Augusta Webster

Gestational trophoblastic disease: A comparative study of the results of therapy in patients with invasive mole and with choriocarcinoma

Abstract A study was made to compare the results of chemotherapy in patients with invasive mole and with choriocarcinoma as obtained in a Center for Trophoblastic Diseases with those obtained in 82 individual hospitals. In the Center 179 patients were treated. In the 82 hospitals 93 patients were treated, in most instances there being only one patient treated in an individual hospital. The data indicate that successful treatment is statistically better in the Center. In only one category of disease—choriocarcinoma, nonmetastatic—is the success of therapy equal in the Center and in the individual hospitals. In the 28 patients transferred to the Center, after failure of therapy in the 82 hospitals, treatment was successful in 17 (60.8 per cent). Possible reasons for the better results obtained in the Center are mentioned.

Hyperemesis gravidarum: A clinical study of 396 cases

Abstract 1. 1. Three hundred ninety-six cases of hyperemesis are reviewed. 2. 2. There are 32 therapeutic abortions. 3. 3. There were 15 deaths in this series. 4. 4. Color, age, parity, and marital state seem to have no influence on the course of the disease. 5. 5. Persistent tachycardia, fever, diacetic acid, and acetone are danger signals. 6. 6. Ability to retain food and fluids in seriously ill patients is not necessarily a sign of improvement. 7. 7. Deaths from hyperemesis are avoidable. 8. 8. The majority of this group responded promptly to rest, diet, glucose therapy, and fluids. 9. 9. Those that fail to respond to adequate treatment in a reasonable length of time should be aborted. 10. 10. Therapeutic abortions delayed too long are not life-saving measures.

Maternal deaths at the Cook County Hospital: Fourteen-year survey (1952–1965)

Abstract A review was made of all maternal deaths at the Cook County Hospital during the 14 year period from 1952 through 1965. There were 226,878 live births and 234 total adult deaths. Postmortem examination was done in 88.5 per cent. All deaths, regardless of the cause, in pregnant women at any period of gestation or within 90 days of termination of the pregnancy were included in the study. Fifty-three per cent were classified as direct obstetric, 24 per cent as indirect obstetric, and 23 per cent as nonrelated deaths. The gross maternal death rate per 10,000 live births for the white population was higher than for the Negro population.

Management of abortion at the Cook County Hospital

T HE term abortion as used here is the interruption of pregnancy before the twentieth week. In the city of Chicago, a pregnancy which terminates at the twentieth week of gestation is reportable as a birth, and the hospital records so record it. Since 1939 when Hillis’ presented his statistics, new drugs and the liberal use of whole blood have altered the method of treatment. It is our intention, in so far as is practicable, to compare this review of abortions treated at the Cook County Hospital in the year 1949 with the previous report made ten years earlier. The management of abortions as outlined by Dr. Hillis was one of extreme conservatism and, indeed, it was the only safe procedure before the advent of the antibiotics. Quinine and Pituitrin in small divided doses were given to aid in evacuation of the uterus and no immediate interference was undertaken except in acute hemorrhage. If, after five days of normal temperature, the uterus had not emptied completely, a dilatation and curettage were done.

Nineteen-year survey of maternal mortality at the Cook County Hospital☆

Abstract 1. 1. Maternal deaths following delivery of 104,123 live babies in nineteen years at the Cook County Hospital are reviewed. 2. 2. In spite of inadequate facilities and limited nursing personnel, the maternal mortality has dropped from 150 per 10,000 live births in 1934 to 7.9 in 1951 (Fig. 8). 3. 3. Reasons for the increased safety of motherhood are discussed. These include the sulfonamides, blood banks, the antibiotics, better prenatal care, increased awareness on the part of both physician and patient as to the necessity of prompt investigation of abnormal signs and symptoms. 4. 4. The greatest hope for further lowering of maternal mortality lies in the complete elimination of deaths due to toxemia. Proper prenatal care, plus convincing physicians that mortality from toxemia is practically zero if convulsions are prevented, could accomplish this.

Quantitative studies in fetal electrocardiography: III. Comparison of breech and cephalic presentation data; endocrine basis for fetal rotation, a hypothesis

On the basis of qualitative and quantitative studies, it is shown that, while the diagnosis of cephalic presentation is quite possible from the fetal electrocardiogram (ECG), the diagnosis of breech presentation is restricted. Fetal ECG amplitudes are shown to be smaller for breech presentations in general as compared with cephalic presentations. An anomalous reversal of magnitudes of ECG values is shown for the breech presentation, with the S N values for the female, for example, being larger than for the male. Regression equations identify the phenomenon and provide a quantitative description. On the basis of these findings, a hypothesis is proposed for an endocrine basis for fetal rotation. An endocrine mechanism is proposed, which, if blocked, leads to persistent breech presentation and breech delivery.