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Ultrasonic image of fetal intestine correlated with gestational age
Use of Hexachlorophene Strickland D, Leonard R, Stavchansky S, et al: Vaginal absorption of hexachlorophene during labor. Am J Obstet Gynecol 147:769, 1983. Because surgical soap containing hexachlorophene is used as an antiseptic lubricant for vaginal examination at some centers, these authors have tried to evaluate the theoretical risk of excessive absorption and possible fetal toxicity. Levels of hexachlorophene were measured in cord blood and postpartum maternal serum from 28 women whose vaginal examinations were lubricated with pHisoHex during labor. The serum of 12 women and 9 cord blood samples showed appreciable levels of hexachlorophene, and the higher amounts were correlated with women whose labors lasted longer than 4 hours. The authors feel that these findings warrant the discontinuation of the use of hexachlorophene as a lubricant for vaginal examination.
Treatment Premature
of Threatened Labor
Valenzuela G, Cline S, Hayashi R: Follow-up of hydration and sedation in the pretherapy of premature labor. Am J Obstet Gynecol 147:396, 1983. At these authors’ institution, a protocol utilizing hydration and sedation with morphine is applied to all patients presenting with possible premature labor (defined as regular, painful uterine contractions occurring at least 2 every 10 minutes for 30 minutes). This treatment is felt to screen out those truly in pre-
Journal of Nurse-Midwifery Copyright
0 1984 by the American
l
mature labor-those whose contractions continue despite treatment-and they are then treated with tocolytic drugs. In this report of 184 patients with threatened premature labor, 55% (101) responded to hydration and sedation and were discharged. Fifteen percent returned in advanced labor and delivered a preterm baby. Seventy percent continued their pregnancies to term. Eighty-three patients did not respond to the hydration and sedation and were treated with tocolytics. Of these, 37% (31) resulted in preterm deliveries. Because the majority of the hydrationand sedation-treated group delivered at term without another hospital encounter and were spared the possible toxic effects of tocolytic therapy, the authors suggest that this screening is warranted. Close follow-up of these patients and additional educational efforts as to the signs and symptoms of premature labor should of course be included in their management plan.
Office Sterilization Silicone Plugs
with
Houck R, Cooper J, Rigberg H: Hysteroscopic tubal occlusion with formed-in-place silicone plugs: a clinical review. Obstet Gynecol 62:587, 1983. This study is a detailed review of 415 patients who underwent sterilization under paracervical anesthesia with hysteroscopically placed silicone plugs. The authors compiled 3200 woman-months without a pregnancy among the 328 women with successfully completed procedures and acceptable follow-up x-rays. Difficulties occurred due to the silicone not flowing into and properly filling the
Vol. 29, No. 3. May/June
College of Nurse-Midwives
1984
tube, with inability to visualize the tubal openings, or failure to align the equipment properly. A high degree of technical skill is required of the physician for this procedure. Patient satisfaction is reported to be high, and there have been no pregnancies, either uterine or ectopic, in women with normal-appearing plugs at the threemonth postprocedure x-ray. In addition, no serious sequellae such as postoperative infections, dysmenorrhea, or menstrual irregularities have been noted. The authors comment that improved instrumentation is required before widespread use of this technique is possible, yet it shows great promise as an alternative to traditional sterilization procedures.
Ultrasonic Image of Fetal Intestine Correlated with Gestational Age Zilianti M, Femandez S: Correlation of ultrasonic images of fetal intestine with gestational age and fetal maturity. Obstet Gynecol 62:569, 1983. This report documents characteristic intestinal changes related to fetal maturity and describes their ultrasonic appearance. Eighty-one women with clinically normal pregnancies were scanned 276 times in order to develop a grading system for the intestinal changes noted by these authors. The stages of the intestine’s advancing maturity are shown to be sequential and related to the duration of pregnancy. The four stages here described are reported to be easily distinguished and reproducible with few interobserver differences. These changes appear to be related to an increase in the 219
meconium content of the intestine and to its gradual displacement to the colon by a progressively more efficient peristalsis, The process appears to accelerate close to term, for the stage of full intestinal maturity (stage 4) appeared in only 28% of casesat 36 to 37 weeks yet increased to 84% of cases by 38 to 39 weeks of gestation.
