E.D. Plass

Respiration and pulmonary ventilation in normal nonpregnant, pregnant, and puerperal women

Abstract 1.1. The respiratory rate is increased slightly from the fourth lunar month of gestation to term. 2.2. The volume of tidal air and the minute volume of respired air increase progressively during pregnancy and return to normal during the second week after delivery. 3.3. The minute volumes of CO 2 produced and of O 2 absorbed increase gradually during pregnancy and approach the normal nonpregnant level from one to two weeks postpartum. 4.4. The ratio of the minute volume of respired air to the CO 2 expired is greater in pregnant than in nonpregnant women. One week after delivery this ratio is less than during pregnancy but still greater than in nonpregnant controls.

Water concentration of the blood during pregnancy, labor, and the puerperium

Abstract During the active childbearing function of women, the water concentrations of whole blood, plasma, and cells follow the same general curve, which is the reverse of that noted for specific gravity of whole blood and plasma, cell volume, plasma proteins, and hemoglobin content of whole blood. These findings confirm the conception of a blood dilution during pregnancy with prompt elimination of the excess water during parturition and the puerperium. There is evidence that the body attempts to compensate for this dilution by increasing the hemoglobin content of individual cells, which consequently show an increased specific gravity. The slight anemia of normally pregnant women recognized by clinical methods is only apparent and can be explained by physiologic dilution of the blood associated with an increased blood volume, and by the further dilution of finger-prick blood with the fluid from edematous subcutaneous tissues.

Basal metabolism studies in normal pregnant women with normal and pathologic thyroid glands

I T IS generally agreed that there is a definite increase in the basal metabolic rate during the latter part of normal pregnancy, but that this increase is “due to the increasing mass of active protoplasmic tissue, consisting of a large part of the fetal tissues and in lesser part of maternal structures” (Sandiford and Wheeler’), and is very moderate in extent. This argument is supported by the fact that subtraction of the calculated heat production of the fetus from the total heat production of the pregnant woman leaves the metabolic rate of the latter unaffected by gestation, and by the observation that almost immediately after delivery the metabolic rate falls to a point corresponding with that obtaining in early gestation or before conception. When expressed in terms of the Aub-Dubois prediction standards, the total increase due to the rapid metabolism in the fetal tissues rarely amounts to more than 15 per cent. If one accepts the statement of Benedict? that all prediction standards are 5 per cent too high for normal women, the normal metabolic rate would range from minus 15 to plus 5 per cent according to the st,andards now in use. Using an increase of 15 per cent during pregnancy as the maximum which may be attributed to an augmentation of the active protoplasmic mass, it would be reasonable to view as potentially abnormal any rate above plus 20 per cent. However, Gustafson and Benedict” insist that even among 10 presumably healthy individuals at, least one or more “will have a metabolism deviating more than plus-minus 10 per cent from the standards. ” This would lead one to anticipate readings of slightly higher or lower values in 10 to 20 per cent of any series. Mussey, Plummer, and Boothby’ say that “a basal metabolic rate of plus 25 or even plus 30 is not necessarily an indication of hyperthyroidism in the latter months of pregnancy,” and thus recognize the occasional variations pointed out by Gustafson and Benedict3 It would seem to be well demonstrated that a high basal metabolic rate unsupported by clinical evidence of hyperthyroidism does not warrant a diagnosis of abnormal thyroid activity. In order to add furt,her confirmation t,o the various previous reports on the basal metabolism of normal pregnant women with normal thyroid glands, and to investigate the metabolism in various varieties of

The Hydrogen Ion Concentration of Human Vaginal Discharge

Summary The available literature on vaginal acidity is reviewed. A quinhydrone microelectrode for the determination of the pH of undiluted vaginal discharge is described and its operation detailed. The pH of the vaginal discharge varies directly with the character of the vaginal flora, higher acidities being associated with a preponderance of the vaginal bacilli of Doderlein which are normally present in pure culture but may be entirely absent in certain infections (gonorrhea). The vaginal discharge is normally quite acid (pH 4.0 to 4.5) during the intermenstrual period but approaches or exceeds neutrality during the early days of menstrual bleeding. During gestation the acidity is somewhat less than in the nonpregnant, irrespective of the bacterial character of the discharge. The pH of the upper (posterior) vagina is usually slightly lower than that of the lower (anterior) portion. Dilution of the vaginal discharge with neutral water tends to raise the pH although the acidity of vaginal washings may be higher than that of the undiluted discharge.

