Albert E. Weiner

The pathologic anatomy of eclampsia, bilateral renal cortical necrosis, pituitary necrosis, and other acute fatal complications of pregnancy, and its possible relationship to the generalized Shwartzman phenomenon.

Abstract Intravascular fibrin deposition in arterioles and capillaries throughout the body is responsible for the necrosis and hemorrhage seen in eclampsia, bilateral renal cortical necrosis, and pituitary necrosis associated with pregnancy. These cases are often accompanied by severe shock, hemorrhage, and anuria. Fibrinogenopenia and fibrinolysins develop in this group of patients. It is suggested that the mechanism behind the fibrin deposition is similar to that in the generalized Shwartzman reaction. In some cases the source of “toxin” may be a bacterial infection. In some cases, particularly those associated with toxemia of pregnancy, the “toxin” may be similar to the “menstrual toxin” described by the Smiths.

I. Intravascular clotting and afibrinogenemia, the presumptive lethal factors in the syndrome of amniotic fluid embolism

I N 1941, Steiner and Lushbaugh’ described the syndrome of amniotic fluid embolism which they considered the major cause of maternal death during labor. The chief clinical signs were dyspnea and sudden shock, and death was ascribed to the embolic effects of amniotic fluid and an associated anaphylactoid reaction. Widespread embolization of the pulmonary arterioles and capillaries by particulate matter contained in amniotic fluid were believed to be responsible for the essential pathologic lesions. The predisposing factors in the causation of this syndrome seemed to be tetanic uterine contractions, multiparity, and exceedingly large infants. Since the original description of amniotic fluid embolism, additional cases of the syndrome have been recognized and reported.2 As in the case OS Steiner and Lushbaugh’s patients, some died undelivered with the classical signs and symptoms of embolism, while others who survived the initial shock succumbed within one to three hours after delivery. In the latter group, bleeding from the mucous membranes and organ surfaces was noted, and some degree of vaginal bleeding was described which was attributed to atony of the uterus, secondary to shock. When these fatal cases are reviewed, two unexplained observations stand out. One is to the effect that the amount of mechanical blockage of the pulmonary vessels by amniotic debris is hardly suf-

The Pathogenesis of Amniotic-Fluid Embolism

IN 1941 Steiner and Lushbaugh1 described the syndrome of amniotic-fluid embolism, which they believed to be the major cause of death during labor. The clinical picture that they observed in 8 patie...

The care of the postpartum cervix

Abstract Factors affecting the rate of healing of 101 postpartum erosions of the cervix were investigated. Erosions which were present at the tenth postpartum week did not heal spontaneously. Adequate cauterization of the cervix resulted in complete healing in an average of 7.8 weeks. It was presumed that cauterization reduced exuberant granulations and allowed resumption of epithelial ingrowth from the periphery of the erosion. The twice daily use of a triple sulfa vaginal cream in conjunction with cauterization reduced the average healing time to one-half that following cauterization alone. It was thought that this reduction in healing time resulted from the control of secondary infection in the cauterized cervix.