Trace Elements in Human Milk Cumming F, Fardy J, Briggs M: Trace elements in human milk. Obstet Gynecol 62:506, 1983. This report establishesbaseline values for nine trace elements in the plasma and milk of a group of 14 lactating Australian women, and reports some changes in their levels with the progression of lactation up to 23 weeks postpartum. The elements studied included: cesium, rubidium, manganese, chromium, zinc, cobalt, copper, iron, and selenium. Fasting plasma and foremilk samples were analyzed at 8, 16, and 23 weeks postpartum. There was a trend for the plasma:milk ratio to increase slightly over this time period. The plasma concentration remained constant and the milk concentrations generally declined. The authors suggest that the exclusively breastfed infant would receive a stable intake of all but zinc and iron because he or she would increase the volume of their intake over the same period. Zinc and iron intake would progressively decline.
Incidence of Breast Cancer Gambrel1 R, Maier R, Sanders B: Decreased incidence of breast cancer in postmenopausal estrogen-progestogen users. Obstet Gynecol62:435, 1983. Although long-term studies of large numbers of women have failed to incriminate exogenous estrogen therapy for any significantly increased risk of breast malignancy, these studies have not looked at the possible protective effect of added progestogens. This report attempts to do that. In a 7-year prospective study, 5563 postmenopausal women were studied for a total of 37,236 patient-years of observation. Fifty-three women were found to have breast cancer, for an incidence of 142.3: 100,000 women per year. The expected incidence according to two large 220
national cancer surveys is 188.3 to 229.2 per 100,000. Among the various hormonally treated and the untreated groups, the lowest incidence of breast cancer was found in women treated with both estrogen and progestogens (67.3:100,000). This was significantly lower than the incidence in the untreated group. With increasing progestogen usage from approximately 9.1% of the estrogen users in 1972 to 51.1% of the estrogen users in 1981, a significant decrease in the incidence of breast cancer occurred in the ninth and tenth years of the study (104.2:100,000 in 1980 and 110.4:100,000 in 1981). The authors conclude that, “apparently, it takes longterm progestogen use to reduce the risk of breast cancer in postmenopausal women.” The reduction in the risk of endometrial cancer from added progestogen was confirmed in the first few years of this study as well. The authors suggest that women who have had a hysterectomy receive added progestogens for 10 days a month. Because it is not clear whether progestogens alone have the same protective effects, consideration should be given to combination estrogen-progestogen therapy when postmenopausal hormone replacement therapy is indicated.
Effect of a Full Bladder on Labor Kerr-Wilson R, Parham G, On J: The effect of a full bladder on labor. Obstet Gynecol 62:319, 1983. In this study, the effect of a full bladder (more than 300 cc) was studied during normal established labor in 20 patients and 10 matched controls. Progress of labor was assessedby vaginal examinations before and after catheterization, and uterine activity was evaluated in Montevideo units calculated from an intrauterine pressure catheter. At catheterization, the mean urine volume of the primigravid subjects was 508.3 ml, and of the multiparas 445.4 ml. These volumes were four to five times greater than those of the controls. The mean intrauterine pressure increased significantly after catheterization from 102.2 to 147.7 in primigravidas, and from 123.2 to 145 in multiparas. Although there was a slight increase in pressure in the control group, it was not statistically significant. Journal
Friedman graphs of each subject’s labor progress showed no change in the slope of the curve after catheterization, and the progress of labor was similar for both subjects and controls. The authors conclude that “it is unnecessay to catheterize patients in the active phase in order to attempt to accelerate progress. This applies particularly to those patients who may have diminished sensation from epidural anesthesia, because catheterization does not appear to affect labor and only increases the risk of infection.”
Mode of Delivery for Low Birth Weight Infants Schwartz D, Miodovnik M, Lavin J: Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps. Obstet Gynecol62:283, 1983. This study was undertaken to evaluate the theory that elective low forceps delivey of the low birth weight infant is less traumatic and, therefore, superior to spontaneous delivery. During the study period 1978-1981, 1065 infants with birth weights between 1000-2500 g were delivered from vertex presentations without evidence of fetal distress. There were no significant differences in neonatal mortality and morbidity between the 394 delivered by low forceps and the 671 delivered spontaneously. This was true for the population as a whole and remained true for each weight categoy. The authors conclude that “it is unclear to what extent low forceps delivery can reduce the incidence of . . . intracranial hemorrhage . . In fact . . . forceps may lead to iatrogenic head injury in such infants.” An individualized approach to each patient, utilizing a large episiotomy in order to facilitate an atraumatic spontaneous delivey is suggested.
