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Vitamin B6 treatment of chemical diabetes
ing the two-year
period, and the Bayley developmental quotient at 24 months of age showed no significant differences in mean motor and mental quotients. The authors conclude that despite the results seen in other similar studies, a favorable outcome may be anticipated for a sizable portion of premature smallfor-gestational age infants, and they ascribe some of the basis for their good outcomes to early delivery and adequate nutritional intake during the first two postnatal months.
Vitamin Bb Treatment Chemical Diabetes
of
Gillmer M, Mazibuko D: Pyridoxine treatment of chemical diabetes in pregnancy. Am J Obstet Gynecol 133:5, 1979. In this very small study, thirteen women with chemical diabetes, diagnosed by oral glucose tolerance test, late in pregnancy were also found to excrete an excessive amount of urinary xanthurenic acid after a tryptophan load (indicative of a relative pyridoxine (vitamin B,) deficiency). These patients were admitted to the hospital and followed very closely during treatment with 100 mg pyridoxine daily. Although the relative pyridoxine deficiency was apparently corrected, the glucose tolerance was improved in only two patients. Glucose tolerance deteriorated in six patients and no significant changes were noted in the remaining five patients. The authors question the validity of this method of determining pyridoxine deficiency, and conclude that other measures might be more useful in finding the patients who will benefit from treatment with this vitamin. At present, however, they see no place for routine therapy with pyridoxine in chemical diabetes of pregnancy.
Longer Lasting Paracervical
Block
Strauss R, Dase D, Doering P: Prolonging paracervical block anesthesia: Addition of dextran to 2chloroprocaine. Am J Obstet Gynecol 133:8, 1979. In this study 40 women in active labor were given paracervtcal block anesthesia
44
in a similar manner and observed by either external or internal fetal monitoring techniques. Each patient was randomly given either 2-chloroprocaine in normal saline or 2-chloroprocaine in dextran, and the length of anesthesia noted. Dextran has been hypothesized to reduce the rate of systemic absorption of local anesthetics either by directly binding the anesthetic or by drawing interstitial fluid to the site of the injection. It is also hypothesized that this slowing of absorption should ameliorate the toxic effects sometimes seen in the fetus. In this study 36 of the 40 patients (90%) were judged to have adequate anesthesia after the injections. The mean duration of anesthesia in the 19 patients who received the chloroprocaine in saline was 55.4 minutes; for those who received chloroprocaine in dextran the mean duration was 72.7 minutes. One fetus in the saline group showed post-PCB bradycardia lasting 3 minutes. All infants had excellent Apgar scores at delivery.
Painless
Abruptio
Placentae
Notelovitz M, Bottoms S, Dase D, Leichter P: Painless abruptio placentae. Obstet Gynecol 53:2, 1979. Three cases of abruption of a posterior fundal placenta are described in this article. All three were characte.&ed by vaginal bleeding and backache. In each case the uterus was not tender and relaxed well between contractions. The article points out that the absence of increased uterine hypertonic@, tenderness, or persistent abdominal pain could lead to delays in recognition and treatment of this serious disorder. In these three cases 30 to 50% of the placentas had detached and two of the three showed the typical signs of a Couvelaire uterus. Despite prompt recognition in these three cases, two of the infants were quite depressed, with one and five minute Apgar scores of 3/8 and 2/4. The third infant had Apgar scores of 8/9. The authors point out that the differential diagnosis between abruptio placenta and placenta previa must be made rapidly, since agressive management is necessary for the former, and conservative management is indicated in the latter case.
Journal of Nurse-Midwifery
??
They suggest immediate ultrasound placental localization and presumption of placental abruption when it is found to be posteriorly located.
Spontaneous Abortion Amniocentesis
after
Park I, Heller R, Kaiser R, Jones H: Spontaneous abortion after midtrimester amniocentesis. Obstet Gynecol 53:2, 1979. Of 371 patients who had midtrimester amniocenteses done by experienced physicians eight subsequently aborted spontaneously (2.2%), and one had a stillbirth at 24 weeks gestation. In three of the nine patients who suffered fetal loss, infection seemed to have played a significant role. Fetal loss rates for amniocentesis patients have been variously reported at 3.5% and 4.7% in other studies and no direct causal relationships have been shown. In this article the authors conclude that the amniocentesis may well have contributed to the subsequent abortions, and that patients should be informed of the potential hazards during preliminary counseling sessions.
Migration of Placenta
Previa
g=-.
Rizos N, Doran T, Miskin M, Benzie R, Ford J: Natural histoy of placenta previa ascertained by diagnostic ultrasound. Am J Obstet Gynecol 133:3, 1979. Placental localization by diagnostic ultrasound was performed on 1098 patients desiring amniocentesis for genetic indications during a six-year period at two hospitals associated with the University of Toronto. Placenta previa was diagnosed in 58 patients (5.3%), all of whom were 16 to 18 weeks pregnant at the time. Forty-seven of these (90%) went on to delivery uncomplicated by placenta previa, and none of these patients showed the usual symptom of third trimester bleeding. Five patients (0.58%) were documented to have placenta previa at delivery, and four of these showed third trimester bleeding.
