E. L., Jr., and Hellman, Louis M.: The Histopathology the Cervix in Pregnancy, Surg., Gpnec. g: Obst. 94: 10, 1951.
of HEIJAI
and Cytology
t11(~ IX.
of
This is a study of cervical biopsies and smears from 300 pregnant women. The safe@ of cervical biopsy during pregnancy is attested by the figures given. The authors noted basal-cell hyperactivity in 6.8 per cent, gland hyperplasia in 28.7 per cent, gland epithelial hyperplasia in 47.4 per cent, adcnomatous hyperplasia of the glands in 44.1 per cent, epidermization in 62.7 per cent, basal-cell hyperactivity in epidermization in 10.7 per cent, and intraepithelial carcinoma in 0.66 per cent. Upon study of the smears normal parahasal cells were seen in 92.2 per cent and abnormal parabasal cells in 20.5 per cent of the cases. Therr l\-as a definite correlation between the occurrence of parabasal cells in the smear and hasnlcell hyperactivity of the biopsy. These changes regress within 7 to 12 weeks post partmtr. Caution should be exercised in t.he assessment and treatment of cases diagnosed as intrn~ cpithelial carcinoma during pregnamap. I,. M. ~JELIA~.\s. Braitenberg, H. : Nonpregnant
Effect of Histamine on the Circulatory System During States, Wien. klin. Wchnsc:hr. 63: 943, 1951.
Pregnant
and
Histamine and histamine-related compounds were studied in pregnant and nonpregnant women. When a woman becomes pregnant, the histamine substance in the blood rises rapidly, and reaches its maximal 1cTel at the seventh month. From this time, the level rapidly decreases, so that by the ninth postpartum day it is at the normal nonpregnant level. The rise in early pregnancy is so marked that it is felt that the quantitative determination is as accurate, or more accurate, than the Aschheim-Zondek test for t,he diagnosis of early pregnancy. Ten normal and ten pregnant women were studied. The authors found that in the nonpregnant states, injection of Imido (Roche) given in 1 C.C. doses subcutaneously resulted in a fall in blood pressure of approximately 7 per cent in the lying position and 10 per cent in the standing position. This drop reached its maximum in 70 to SO minutes. On the other hand, during pregnancy the effect had already reached its maximal and had completely disappeared after 30 to 40 minutes. ‘\Vhere a low blood pressure already exists, probably due to increased amounts of histamine, the injection of further histamine may producse collapse in a normal woman. This effect is not noted in pregnant women with hypotension. The interpretation of this difference is thought to be due to the changes in histamine and histaminase compounds in the b!ood. L. B. WINKELSTEIK.
Puerperium Lorenz, Siefried: The Dangers of Partial Placental Retention of Treatment, Zentralbl. f. GynHk. 73: 1337, 1951.
After Delivery
and Methods
In normal delivery the placenta is usually delivered spontaneously or is removed by the Crede maneuver. There is no danger in leaving the placenta in the uterus for a short time following delivery providing no bleeding is present, but it should be removed manually after a reasonable length of time has passed. It often occurs that with too forceful attempts at removing the placenta portions are left in the uterine cavity (3 times more frequent). Other conditions such as changes in the uterine lining, fibroids, eornual implantation, placenta previa, hydramnios, and partial accreta result in nondetachment of portions of placental tissue. Infections such as syphilis, gonorrhea, endometritis, and changes such as decreased hormone function may have something to do with the retention of all or a portion of the afterbirth. Therefore, in all cases, after the third stage of delivery is completed, the placenta should be thoroughly inspected for absent portions. This is especially true when any of the