Ritodrine and Neonatal Icterus Huisjes H, Touwen B: Neonatal outcome after treatment with ritodrine: A controlled study. Am J Obstet Gynecol 147:250, 1983. In a previous screening, these authors found a highly significant excess of neonatal icterus among babies born at term after maternal treatment with ritodrine.
of Nurse-Midwifery
l
Vol. 29, No. 3, May/June
1984
Treatment Premature
of Threatened Labor
Valenzuela G, Cline S, Hayashi R: Follow-up of hydration and sedation in the pretherapy of premature labor. Am J Obstet Gynecol 147:396, 1983. At these authors’ institution, a protocol utilizing hydration and sedation with morphine is applied to all patients presenting with possible premature labor (defined as regular, painful uterine contractions occurring at least 2 every 10 minutes for 30 minutes). This treatment is felt to screen out those truly in pre-
Journal of Nurse-Midwifery Copyright
0 1984 by the American
l
mature labor-those whose contractions continue despite treatment-and they are then treated with tocolytic drugs. In this report of 184 patients with threatened premature labor, 55% (101) responded to hydration and sedation and were discharged. Fifteen percent returned in advanced labor and delivered a preterm baby. Seventy percent continued their pregnancies to term. Eighty-three patients did not respond to the hydration and sedation and were treated with tocolytics. Of these, 37% (31) resulted in preterm deliveries. Because the majority of the hydrationand sedation-treated group delivered at term without another hospital encounter and were spared the possible toxic effects of tocolytic therapy, the authors suggest that this screening is warranted. Close follow-up of these patients and additional educational efforts as to the signs and symptoms of premature labor should of course be included in their management plan.
Office Sterilization Silicone Plugs
with
Houck R, Cooper J, Rigberg H: Hysteroscopic tubal occlusion with formed-in-place silicone plugs: a clinical review. Obstet Gynecol 62:587, 1983. This study is a detailed review of 415 patients who underwent sterilization under paracervical anesthesia with hysteroscopically placed silicone plugs. The authors compiled 3200 woman-months without a pregnancy among the 328 women with successfully completed procedures and acceptable follow-up x-rays. Difficulties occurred due to the silicone not flowing into and properly filling the
Vol. 29, No. 3. May/June
College of Nurse-Midwives
1984
tube, with inability to visualize the tubal openings, or failure to align the equipment properly. A high degree of technical skill is required of the physician for this procedure. Patient satisfaction is reported to be high, and there have been no pregnancies, either uterine or ectopic, in women with normal-appearing plugs at the threemonth postprocedure x-ray. In addition, no serious sequellae such as postoperative infections, dysmenorrhea, or menstrual irregularities have been noted. The authors comment that improved instrumentation is required before widespread use of this technique is possible, yet it shows great promise as an alternative to traditional sterilization procedures.
Ultrasonic Image of Fetal Intestine Correlated with Gestational Age Zilianti M, Femandez S: Correlation of ultrasonic images of fetal intestine with gestational age and fetal maturity. Obstet Gynecol 62:569, 1983. This report documents characteristic intestinal changes related to fetal maturity and describes their ultrasonic appearance. Eighty-one women with clinically normal pregnancies were scanned 276 times in order to develop a grading system for the intestinal changes noted by these authors. The stages of the intestine’s advancing maturity are shown to be sequential and related to the duration of pregnancy. The four stages here described are reported to be easily distinguished and reproducible with few interobserver differences. These changes appear to be related to an increase in the 219
meconium content of the intestine and to its gradual displacement to the colon by a progressively more efficient peristalsis, The process appears to accelerate close to term, for the stage of full intestinal maturity (stage 4) appeared in only 28% of casesat 36 to 37 weeks yet increased to 84% of cases by 38 to 39 weeks of gestation.
Trace Elements in Human Milk Cumming F, Fardy J, Briggs M: Trace elements in human milk. Obstet Gynecol 62:506, 1983. This report establishesbaseline values for nine trace elements in the plasma and milk of a group of 14 lactating Australian women, and reports some changes in their levels with the progression of lactation up to 23 weeks postpartum. The elements studied included: cesium, rubidium, manganese, chromium, zinc, cobalt, copper, iron, and selenium. Fasting plasma and foremilk samples were analyzed at 8, 16, and 23 weeks postpartum. There was a trend for the plasma:milk ratio to increase slightly over this time period. The plasma concentration remained constant and the milk concentrations generally declined. The authors suggest that the exclusively breastfed infant would receive a stable intake of all but zinc and iron because he or she would increase the volume of their intake over the same period. Zinc and iron intake would progressively decline.
