MODERN TREATMENT OF PLACENTA PREVIA—A Study of 234 Cases

Study was made of 234 cases of placenta previa occurring in 48,752 deliveries at one hospital during the period 1947-1956. There was no maternal mortality. The uncorrected fetal mortality rate for all weight groups was 21.4 per cent. The rate varied from 88 per cent in babies under 1,500 grams to 5.7 per cent in babies over 2,500 grams. Initial conservative management to permit gestation to continue as close to term as possible is advisable.Ultimate termination of the pregnancy by cesarean section under spinal anesthesia gave the best results. The incidence of transverse and breech presentations in association with placenta previa was inordinately high. A progressive trend toward more conservative treatment of placenta previa was noted in the present series, with a concomitant reduction in fetal mortality rate.     

Human fetal growth in Costa Rica, 1970-1975

Costa Rica has experienced a marked reduction in infant mortality--both in the neonatal and post-neonatal components--in the last decade. The decline could be related to improvements in the pattern of fetal growth. The present report analyses the birth weight of newborns from a random sample of all births in the Republic of Costa Rica during 1970 and 1975. While the average birth weight in that period was 3100 grams, the prevalence of low birth weight neonates decreased from 9 to 7 per cent in five years. The provinces of Limon and San Jose exhibited the highest frequency of low birth weight. Women 20 to 29 years old had babies with better or optimal body weight. Age, marital status and occupation of the mother appeared correlated with birth weight. A relationship between changes in fetal growth and changes in maternal, perinatal and neonatal mortality is apparent. The present situation of birth weight places Costa Rica among the countries in transition with a clearer perspective to attain an even higher infant survival in the near future. In this regard, several measures oriented toward prevention of low birth weight are recommended.     

CONSERVATIVE MANAGEMENT OF THIRD TRIMESTER BLEEDING

In a series of 99 patients with bleeding in the third trimester of pregnancy the absence of any maternal mortality and a gross fetal mortality of 8.9 per cent speak well for the conservative observation policy by which these patients were managed.Although cost of hospitalization is a drawback to the employment of this approach, it is more than compensated for by reduced operative interference and increased safety for mother and child.     

CESAREAN SECTION EXPERIENCE AT THE UNIVERSITY OF CALIFORNIA HOSPITAL

A review of the 746 cesarean sections performed at the University of California Hospital from 1907 through 1948 shows an overall cesarean section incidence of 3.91 per cent. The maternal mortality rate associated with these cesarean sections has been 1.61 per cent. There has been a steady decline in mortality over the 40-year period and there have been no deaths from cesarean section in the last ten years. The over-all incidence of morbidity associated with cesarean section has been 40.5 per cent and again there has been a significant improvement in recent years. The fetal mortality associated with cesarean section has been 6.1 per cent. In view of recent experience, standards based on figures collected 20 years ago are no longer tenable.     

PERFORATED PEPTIC ULCER—Selective Gastric Resection in Emergency Treatment

In a series of 240 cases of perforated peptic ulcer prior to 1952 there was a total mortality of 17 per cent. This included cases treated conservatively as a planned procedure or because of other morbid conditions and undiagnosed cases, all ending in death.In cases treated by simple suture, mortality was 2.6 per cent for patients under 50 years of age and 17 per cent for those over 50, the rate rising very steeply with each decade over 50.From 1953 through 1959 selective gastric resection was carried out, the operation being done in all cases of perforated gastric ulcers, of chronic duodenal ulcers and of perforations associated with hemorrhage.During this period 303 perforated ulcers were treated, with a mortality of 15.5 per cent. Patients with associated morbid conditions and those admitted moribund and died, or died undiagnosed were again included.In this series also the mortality increased steeply from age 50 onward.Gastric resection was carried out in 148 cases of perforated peptic ulcer with a mortality of 6 per cent. In 105 cases under 60 years of age there were no deaths but in those over 60 the mortality rate was 21.8 per cent. Results in the patients who had resection, as determined after three years of observation, compared favorably with the results in patients who were treated by suture.The mortality of perforated ulcers in females was higher than in males.Emergency gastric resection has a definite place in the treatment of perforated peptic ulcer.     

