August F. Daro

Premature separation of the normally implanted placenta; a review of 306 cases.

Abstract 1.1. Most obstetric patients with premature separation can be delivered vaginally without increasing the maternal mortality. Evaluation in retrospect of the maternal deaths at the Cook County Hospital offers no improvement in results if cesarean sections could have been utilized. 2.2. The infant mortality is not increased by vaginal delivery. Cesarean section does not ensure a living baby as evidenced by a 22.2 per cent neonatal fetal mortality. 3.3. Indications for cesarean sections were:A. Maternal: (1) shock and/or persistent bleeding where vaginal delivery is not imminent. (2) cases where a completely damaged uterus is suspected.B. Fetal: In the presence of a normal, good-sized, living fetus with vaginal delivery not anticipated in a reasonable length of time. 4.4. Toxemia of pregnancy occurred in one-third of the patients with premature separation. The incidence of prematurity increased with the presence of toxemia. The severity of the premature separation increased with the severity of the toxemia. 5.5. Pituitrin appears to be a valuable adjunct in the treatment of premature separation.

A study of the management of prolonged labor

Abstract The following results were obtained in a study of 556 cases of prolonged labors, part of which were treated inactively (watchful expectancy) and the remainder treated actively (artificial rupture of the fetal membranes and/or administration of posterior pituitary extract where indicated): 1. 1. Artificial rupture of fetal membranes alone produced adequate uterine contractions resulting in the delivery of 32.7 per cent of all patients in the active series. 2. 2. Posterior pituitary extract was effective in producing satisfactory progress in 95.8 per cent of cases (161 cases) of uterine inertia which failed to respond to rupture of the membranes. Operative delivery was deemed necessary in 4.2 per cent. The effective dose varied from 1 minim (45.8 per cent) to over 4 minims (4.27 per cent). 3. 3. There were no deleterious effects upon either the fetus or mother that could be attributed to the artificial rupture of the fetal membranes or to the administration of posterior pituitary extract. Active treatment produced no obvious deleterious effect on mother or baby. 4. 4. The incidence of protracted labors was reduced in the active series; 6.4 per cent of the primiparas in the active group were in labor over 36 hours as compared to 36.4 per cent of the inactive group, and 0.9 per cent of the multiparas in the active group were in labor for over 36 hours as compared to 17.3 per cent in the inactive group. 5. 5. There was a distinct decrease in incidence of midforceps deliveries in the active series. The rate of cesarean section was higher in the active group (3.0 per cent to 1.0 per cent). 6. 6. The rate of other operative procedures (Duhrssens incisions and craniotomies) was higher in the inactive series. 7. 7. The incidence of maternal complications was greater in the inactive series than in the active series. 8. 8. The maternal morbidity was 1.1 per cent in the active series as compared to 4.3 per cent (corrected) in the inactive series. 9. 9. The fetal mortality was 0.75 per cent in the active series as compared to 4.5 per cent in the inactive series. 10. 10. There were no maternal deaths in either series.

Spontaneous rupture of a primary carcinoma of the ovary complicating pregnancy.

Abstract 1. 1. Primary ovarian malignancy complicating pregnancy is uncommon. 2. 2. Nineteen authentic cases are reported in the literature; of these nine are sarcomas, the remainder being carcinomas. 3. 3. That herewith reported is the only case of ruptured ovarian malignancy associated with pregnancy. 4. 4. Ruptured ovarian malignancy may simulate abruptio placenta, ruptured uterus, and the other conditions associated with pregnancy causing an acute abdomen.

Artery ligation in bleeding cervical cancer

Abstract A method of attacking carcinoma of the cervix by severing the nutritional supply line and at the same time stopping or markedly reducing the amount of bleeding is presented. The advantages of the procedure and the two different approaches are presented with a review of the anatomy involved. Although ligation of the internal iliac and ovarian arteries is not a new method for controlling uterine hemorrhage, it is felt that it does have a definite place in the management of uncontrollable hemorrhage from cervical malignancy and its use should be performed more frequently. The combined ligation of the iliac and ovarian arteries seems to be the procedure of choice.

A management of postpartum hemorrhage by prolonged administration of oxytocics

Abstract Two methods of controlling postpartum hemorrhage are described and recommended. 1. 1. Administration of posterior pituitary extract (Pitocin) and Ergotrate in alternate doses, at half-hour intervals, over a period of three to four hours. 2. 2. The use of dilute Pitocin intravenously—1 to 2 c.c. Pitocin in 1,000 c.c. 5 per cent glucose solution. This prolonged administration of oxytocics to patients with intractable postpartum hemorrhage has yielded us a high degree of success.

Caffeine as an aid to sodium pentobarbital analgesia in labor

Abstract The search for the ideal drug or combination of drugs for obstetric analgesia and amnesia has been long and arduous. It has been stated that the proper drugs have not been discovered. In recent years however, the barbiturates have given promise of fulfilling the varied requirements for ideal effect. Sodium pentobarbital in particular seems to be the most likely of the many preparations that have been tried. Nevertheless, and notwithstanding many clinical studies which emphasize the favorable results attained by the use of sodium pentobarbital alone or in combination, there still remain certain objectionable features, viz.: the confusion, restlessness, and maniacal states which this drug may cause. In the most recent review of the progress of the barbiturates in obstetric analgesia, Hellman1 points out that “the chief objection to all analgesia technics has been, and remains today, the excitatory action of the drugs. … The future development of obstetric analgesia seems to depend on the discovery of compounds whose action is less excitant and whose effects are more controllable.” Since experiments with new and different barbiturates have not been promising, another combination of drugs was sought. At the suggestion of the late Dr. Bernard Fantus, to whom the objectionable features of sodium pentobarbital analgesia were outlined, we decided to add caffeine, a mild cerebral stimulant, to the drug. Thus the delirium of the mother which may be due to a cutting-off of the control of the voluntary cerebral impulses might be counteracted by the mild cerebral stimulation of caffeine. The purpose of this paper is to report the results of these experiments. While the number of cases is not large, it is a well-selected and controlled group and reflects the valuable contributory action of this cerebral stimulant; it also intimates that other, more powerful, cerebral stimulants might be valuable adjuncts. We hope that it will open new vistas into the future progress of obstetric analgesia.