Alan J. Margolis

The impact of midtrimester abortion techniques on patients and staff

We studied 250 midtrimester abortions by dilatation and extraction (D and E) under general anesthesia and compared them with abortions by the intra-amniotic injection of prostaglandin (amnio) in order to assess the physical and emotional changes experienced by patients and staff under the different circumstances represented by each procedure. We found patients undergoing D and E abortions had fewer physical complications and described the procedure as minor surgery which went smoothly. The patients who had amnio abortions had more pain and reacted with more anger and depression afterward. Nurses were more disturbed by amnio abortions in which they played major roles in supporting the patient as well as in her abortion. Physicians reported the D and E procedures to be emotionally difficult which may limit the adoption of this procedure despite its value to patients.

Amino acid concentrations in fetal and maternal plasma

Summary Fetal and maternal plasma samples, obtained at the time of cesarean section, were analyzed by column ion exchange chromatography for individual amino acids. The oncentrations of 9 individual and 3 paired amino acids, plus taurine and urea, are compared. Each amino acid with the exception of proline was found to exist in higher concentration in the fetal blood. This was found to be true when fetal and maternal blood samples were drawn simultaneously and also when maternal samples were compared to blood samples obtained from the newborn infants of other mothers. The data are presumed to be evidence favoring an active, mediated transport of the amino acids across the placental barrier. The relationship of these findings to the rate of fetal protein synthesis and to the endocrine control of the cellular uptake of free amino acids is discussed.

Paracervical block anesthesia in obstetrics: II. Etiology of fetal bradycardia following paracervical block anesthesia

Fetal scalp sampling and gas chromatographic mepivacaine analysis techniques were used to determine fetal and maternal blood mepivacaine concentrations and acid-base changes following paracervical block in 17 patients. Fetal acidosis was found in the 7 fetuses which developed bradycardia. In most cases of fetal bradycardia, fetal blood mepivacaine concentrations were higher than peak maternal arterial blood levels; this suggests that mepivacaine reaches the fetus by a route more direct than maternal systemic absorption. The proximity of the paracervical injection site to blood vessels supplying the placenta might facilitate direct uptake of the anesthetic from the site of injection to the intervillous space of the placenta.

Paracervical block anesthesia in obstetrics: I. Fetal complications and neonatal morbidity

Eight hundred and forty-five blocks were administered to patients in labor, and fetal heart tones were monitored frequently following the blocks: Fetal heart rate changes were noted following 30 per cent of the blocks; primiparity, prematurity, and pre-existing fetal distress were associated with increased incidence of these changes. The incidence of neonatal depression was significantly increased at one and five minutes of age in those infants who had developed fetal heart rate changes following paracervical block. Paracervical blocks not followed by fetal heart rate changes were associated with a normal incidence of neonatal depression. No method for reliably predicting or preventing these fetal heart rate changes in any given patient was discovered.

Therapeutic abortion follow-up study

From November 1967 to June 1968, a heterogeneous group of 55 pregnant women applied for abortion to the staff of the obstetrical services of the University of California/San Francisco because of possible impairment of mental and/or physical health. 43 of 50 were followed for 3 to 6 months. Ambivilance and guilt appeared more substantially in young women under 18 years of age. Three to 6 months afterward, 29 patients expressed a positive reaction toward abortion. 10 reported no significant change in their life situations and 4 responded negatively. Of the 41 patients remaining fertile, 4 had purposely become pregnant again. 8 others were apparently without consistent contraception. It was concluded that preabortion counseling should outline the necessary steps for Committee consideration, give reassurance as to physical safety and help the patient understand her motives and goals. Postabortion follow up should emphasize a clear contraceptive program.

Survey of men and women residents entering United States obstetrics and gynecology programs in 1981

In July 1981, questionnaires were distributed to 1,128 residents entering the field of obstetrics and gynecology throughout the United States; 546 (48%) were returned and evaluated, 229 from women (42%) and 317 from men (58%). Factors that related to the choice of the specialty showed a universal interest in the birthing process and the surgical aspects of the specialty, with a large majority also interested in health education, endocrinology, primary care of young people, and achievement of a greater understanding of sexuality. Private partnership practice was favored by most of the respondents. Men attributed a greater importance to income than did women, who were more interested in a salaried practice and less irregularity of hours. Women tended to be more liberal on questions that were related to controversial medical and ethical issues in the field of obstetrics and gynecology. Role models, half of whom were teachers, were equally common to men and women (66%).

Studies of the isolated perfused human placenta

Summary Methods of perfusing the isolated, surviving human placenta under nearly physiologic circumstances are presented. During periods up to 12 hours, the rate of glucose utilization is about 1 Gm. per kilogram per hour. The production of organic acids causes a steady rise in hydrogen ion concentration with a parallel rise in potassium concentration. No conjugation of bilirubin with glucuronic acid could be observed. Hypoxia results in vasodilatation with increased rates of flow through the fetal vascular bed, whereas high oxygen pressures cause the reverse. It is believed that similar responses occur in utero. The fetal circulation is not responsive to epinephrine or norepinephrine but responds with vigorous vasoconstriction to serotonin and histamine.

Experience with 276 intra-amniotic prostaglandin F2α induced midtrimester abortions

Induction of midtrimester abortion using 40 mg intra-amniotic prostaglandin F2alpha was performed on 276 patients. Gestational age and fetal status had no effect on injection-to-abortion time while multiparity and the concomitant use of laminaria appeared to decrease the abortion time. The side effect and complication rates were acceptable and the results compare favorably with those of other midtrimester abortion techniques.

Forane Increases Bleeding in Therapeutic Suction Abortion

The effect of forane, an anesthetic, upon uterine bleeding during therapeutic abortions was examined in 13 women, ranging in age from 19-36 years, who were 8-13 weeks pregnant. 9 received forane-70%nitrous oxide-oxygen maintained at 1.0% or .5%. 4 women received a 1.4% concentration of forane-oxygen. No patients moved during the abortion, performed by the suction technique. The average blood loss was 208 plus or minus 43 ml. In pregnancies of less than 10 weeks, average blood loss was 181 plus or minus 61 ml, while women who were more than 10 weeks pregnant had an average blood loss of 251 plus or minus 55 ml. There was a tendency toward less bleeding (85 plus or minus 13 ml) in the 4 women who received forane without nitrous oxide as compared with the blood loss of the group who used forane with nitrous oxide (262 plus or minus 53 ml). Forane was judged to increase uterine bleeding and was therefore unacceptable as an anesthetic during suction abortions.

Amniotic fluid evaluation and intrauterine transfusions for erythroblastosis fetalis

Abstract Amniotic fluid samples were evaluated by the method of Bevis, as modified by Liley, 166 times on 105 women suspected of bearing infants afflicted with erythroblastosis. The accuracy of prediction is 83 per cent. Eight patients were selected for intrauterine intraperitoneal transfusion because a prediction of imminent fetal death was made prior to the thirty-third week of pregnancy. Five of these infants proved to have hydrops fetalis and were stillborn. The remaining 3 cases were successful, as judged not only by survival, but by the high levels of adult hemoglobin present in the infants circulation at birth.