Vol. 24, No. 5, September/October
1979
period, and the Bayley developmental quotient at 24 months of age showed no significant differences in mean motor and mental quotients. The authors conclude that despite the results seen in other similar studies, a favorable outcome may be anticipated for a sizable portion of premature smallfor-gestational age infants, and they ascribe some of the basis for their good outcomes to early delivery and adequate nutritional intake during the first two postnatal months.
Vitamin Bb Treatment Chemical Diabetes
of
Gillmer M, Mazibuko D: Pyridoxine treatment of chemical diabetes in pregnancy. Am J Obstet Gynecol 133:5, 1979. In this very small study, thirteen women with chemical diabetes, diagnosed by oral glucose tolerance test, late in pregnancy were also found to excrete an excessive amount of urinary xanthurenic acid after a tryptophan load (indicative of a relative pyridoxine (vitamin B,) deficiency). These patients were admitted to the hospital and followed very closely during treatment with 100 mg pyridoxine daily. Although the relative pyridoxine deficiency was apparently corrected, the glucose tolerance was improved in only two patients. Glucose tolerance deteriorated in six patients and no significant changes were noted in the remaining five patients. The authors question the validity of this method of determining pyridoxine deficiency, and conclude that other measures might be more useful in finding the patients who will benefit from treatment with this vitamin. At present, however, they see no place for routine therapy with pyridoxine in chemical diabetes of pregnancy.
Longer Lasting Paracervical
Block
Strauss R, Dase D, Doering P: Prolonging paracervical block anesthesia: Addition of dextran to 2chloroprocaine. Am J Obstet Gynecol 133:8, 1979. In this study 40 women in active labor were given paracervtcal block anesthesia
44
in a similar manner and observed by either external or internal fetal monitoring techniques. Each patient was randomly given either 2-chloroprocaine in normal saline or 2-chloroprocaine in dextran, and the length of anesthesia noted. Dextran has been hypothesized to reduce the rate of systemic absorption of local anesthetics either by directly binding the anesthetic or by drawing interstitial fluid to the site of the injection. It is also hypothesized that this slowing of absorption should ameliorate the toxic effects sometimes seen in the fetus. In this study 36 of the 40 patients (90%) were judged to have adequate anesthesia after the injections. The mean duration of anesthesia in the 19 patients who received the chloroprocaine in saline was 55.4 minutes; for those who received chloroprocaine in dextran the mean duration was 72.7 minutes. One fetus in the saline group showed post-PCB bradycardia lasting 3 minutes. All infants had excellent Apgar scores at delivery.
Painless
Abruptio
Placentae
Notelovitz M, Bottoms S, Dase D, Leichter P: Painless abruptio placentae. Obstet Gynecol 53:2, 1979. Three cases of abruption of a posterior fundal placenta are described in this article. All three were characte.&ed by vaginal bleeding and backache. In each case the uterus was not tender and relaxed well between contractions. The article points out that the absence of increased uterine hypertonic@, tenderness, or persistent abdominal pain could lead to delays in recognition and treatment of this serious disorder. In these three cases 30 to 50% of the placentas had detached and two of the three showed the typical signs of a Couvelaire uterus. Despite prompt recognition in these three cases, two of the infants were quite depressed, with one and five minute Apgar scores of 3/8 and 2/4. The third infant had Apgar scores of 8/9. The authors point out that the differential diagnosis between abruptio placenta and placenta previa must be made rapidly, since agressive management is necessary for the former, and conservative management is indicated in the latter case.
Journal of Nurse-Midwifery
??
They suggest immediate ultrasound placental localization and presumption of placental abruption when it is found to be posteriorly located.
Spontaneous Abortion Amniocentesis
after
Park I, Heller R, Kaiser R, Jones H: Spontaneous abortion after midtrimester amniocentesis. Obstet Gynecol 53:2, 1979. Of 371 patients who had midtrimester amniocenteses done by experienced physicians eight subsequently aborted spontaneously (2.2%), and one had a stillbirth at 24 weeks gestation. In three of the nine patients who suffered fetal loss, infection seemed to have played a significant role. Fetal loss rates for amniocentesis patients have been variously reported at 3.5% and 4.7% in other studies and no direct causal relationships have been shown. In this article the authors conclude that the amniocentesis may well have contributed to the subsequent abortions, and that patients should be informed of the potential hazards during preliminary counseling sessions.
Migration of Placenta
Previa
g=-.
Rizos N, Doran T, Miskin M, Benzie R, Ford J: Natural histoy of placenta previa ascertained by diagnostic ultrasound. Am J Obstet Gynecol 133:3, 1979. Placental localization by diagnostic ultrasound was performed on 1098 patients desiring amniocentesis for genetic indications during a six-year period at two hospitals associated with the University of Toronto. Placenta previa was diagnosed in 58 patients (5.3%), all of whom were 16 to 18 weeks pregnant at the time. Forty-seven of these (90%) went on to delivery uncomplicated by placenta previa, and none of these patients showed the usual symptom of third trimester bleeding. Five patients (0.58%) were documented to have placenta previa at delivery, and four of these showed third trimester bleeding.
Vol. 24, No. 5, September/October
1979