Berel Held

The correlation of maternal cytomegalovirus infection during varying stages in gestation with neonatal involvement

An obstetric population was prospectively followed for evidence of primary maternal cytomegalovirus infection during gestation. The cord serum of infants whose mothers had serologic evidence of infection was analyzed for the level of IgM and for the presence of specific anticytomegalovirus IgM antibodies. The progeny were cultured for cytomegalovirus. In the four cases of maternal infection identified, the cord sera were found to be positive by immunofluorescence for anticytomegalovirus IgM immunoglobulins and correlated with recovery of virus in the immediate neonatal period or beyond. There was a direct correlation between severity of neonatal infection and presumed duration of disease in utero. These observations suggest that cytomegalovirus is capable of infecting the products of conception irrespective of gestational age, and that the clinical manifestations of congenital cytomegalovirus infection appear to be primarily a reflection of the duration of infection in utero.

Relationship between the oral contraceptive and folic acid metabolism: serum folate concentrations.

Abstract A study of women who developed severe megaloblastic anemia while receiving oral contraceptive agents prompted a hematologic investigation of individuals taking such drugs. A group of patients receiving two different oral contraceptives has been evaluated and compared to a control series. No subjects became folate deficient. There does not appear to be any significant relationship between the duration of therapy and the serum folate level. The exact interaction between folic acid and estrogen remains to be determined.

Relationship of herpes simplex genital infection and carcinoma of the cervix: Population studies

Abstract Population studies of upper middle-class women revealed an extremely low incidence of genital herpesvirus. On the other hand, patients with diagnosed genital herpes infection shed virus during and in the absence of vulvar lesions indicating a chronic infection.

Contemporary management and conduct of preterm labor and delivery: a review.

Current concepts in the conduct of preterm labor and management of delivery of the premature infant are reviewed. Pharmacologic modalities available for inhibiting preterm labor are discussed as well as the efficacy, indications and contraindications for these agents. An analysis of the role of corticosteroids in achieving fetal pulmonary maturity in the preterm infant is reviewed, and based on the existent literature the intrapartum management of the small fetus is outlined. The mode of delivery, vaginal or via cesarean section, for these infants is likewise discussed.

Research in the delivery of female health care: The recipients' reaction

Abstract A random group of women followed during their prenatal course in extramural and intrahospital clinics was questioned regarding the services they received. The findings suggest the following: (1) greater positive acceptance to care when rendered in the local community, (2) significant transportation difficulties in attending clinic sessions, especially in the more rural locations, and (3) considerable confusion in the hospital setting. The implications of these observations are discussed relative to strengthening existing services.

Research in the delivery of health care: Changing reproductive trends☆

Abstract A three-year analysis of changing reproductive trends in a rural low-income population is described. There is a decline in the number of patients with high parity. Associated with this finding is the increasing proportion of primigravid deliveries, in particular among young teenagers. The implications of these observations suggest the future direction for population control efforts.

Research in the delivery of female health care: Manpower development—expanded roles for nursing and the nonprofessional in family planning

Abstract The preparation for and mechanics of female health clinics are described whereby the entire operation is performed by 2 public health nurses and 5 outreach workers. After 11 months, these personnel have achieved a patient population which totals 2,825 women. The delivery of female health care whereby the primary provider is a nonphysician is described relative to patient acceptance and quality of service. Further, its expanding role is discussed.

Research in the delivery of female health care: Effort and effectiveness

Abstract An analysis of 502 low-income pregnant patients registered in the University of Florida multicounty female health care program was conducted. Planned pregnancies account for only 14 per cent of the total. Greater than half of the population had received no contraceptive services. The relationship between physician effort and effectiveness of care is discussed.

Research in the delivery of female health care: A decade's experience in resident education and a university-based mobile health care team

Abstract This presentation describes how a university-based mobile medical team provides comprehensive female health services on a continuing basis to a rural, low-income population dispersed throughout a 13 county, 10,000 square mile region. This population seen in their local environment during regularly scheduled extramural clinic sessions is the primary responsibility of the resident staff of the Department of Obstetrics and Gynecology and provides the residents with their practical teaching material both in the clinic and in the hospital. The health-care delivery system that is in effect is an integral part of the resident staff educational program.

Research in delivery of female health care

Abstract The purpose of this report is to relate a single experience as it involves one concerned with relationships between various parties involved in health care—in particular, family planning. The presentation of this material points up problems. They have implication at Federal, regional, state, and local levels. We conclude that until mechanisms for coping with same are devised, the implementation and effectiveness of programs conceived to meet urgent national priorities can be seriously jeopardized.