Charles C. Roby

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 circulating red cell volume and body hematocrit in normal pregnancy and the puerperium: By direct measurement, using radioactive red cells☆

Dieckmann and Wegner,l Thomson, 2 McLennan and Thouin and Caton, Roby and associates,4 have all measured and reported plasma, whole blood, and red cell volumes during pregnancy. The studies reviewed agree that there is a progressive increase in plasma volume into the third trimester. Indirectly calculated red cell volumes revealed the same progressive increase. There are differences of opinion, however, as to whether there is a statistically significant reduction in plasma and total blood volume prior to delivery. The length of time for plasma and total blood volume to return to normal also varies in the different reports. No doubt part of the disagreement has been the result of too few determinations on the same individual. The lack of a significant number of postpartum observations, especially late postpartum determinations as compared to the prepartum period, adds to the difficulty in interpreting the gestational data. Perhaps if more investigators had used late postpartum observations for a norm rather than a nonpregnant group, the data might have been better evaluated. Rather wide variations in results were also reported. These inconsistencies were due in part to the technical limitations of the dye technique. Also, in a small series extreme individual variations, especially when compared to nonpregnant control groups, are of sufficient degree to affect an arithmetic mean. Indirectly calculated red cell volumes are subject to known inherent errors, and in individual determinations this error may be considerable. The use of nonpregnant groups as controls for comparison limits the evaluation of the data in quantitative terms.

The effect of relaxin on the excretion of diodrast in the castrate hysterectomized rabbit.

Abstract 1. 1. Intravenous pyelograms were taken of rabbits prior to and after hysterectomy and castration, after ethinyl estradiol administration, and following estradiol and relaxin administration. 2. 2. Intravenous pyelograms were taken of a pregnant rabbit on the twentysecond day of gestation. 3. 3. The pyelograms taken after relaxin administration demonstrated delay in complete filling of the ureters and appearance of the dye in the bladder comparable to that seen in the pregnant rabbit. 4. 4. This delay in ureteral and bladder filling is due, we believe, to atonicity of the ureteral musculature caused by estradiol relaxin therapy.

Tolerance trial of neostigmine methylsulfate in pregnancy

Abstract Seventy patients in various stages of pregnancy ranging from the seventh week through delivery received intramuscular injections of neostigmine methylsulfate. Twenty patients in the first trimester received 2 c.c. of 1:2,000 on three successive days. There was no interference with normal gestation, and fifteen patients have been delivered of sixteen infants who are living and well. The five patients remaining undelivered are following normal prenatal courses. Fifty patients from the fourteenth week through delivery received 1 c.c. of 1:2,000 neostigmine methylsulfate every three hours for six doses. The drug did not produce any noteworthy subjective symptoms or objective signs of an alarming nature. Forty patients have been delivered of thirty-three infants who are living and well. Two infants died following delivery. There were four stillbirths, one a twin. Two patients underwent therapeutic abortion. Ten patients remain undelivered.