子宫动脉栓塞术在穿透性凶险性前置胎盘中的临床应用研究

目的:探讨子宫动脉栓塞术在穿透性凶险性前置胎盘中的临床应用效果。方法:选取2010年1月~2014年12月唐山市妇幼保健院收治的孕晩期穿透性凶险性前置胎盘患者36例,依据是否行子宫动脉栓塞术分为子宫动脉栓塞组20例和非子宫动脉栓塞组16例,比较两组患者的术中情况和临床结局。结果:子宫动脉栓塞组患者失血量、红细胞输血量、冷沉淀输血量均少于非子宫动脉栓塞组(P0.05)。两组患者血浆输血量和术后住院时间比较差异无统计学意义(P0.05)。子宫动脉栓塞组ICU入住率、子宫切除率、产后出血、DIC发生率均低于非子宫动脉栓塞组(P0.05)。两组患者的产褥感染率、失血性休克发生率、早产儿发生率以及新生儿轻度窒息率比较差异均无统计学意义(P0.05)。结论:子宫动脉栓塞术可以减少术中出血及术后并发症的发生率,改善穿透性凶险性前置胎盘的临床结局。     

A multiple pregnancy register in the north of England.

A regional population-based Multiple Pregnancy Register was established in 1998, with the aim of collecting detailed information on multiple pregnancies to enable research into mortality and morbidity in multiples. Multiple pregnancies are notified to the Register as soon as they are detected, irrespective of whether they resulted in a spontaneous abortion, termination of pregnancy or registered birth. Nine hundred and twenty-six twin pregnancies were recorded during 1998-99, giving a twinning rate of 14.8 per 1000 maternities (rate at birth 13.0 per 1000 maternities). Sixty one per cent of twin pregnancies were detected before 13 weeks of gestation. Chorionicity was determined in 82.6% of 849 twin maternities with at least one stillbirth or livebirth. The fetal loss rate before 24 weeks of gestation was 10.5% (194/1852). The perinatal and infant mortality rates were 40.6 per 1000 births and 32.6 per 1000 livebirths respectively. A prospective Multiple Pregnancy Register not only allows monitoring of trends in multiple birth rates and mortality, but also etiological research and long-term follow-up studies.     

Vertical transmission of hepatitis B in north India.

A total of 2337 mother-baby paired sera were screened for the presence of hepatitis B surface antigen. Fifty eight mothers (2.48 per cent) were positive for HBsAg. Six babies (10.3 per cent) were positive for HBsAg at birth. The risk of the babies acquiring the infection during the first year of life varied with the serological status of the mothers. In HBeAg positive mothers the babies were at the greatest risk, with 11/15 (73.3 per cent) babies acquiring the infection by twelve months. If the mothers were only HBsAg positive the risk was lower (17.3 per cent), and if the mother was anti-HBe positive also then the baby had the least chance of becoming infected (9 per cent).     

Hemorrhage of late pregnancy

Rupture of the uterus, cesarean section and uterine atony were the major causes of maternal death associated with hemorrhage of late pregnancy for the five years 1945 to 1949 in New York County. Shock occurred earliest in rupture of the uterus and cesarean section, while in uterine atony there was some delay before shock was evident. Placenta previa was preceded by an initial small hemorrhage, and the time interval before shock was relatively long. It appeared that in cases of retained placenta, manual removal of the organ and hysterectomy were unduly delayed. Ten per cent of the maternal deaths reviewed were associated with severe transfusion reactions. Early recognition of a serious situation, rapid blood replacement and hysterectomy might have salvaged most of the patients.     