Incidence of Breast Cancer Gambrel1 R, Maier R, Sanders B: Decreased incidence of breast cancer in postmenopausal estrogen-progestogen users. Obstet Gynecol62:435, 1983. Although long-term studies of large numbers of women have failed to incriminate exogenous estrogen therapy for any significantly increased risk of breast malignancy, these studies have not looked at the possible protective effect of added progestogens. This report attempts to do that. In a 7-year prospective study, 5563 postmenopausal women were studied for a total of 37,236 patient-years of observation. Fifty-three women were found to have breast cancer, for an incidence of 142.3: 100,000 women per year. The expected incidence according to two large 220
national cancer surveys is 188.3 to 229.2 per 100,000. Among the various hormonally treated and the untreated groups, the lowest incidence of breast cancer was found in women treated with both estrogen and progestogens (67.3:100,000). This was significantly lower than the incidence in the untreated group. With increasing progestogen usage from approximately 9.1% of the estrogen users in 1972 to 51.1% of the estrogen users in 1981, a significant decrease in the incidence of breast cancer occurred in the ninth and tenth years of the study (104.2:100,000 in 1980 and 110.4:100,000 in 1981). The authors conclude that, “apparently, it takes longterm progestogen use to reduce the risk of breast cancer in postmenopausal women.” The reduction in the risk of endometrial cancer from added progestogen was confirmed in the first few years of this study as well. The authors suggest that women who have had a hysterectomy receive added progestogens for 10 days a month. Because it is not clear whether progestogens alone have the same protective effects, consideration should be given to combination estrogen-progestogen therapy when postmenopausal hormone replacement therapy is indicated.
Effect of a Full Bladder on Labor Kerr-Wilson R, Parham G, On J: The effect of a full bladder on labor. Obstet Gynecol 62:319, 1983. In this study, the effect of a full bladder (more than 300 cc) was studied during normal established labor in 20 patients and 10 matched controls. Progress of labor was assessedby vaginal examinations before and after catheterization, and uterine activity was evaluated in Montevideo units calculated from an intrauterine pressure catheter. At catheterization, the mean urine volume of the primigravid subjects was 508.3 ml, and of the multiparas 445.4 ml. These volumes were four to five times greater than those of the controls. The mean intrauterine pressure increased significantly after catheterization from 102.2 to 147.7 in primigravidas, and from 123.2 to 145 in multiparas. Although there was a slight increase in pressure in the control group, it was not statistically significant. Journal
Friedman graphs of each subject’s labor progress showed no change in the slope of the curve after catheterization, and the progress of labor was similar for both subjects and controls. The authors conclude that “it is unnecessay to catheterize patients in the active phase in order to attempt to accelerate progress. This applies particularly to those patients who may have diminished sensation from epidural anesthesia, because catheterization does not appear to affect labor and only increases the risk of infection.”
Mode of Delivery for Low Birth Weight Infants Schwartz D, Miodovnik M, Lavin J: Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps. Obstet Gynecol62:283, 1983. This study was undertaken to evaluate the theory that elective low forceps delivey of the low birth weight infant is less traumatic and, therefore, superior to spontaneous delivery. During the study period 1978-1981, 1065 infants with birth weights between 1000-2500 g were delivered from vertex presentations without evidence of fetal distress. There were no significant differences in neonatal mortality and morbidity between the 394 delivered by low forceps and the 671 delivered spontaneously. This was true for the population as a whole and remained true for each weight categoy. The authors conclude that “it is unclear to what extent low forceps delivery can reduce the incidence of . . . intracranial hemorrhage . . In fact . . . forceps may lead to iatrogenic head injury in such infants.” An individualized approach to each patient, utilizing a large episiotomy in order to facilitate an atraumatic spontaneous delivey is suggested.
Ritodrine and Neonatal Icterus Huisjes H, Touwen B: Neonatal outcome after treatment with ritodrine: A controlled study. Am J Obstet Gynecol 147:250, 1983. In a previous screening, these authors found a highly significant excess of neonatal icterus among babies born at term after maternal treatment with ritodrine.
of Nurse-Midwifery
l
Vol. 29, No. 3, May/June
1984