Clifford P. Goplerud

Aerobic and anaerobic flora of the cervix during pregnancy and the puerperium.

Comparison of species of bacteria isolated from patients with endometritis with species isolated from normal pregnant and nonpregnant women suggests that bacteria causing infections are indigenous to the genital tract. However, complete studies of the flora of pregnant women, especially anaerobic flora, are lacking. Aerobic and anaerobic cultures of the endocervix were obtained from women in all trimesters of pregnancy and at three days and six weeks post partum. The incidence of occurrence of each species of bacteria and the average number of different species per culture were determined for each period. The most prevalent organisms in each period were aerobic gram-positive rods and cocci and anaerobic gram-positive cocci. The average number of species of aerobic bacteria per culture remained approximately the same in each culture period. The average number of anaerobic species per culture decreased as pregnancy progressed, peaked on the third postpartum day, and at six weeks post partum returned to a level similar to that of the first trimester.

Serial hormonal studies in normal and abnormal pregnancy

Abstract Serum HPL levels studied in control patients were low in the first trimester followed by a fairly acute rise during the second trimester that continued until near term. Serum HCG and HGH and urinary estriol and pregnanediol showed the expected values. Patients with diabetes, Rh isoimmunization, and toxemia were compared with controls. HPL levels were of no prognostic significance in diabetic patients, isosensitized patients, or in most toxemic patients. Urinary estriol and pregnanediol offered no help in the isosensitized patients and were higher than controls in the diabetic patients. One toxemic patient had HPL levels lower than expected. The baby died during labor. HPL levels in another patient studied from week 5 were low at 30 weeks and following the thirty-fifth week decreased to second-trimester range. The live-born infant, delivered at 281 days, exhibited classical stigmas of placental dysfunction. Estriol levels, variable earlier, dropped at 39 weeks. Pregnanediol levels had been somewhat depressed.

Intrauterine fetal transfusion, 1965–1976, with an assessment of the surviving children ☆

The need for IUT in the management of Rh hemolytic disease is likely to continue in the foreseeable future. Recent reports have been skeptical about the success of this procedure and the quality of the surviving infants. Of 84 fetuses who received 134 IUTs, over all, 35.7 per cent survived; 48.3 per cent of the nonhydropic group survived. Fifteen of the 23 survivors between 3 and 11 years of age received intellectual, academic, behavioral, health, and developmental evaluations. When compared to sibling and high-risk control groups, the study children showed no significant differences in intelligence quotients, arithmetic achievements, or reading achievements; their school performance is acceptable and none is presenting significant behavioral problems. Except for an excessive number of umbilical and inguinal hernias, there were no physical abnormalities that could be directly related to IUT.

Response of peripheral plasma progesterone concentration to intra-amniotic hypertonic saline

Abstract The recent literature contains conflicting results on the peripheral plasma progesterone concentration in abortions induced by intra-amniotic hypertonic saline. In this study peripheral plasma progesterone levels were determined in 15 patients undergoing therapeutic abortion. Plasma samples were taken before and for variable periods of time after the intra-amniotic instillation of 20 per cent sodium chloride. The majority of patients demonstrated a transient drop in concentration with subsequent return to control levels. A minority showed a transient rise with subsequent return to the preinduction values. No significant difference from the control sample was noted in patients followed through labor. Previous studies are reviewed and the relationship between progesterone and the onset and progress of labor discussed.

Effect of arginine infusion on plasma levels of growth hormone, insulin, and glucose during pregnancy and the puerperium☆☆☆

Abstract Growth hormone response to arginine infusion was measured during each of the three trimesters of pregnancy and 2 to 3 days post partum and the values compared with that in control nonpregnant subjects. The response was equivalent to control during the first trimester, moderately reduced in the second, and markedly reduced in the last. These progressive changes in the response of HGH to arginine stimulation during the three trimesters of pregnancy suggest that the dynamics are related to physiologic alterations requiring months to become fully manifest.

Quantitative serum chorionic gonadotropin studies in abnormal pregnancy

Abstract 1. 1. A study of serum chorionic gonadotropin levels in normal pregnancy and certain pregnancy complications is presented. 2. 2. Values in the control series compare favorably with those of prior studies by other investigators. 3. 3. In some multiple pregnancies, the serum levels of chorionic gonadotropin were elevated, in others the values fell within the normal range. 4. 4. There was no demonstrable relationship in diabetics to the development of preeclampsia, spontaneous premature labor, or perinatal mortality. 5. 5. There was a definite relationship between high values of serum chorionic gonadotropin and perinatal mortality in Rhnegative isoimmunized mothers. This test is not conclusive enough to be used alone as indication for early delivery, however, since some babies were lost when chorionic gonadotropin levels were within normal range. 6. 6. The findings in pre-eclampsia, eclampsia, essential hypertension, and hyperemesis gravidarum are predominantly within the normal range. 7. 7. The findings of elevated serum chorionic gonadotropin in over 50 per cent of patients with polyhydramnios cannot be explained but it could represent renewed trophoblastic proliferation and chorionic gonadotropin production in patients in whom polyhydramnios has developed in relation to specific types of obstetric complications.

The first Rh-isoimmunized pregnancy.

Abstract There is adequate information in the literature from which to conclude that the greatest opportunity for fetal salvage is the first Rh-sensitized pregnancy. Too many interpret this to mean that the first affected baby will be minimally or mildy involved. This report of 109 first affected pregnancies indicates that 20 per cent of the Rh-positive fetuses are severely involved, that as many as 10 per cent may require intrauterine transfusion, and that the perinatal mortality rate is 10 per cent. These data are presented to emphasize the necessity of careful antepartum assessment of the fetus during the first isoimmunized pregnancy.

Delivering the Dead Fetus

At the University of Iowa Hospitals, physicians have studied the delivery of dead fetuses from 360 patients. Labor was spontaneous in 58.9 percent but induced in 36.4 percent. Eleven patients who had retained a dead fetus from 4 to 10 weeks evidenced hypofibrinogenemia. Aggressive management for fetal death in utero is recommended.