Malaria Transmission and Fetal Growth

In view of the known relation between infection of the maternal circulation of the placenta with Plasmodium falciparum and impaired fetal growth a study was made of the effect on birth weights of a malaria eradication campaign in the British Solomon Islands. Mean birth weights rose substantially within months of starting antimalarial operations. The increases between 1969 and 1971 averaged 252 g in babies of primigravidae and 165 g in all babies. The proportion of babies with birth weights of less than 2,500 g fell by 8% overall and by 20% among babies of primigravidae. The adverse effect of malaria transmission on fetal growth was apparently reversible if transmission of infection in the community was interrupted up to as late as the third trimester of pregnancy. The beneficial effects of malaria eradication operations on infant survival, child development, and social attitudes in developing countries are discussed.     

The management abscess of the lung

A review of the literature raises considerable doubt as to the advisability of surgical drainage of lung abscess as a definitive procedure. The mortality rate with use of this procedure and other hazards associated with it, must now be viewed in the light of improved methods of conservative therapy - involving the use of penicillin, bronchoscopic treatment and postural drainage-by which cure can be obtained in more than 80 per cent of cases of acute abscess and in a smaller proportion of cases of chronic abscess. Another factor to be considered is the better chance for diagnosis and effective resection of associated carcinoma when conservative treatment is employed.     

血清HCG, AFP联合超声检查对前置胎盘植入类型的相关性分析

目的:探讨超声对植入胎盘诊断的敏感性及特异性及血清AFP、HCG和不同胎盘植入类型的相关性。方法:选取孕晚期前置胎盘产妇208例,按孕周1:1匹配,选取入无前置胎盘无胎盘植入的产妇208例为对照组。产前对所有研究对象进行胎盘超声学检查,根据术后病理将胎盘植入类型分为粘连性胎盘、植入性胎盘和穿透性胎盘组。同时测定产前、产后3 d、产后4 w血清AFP和HCG水平。结果:208例前置胎盘最终病理确诊胎盘植入67例,占32.21%(其中粘连性胎盘组31例、植入性胎盘组19例、穿透性胎盘组17例),产前超声诊断62例。超声对胎盘植入诊断总的敏感性86.56%,特异性97.16%。对照组、前置胎盘并胎盘植入组、单纯胎盘前置组胎盘厚度平均(2.34±0.63)cm、(3.27±0.78)cm、(2.42±0.61)cm,差异有统计学意义(P0.05)。粘连性胎盘植入组、植入性胎盘组、穿透性胎盘组产前、产后3 d、产后4 w各时间点血清AFP、β-HCG均明显高于对照组和前置胎盘组,差异有统计学意义(P0.05)。穿透性胎盘组产前、产后3 d、产后4 w各时间点血清AFP、β-HCG高于粘连性胎盘组和植入性胎盘组,差异有统计学意义(P0.05)。结论:超声对穿透性胎盘植入诊断具有较高的特异性和敏感性,但对粘连性胎盘植入诊断的敏感性和特异性不高,血清AFP和HCG水平和胎盘植入类型有一定关系,联合检测有助于胎盘植入类型的诊断。     

Role of transferrin in iron transport between maternal and fetal circulations of a perfused lobule of human placenta

The transfer of iron between the maternal and fetal circulations of an isolated perfused lobule of term human placenta was investigated using 125I-labelled or 59Fe-labelled diferric transferrin. There was negligible transplacental transfer of intact transferrin whereas nearly 4 per cent of the added 59Fe was transferred into the fetal circulation after 2 h, where it became associated with fetal transferrin. Over 20 per cent of the added 59Fe radioactivity was sequestered within the placental tissue during this period, associated with transferrin, ferritin and other uncharacterized molecules. This suggests an important role for an intracellular pool in regulating transfer. The presence of 10 mM chloroquine in the maternal circulation substantially reduced tissue accumulation of 59Fe and totally inhibited transfer to the fetus. It is concluded that the initial stages of iron transfer to the fetus involve the internalization of maternal iron-saturated transferrin bound to membrane receptors by receptor-mediated endocytosis, which can be inhibited by the drug chloroquine. Subsequently, the transplacental transfer of iron to the fetus does not involve the concomitant movement of transferrin.     

Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994.

OBJECTIVE: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome in near to being achieved. DESIGN: Prospective collection of population based information on pregnancies in women with diabetes from all participating hospitals. SETTING: District general and teaching hospitals of the former Northern region. SUBJECTS: 111 diabetic women booking with pregnancy during 1 January to 31 December 1994. MAIN OUTCOME MEASURES: Diabetic control, perinatal mortality rate, fetal abnormality rate. RESULTS: The perinatal mortality rate was 48/1000 for diabetic pregnancies compared with 8.9/1000 for the background population (odds ratio 5.38; 95% confidence interval 2.27 to 12.70) and the neonatal mortality rate was 59/1000 compared with 3.9/1000 (15.0; 6.77 to 33.10). Two late neonatal deaths were due to congenital heart defects. Six per cent of all fetal losses (6/109 cases) were due to major malformations. The congenital malformation rate was 83/1000 compared with 21.3/1000 (3.76; 2.00 to 7.06) in the background population. CONCLUSIONS: Diabetic pregnancy remains a high risk state with perinatal mortality and fetal malformation rates much higher than in the background population.     

Survival in acute myocardial infarction; factors observed in 318 patients

Factors influencing survival in a group of 318 cases of acute myocardial infarction were analyzed. The mortality rate for the entire series was 41 per cent. Among the men it was 39.5 per cent; among women, 44.4 per cent. The mortality rate increased with the age of the patient. Twenty-six per cent of all deaths occurred within the first 24 hours, 44 per cent within 72 hours, and 71 per cent within the first week following hospital admission. Increased mortality rate was associated with previous history of congestive failure, myocardial infarction, hypertension or cardiomegaly. As to circumstances immediately preceding an infarction, the only ones that seemed to be related to a high mortality rate were hemorrhage and the postoperative state. Not only the presence but the degree of shock, congestive failure, cyanosis and dyspnea adversely influenced chances for survival. Duration, location, radiation and number of attacks of pain did not appear to be associated with extraordinary mortality rates. Anterior was slightly more common than posterior infarctions, and the mortality rate was much higher. Thromboembolic complications and certain disorders of rhythm and of conduction definitely worsen prognosis. Comparison of average mortality data as reported in different studies on acute myocardial infarction is improper and misleading because of the great differences between the kinds of patients included in various series reported upon. A standard method of grading the severity of acute myocardial infarction would help toward sounder comparisons.     

Effects of retention of fetal membranes on subsequent reproductive performance of dairy ewes

Seventy-one pairs of ewes with or without retention of fetal membranes in the previous lambing season, were included in a cohort study of 25 flocks in southern Greece; in 27 pairs regulation of the breeding cycle was applied, whilst in the other 44 pairs natural mating took place. The following measures of reproductive performance were calculated: cycling rate, mating rate, return-to-estrus rate, abortion rate, lambing rate, total lambs born per ewe, liveborn lambs per ewe, stillbirth rate, lamb-bodyweight per ewe; furthermore, the incidence risk of retention of fetal membranes during the lambing examined in this study was also calculated. No statistically significant differences were observed in the reproductive performance among ewes that had or had not retained their fetal membranes during the previous lambing, whether the breeding cycle was regulated or not. The incidence risk of retention of fetal membranes among ewes that had not retained its placenta in the previous lambing was 1.6%, whilst that among ewes that had retained its placenta in the previous lactation was 0%. It is concluded that retention of fetal membranes did not appear to adversely affect subsequent reproductive performance of ewes.     

