Curtis L. Mendelson

Disorders of the heartbeat during pregnancy

Abstract Disorders of the heartbeat during pregnancy are discussed in relation to published reports and experiences at the New York Lying-In Hospital. The various disturbances are analyzed in terms of medical and obstetric implications.

Pregnancy and coarctation of the aorta

Abstract Coarctation of the aorta is discussed and the literature surveyed with regard to pregnancy complicated by this condition. Three additional cases are analyzed. Evidence is presented to show that pregnancy adds to the risk in patients with this condition.

The management of delivery in pregnancy complicated by serious rheumatic heart disease

Abstract A series of 1,089 patients with pregnancy complicated by rheumatic heart disease is presented. This complication occurred in 2.6 per cent of 41,459 pregnancies. The functional capacity diagnoses according, to the New York Heart Association criteria were: 480 (44 per cent) Class 1, 442 (41 per cent) Class 2, 113 (10 per cent) Class 3, and 54 (5 per cent) Class 4. The total mortality was 11 (1 per cent), and the cardiac mortality 8 (0.7 per cent). All cardiac deaths were due to decompensation—five died undelivered, and three died following abdominal delivery. The Class 3 and Class 4 cases are completely analyzed. Twenty-six were delivered abdominally with 3 deaths (12 per cent). One hundred thirty-six were delivered vaginally with no deaths. The abdominal group consisted of 5 hysterotomies with 1 death, and 21 cesarean sections with 2 deaths. The vaginal group consisted of 35 abortions and 101 viable deliveries. Cardiac failure occurred after the fourth month, and 15 per cent of these cases died. An outline for management of pregnancy complicated by serious rheumatic heart disease (Class 3 and Class 4) is presented.

Pregnancy and subacute bacterial endocarditis

Abstract There have been 10 cases with a diagnosis of subacute bacterial endocarditis complicating pregnancy in some 50,000 patients at the New York Lying-In Hospital from 1932 through 1947. The incidence of this complication is 0.02 per cent. Three cases with positive blood cultures occurred before the use of penicillin and all died during pregnancy or the puerperium. Seven cases treated with penicillin survived pregnancy and delivered normal living children. Two of the penicillin-treated cases had clinically authentic subacute bacterial endocarditis during pregnancy unconfirmed by positive blood cultures. Five of the penicillin-treated cases were proved by positive blood cultures: three had recently recovered from the disease prior to the pregnancy under consideration, and two developed the disease during pregnancy. The five proved cases are reviewed in an attempt to evaluate the significance of subacute bacterial endocarditis prior to and during pregnancy. An outline for the management of pregnancy, delivery, and the puerperium in rheumatic and congenital cardiac patients is given.

The pulse and respiratory rates during labor as a guide to the onset of cardiac failure in women with rheumatic heart disease

I N A previously reported study1 of the pulse and respiratory varial ions of 180 normal women during labor, it was observed that the pulse and respirations remained practically unchanged throughout the first stage of labor. With the advent of bearing down efforts ill the second stage of labor 4 per cent of patients showed a rise of the pulse rate to above 110 per minute with respirations of not. over 24 per minute. Such elevations were considered as established only when they persisted for at least forty-five minutes. Thirteen per cent showed a rise in t,he respiratory rate to above 24 per minute with the pulse rat.e not over 110, and 7 per cent showed a rise of both pulse and respirat,ory rates above these values. The levels of 110 and 24 were chosen arbitrarily since a large percentage of patients approached or reached these values but relatively few esceeded them. Prolonged labor and prulungetl second stage were found to predispose to such rises but no definite influence of analgesia or of the particular analgesic used could be observed. We have extended these studies to women wit,h rheumatic+ heart disease to note if their pulse and respiratory variations during labor differed in any way from those of normal women su as to give a warning of the approach of serious cardiac insuficiency~. The 200 patients studied were first seen in the ante-yartnm clinic at various stages of t,heir pregnancy. The diagnosis of the particular form of heart disease was made at this t,ime and sometimes was amended as later observations seemed t,o indicate. The patients wer(’ classified as IO their functional capacit,y (Class 1. 2. 3, or 4) according to t,he criteria uf the New York Heart Association, and as they were followed progressively in tile antepartum clinic, this diagnosis was changt~cl as indicat,ions seemed t.0 warrant. At the onset, of labor or as soon thereafter as the patient was admitted t,o the hospital, the pulse and respirations were counted every fiftc(:rr minutes between pains and charts made of this similar to those appear-~___.

Acute isolated myocarditis in pregnancy

Abstract Two antepartum deaths from acute isolated myocarditis are reported. These cases represent the experience with this disease in 2,310 cardiac patients out of 64,992 pregnant women at the New York Lying-In Hospital from 1932 through 1950. The literature is reviewed and the clinical and pathological features are discussed.