Premature elective rupture of the membranes

Abstract In 1936, Plass and Seibert 1 reported on the results obtained in 681 consecutive patients in whom premature rupture of the membranes had been employed as a means for inducing labor, and concluded that this procedure offers the safest and most efficient method for inaugurating parturition. Since the series included 84 patients who presented some complication of pregnancy and since no control material was utilized, the data did not permit a real comparison except in most general terms. Because of the apparent good results, and because of the peculiar conditions in regard to obstetric patients in the University Hospitals, elective premature rupture of the membranes has been employed extensively during the intervening period. The present study was designed to permit an accurate comparison between patients who had late spontaneous rupture of the membranes and those who were subjected to induction of labor by elective early rupture of the bag of waters.

An evaluation of prophylactic penicillin administration to parturient women

T HE effectiveness of penicillin in combating postpartum infections has suggested its use prophylactically during labor. The drug has already been used by Ode11 andPlassl in the control of intrapartum infections with considerable benefit to both mother and child. On the basis of these casual observations, it, seemed advisable to learn more accurately if penicillin administration during labor and the early puerperium would produce a significant reduction in the number of puerperal fevers. This study was directed at ascertaining this information by means of controlled experimental use of the drug. The patients were delivered in the Department of Obstetrics and Gynecology of the State University of Iowa.Hospitals between Feb. 3,1947, and Feb. 1,1948. So far as was practicable, alternate patients as determined by the delivery room nurse received prophylactic penicillin” according to a predetermined schedule. The only patients excluded were those delivered by the abdominal route and those receiving penicillin therapeutically prior to the onset of labor. All patients were delivered under similar delivery room technique by medical students, residents, or the senior staff. Postpartum temperatures were taken by mouth every four hours (excluding 2:00 A.M.) during labor and the postpartum stay, which averaged from six to nine days.

Latent gonorrhea in obstetric patients

Abstract The gonococcus has long been identified as an etiologic factor in puerperal morbidity and the syndrome of second-week fever associated with lower abdominal pain and considerable general reaction has been recognized as characteristic of this type of puerperal infection. It has also been appreaciated that certain women who harbor gonococci even during the last month of pregnancy suffer no such complication, but the true extent of such silent infections could not be demonstrated. Recently improved cultural techniques offer the opportunity to approximate more closely the true frequency of latent gonorrheal infections. This report is concerned with an investigation by modern bacteriologic methods of the vaginal flora of a consecutive series of patients admitted to the University Hospitals for delivery.

Syphilis in obstetrics

Abstract Syphilis is an obstetric problem of considerable significance among patients in the lower economic groups, even in a predominately rural state such as Iowa, where most of the people are native born whites. The fate of the offspring of syphilitic women appears to depend less upon the duration of the infection at the time of conception and previous antisyphilitic therapy than upon the character and extent of treatment during pregnancy. The best results are obtained when treatment during pregnancy follows anteconceptional therapy. None of the diagnostic measures available makes possible the determination of the syphilitic status of the child of a syphilitic woman during the neonatal period. Standard serologic tests are practically pathognomonic at the age of two or three months and are alone to be depended upon. The syphilitic pregnant woman appears especially likely to develop treatment reactions to the arsenical antisyphilitic drugs, which should, therefore, be used with caution.

Intrapartum fever: A preliminary study

Abstract Fever during labor may be due to dehydration, extragenital disease, or birth canal infection. The last is diagnosed by excluding the other two, or by the discharge of foul material from the tract. The primary lesion in infections of the genital tract is an amnionitis (placentitis) which subjects both the mother and the child to serious sequelae. In the mother, puerperal infection frequently develops and may be fatal, while aspiration pneumonia and septicemia by direct extension into the placental vessels constitute the chief risks to the child. In this series of 187 febrile labors, 129 presented evidence of birth canal infection alone or in combination with an extragenital factor. In the latter group, eight mothers and sixty-one infants died, mortality rates of 6.2 per cent and 46.9 per cent, respectively. Dehydration fever was followed by no maternal or fetal deaths, but pyrexia of extragenital origin (no evidence of uterine infection) led to a maternal death rate of 36.8 per cent and a fetal mortality rate of 42.2 per cent. Treatment of dehydration fever and of extragenital diseases followed usual lines. On the other hand, therapy of intrapartum birth canal infections has been significantly and favorably altered by recognition of the dangers involved and by the use of the newer antibiotics, the sulfonamides, and penicillin, prophylactically and curatively.

Secondary perineorrhaphy at a subsequent delivery

Abstract In secondary perineorrhaphy performed immediately after a subsequent delivery, the obstetrician has available a procedure, which (1) is technically simple, (2) gives more generally satisfactory results than do similar operations performed some time after the last preceding pregnancy, (3) is economically advantageous for the patient because it avoids a separate hospitalization solely for the repair, and (4) usually does not complicate convalescence nor increase appreciably the duration of postpartum hospitalization. It is, therefore, recommended for consideration by those who are familiar with the surgical principles involved in the repair of perineal lacerations and relaxations.