脐血管前置产前超声表现及临床效果分析

目的:研究脐血管前置产前超声表现及临床效果。方法:回顾性分析2017年1月至2018年12月期间本院收治的34例脐血管前置孕妇临床资料,均进行产前超声检查,将结果与产后病理结果进行比较,分析超声表现。结果:同产后病理检查结果相比较,34例孕妇的产前超声诊断准确率、误诊率分别为97.06%、2.94%,数据对比差异无统计学意义(P>0.05),产前超声检查显示的胎盘及脐带入口情况主要为帆状胎盘、脐带胎盘边缘附着、边缘性前置胎盘、低置性前置胎盘、副胎盘等。结论:产前超声检查具有较高的脐血管前置诊断准确率,可为临床分娩结局的改善提供指导,适合推广应用在临床中。     

腹主动脉球囊预置术治疗凶险型前置胎盘疗效评价

目的:探讨腹主动脉球囊预置术治疗凶险型前置胎盘的疗效及安全性。方法:收取2014年3月至2016年3月我院收治的凶险型前置胎盘患者71例临床资料进行回顾性分析,观察组患者35例,行剖宫产前进行腹主动脉球囊预置术;对照组患者36例,直接进行剖宫产。对两组患者手术情况、术后情况以及新生儿情况进行观察比较。结果:两组患者手术时间及胎盘植入情况无显著差异,观察组术中出血量及输血量明显低于对照组,医疗费用明显高于对照组,产后出血及并发症发生率明显低于对照组,差异均有统计学意义(P0.05)。两组患者子宫切除率无显著差异(P0.05)。两组新生儿体质量及窒息情况无显著差异(P0.05)。结论:剖宫产前行腹主动脉球囊预置术可有效控制术中出血,是治疗凶险型前置胎盘安全有效的方法。     

APPENDICITIS AND PREGNANCY

In 74,000 obstetrical patients at Los Angeles County Hospital the incidence of acute appendicitis in pregnancy was 0.05 per cent. In a study of 36 cases of clinically diagnosed appendicitis in pregnancy between 1956 and 1960, it was shown that the fetal and maternal morbidity and mortality were decreased when a definite operative procedure was done early. The difficulty in diagnosis is increased by the necessary consideration of pyelonephritis and twisted ovarian cyst. Rupture of the appendix increased hazards to maternal and fetal survival. It was noted also that threatened premature labor may indicate a ruptured appendix. Emergency operation with the use of antibiotics in such cases was effective therapy. The incidence of premature delivery was proportionate to the delay in operating. If operation was performed in less than eight hours after admission to the hospital, there was no maternal or fetal loss. A delay greater than eight hours resulted in a 17 per cent fetal loss in premature delivery and 4 per cent fetal loss of infants at term.     

Parathion Poisoning—A New Antidote!

Two thousand five hundred forty-five cases of upper gastrointestinal tract hemorrhage were studied especially with a view to determining the indications for urgent surgical treatment.Decisions as to whether and when to operate were as follows:Immediate operation for patients over 50 years with a good history of ulcer and a severe initial bleed.Operation after the first repetition of bleeding in patients (1) over 50 with a good history and a mild initial bleed, (2) over 50 with inconclusive history but severe initial bleed, (3) under 50 with a good history and a severe initial bleed.In all other cases, operation was used only if conservative treatment failed.Absolute indications for operation were (a) association with perforation, (b) association with stenosis, (c) persistence of severe ulcer pain after hemorrhage, (d) continuous bleeding.Since operation is to be avoided if possible in cases of esophagitis, erosive gastritis and small acute or subacute ulcers, emergency gastroscopy has valuable uses.Where operation is deemed necessary and no obvious lesion found at laparotomy, blind gastrectomy^* appears to be the most satisfactory procedure.The mortality rate associated with upper gastrointestinal tract bleeding in patients less than 60 years of age was low (2.5 per cent). Even in cases in which operation was required, it was 6.2 per cent. Over 60 years the mortality rises steeply with increasing age, and in cases of operation the rise is even steeper.By using the methods of selection the overall mortality rate was appreciably reduced.