E. Stewart Taylor

Oxygen saturation of the blood of the newborn, as affected by maternal anesthetic agents.

Abstract 1. 1. Oxygen saturation of capillary blood was studied in 94 full-term newborn infants. Separate determinations were made on 708 samples of blood. The infants were born vaginally by normal spontaneous or outlet forceps delivery following various forms of maternal anesthesia. Capillary blood samples were drawn at birth, one-half hour, and one hour. In some cases, samples were collected at two, three, twelve, and eighteen hours after delivery. The anesthetics studied were regional, ether with and without neonatal supplemental oxygen, nitrous oxide, cyclopropane, and Pentothal Sodium, all carefully administered for short periods. 2. 2. No statistically significant differences were found between the average saturations at birth or at one hour when a single anesthetic agent is compared with regional anesthesia. 3. 3. Significant differences were found when regional anesthesia was compared with the whole group of general anesthetics with respect to percentage of infants whose one-hour oxygen saturation was above 90 per cent. 4. 4. In the regional anesthesia group, 45 per cent of the infants were 90 per cent oxygen saturated, or over, at one hour of life. In the ether series three hours of life were necessary before a similar number of the infants reached 90 per cent oxygen saturation. 5. 5. The administration of oxygen to the newborn infant after maternal ether anesthesia produced no significant changes in oxygen saturation of the infants blood. 6. 6. Artificial resuscitation, which was given if respirations were not spontaneously established within three minutes after birth, was required for none of 30 infants born of mothers receiving regional anesthesia. One of 10 infants from the Pentothal Sodium series, 3 of 10 after nitrous oxide, 14, or 45 per cent, of 31 infants from the ether series, and 7, or 54 per cent, of infants born of mothers receiving cyclopropane anesthesia required artificial resuscitation.

Estriol concentrations in blood during pregnancy.

Abstract Total plasma estriol concentrations and 24 hour total urinary estrogen excretions were measured at frequent intervals during the last half of gestation in a group of selected subjects. The blood analyses frequently gave a more reliable indication of well-being of the infant in utero than the urine analyses and was less inconvenient to the subject. Plasma estriol determination is not substantially more difficult or costly than accurate measurement of the hormone in urine, and the blood analysis therefore should replace the older method.

A comparative study of the disappearance of radioactive sodium from human uterine muscle in normal and abnormal pregnancy

Abstract The pioneering work of several British investigators 1–4 on placental and myometrial circulation has provided a new approach to the study of normal and abnormal physiology in the human gravid uterus. Their methods consist of injecting a tracer amount of radioactive sodium into the intervillous space and/or the myometrium and recording the time for one half of the radioactivity to disappear. Their experimental results show that there is a delay in the disappearance of radioactive sodium from the injected sites in cases of toxemia as compared to normal controls. They interpret these data to indicate reduced placental and myometrial circulation in the toxemias of pregnancy. With the use of this same tracer technique, preliminary studies 5, 6 performed in this department indicated that premature labor was associated with three rather constant factors: reduced urinary excretion of steroid metabolites, increased uterine contractility, and delayed disappearance of radioactive sodium from the myometrium. These changes were observed most frequently in complicated prematurity, but were found also in patients who were delivered prematurely without apparent cause. This study was designed to establish the pattern of disappearance of radioactive sodium from the myometrium during the last half of normal pregnancy and to compare these data with those from abnormal pregnancy, both full term and premature.

Vitamin K administered to the mother during labor as a prophylaxis against hemorrhage in the newborn infant

Abstract This investigation has been conducted as two separate studies. Part I consisted of the determination of the prothrombin activity in normal newborn infants together with observations on the alterations in this activity which result from the administration of vitamin K to the mother. Part II was concerned with the practical application of the knowledge gained from the first study. It aimed to show the value of intra-partum vitamin K administration in reducing the incidence of hemorrhage in newborn infants.

Studies of blood oxygen saturation and causes of death in premature infants

Abstract Four and one-half years of neonatal premature infant results have been reviewed. During this period, 465 infants weighing less than 2,500 grams were born alive on the obstetrical service. The incidence of premature births was 11.7 per cent. The neonatal premature infant mortality for the same period was 13.3 per cent. Careful autopsy examinations were done on the premature infants that died. An analysis has been made of the pathological anatomical findings in infants between 1,000 and 2,500 grams. These findings have been correlated with the obstetrical histories of the mothers and the neonatal courses of the infants. Fifty per cent of the infants died from causes related to anoxia. In addition, a study has been made of the effect of prematurity on the ability of the newborn infant to oxygenate the blood during the early hours of life.

Spontaneous annular detachment of the cervix during labor

Summary Annular detachment of the vaginal portion of the cervix during labor is a rare complication. The basic causes for the condition are an unyielding cervix, disproportion, and a faulty mechanism of labor. The unyielding cervix develops a circular line of cleavage and is torn away at its cervicovaginal junctiva. The fetal mortality has been extremely high (29 per cent). The high rate of stillbirths is due to the long labors, and the small pelves, not cervical detachment per se. In only one instance is spontaneous abortion mentioned as a sequel to cervical amputation. One would expect this to occur more often following amputation of the cervix. Our experience with pregnancy following cervical amputation is that spontaneous abortion occurs frequently. Four women here reported had successful subsequent pregnancies and vaginal deliveries. Gilles patient had five normal deliveries later. DeCostas patient was later delivered by elective cesarean section. The indication for section was the former long difficult labor and the amputated cervix. An elective cesarean section is probably the best way to manage subsequent pregnancies. There will be exceptions to this rule.

Results of vaginal hysterectomy; Immediately and two and one-half to seven years after operation

Abstract 1. 1. One hundred sixty-three vaginal hysterectomy operations were performed at Colorado General Hospital and Denver General Hospital from July, 1946, to July, 1951. 2. 2. Our technique for vaginal hysterectomy is briefly presented. 3. 3. Seventy-four of the 163 patients have been followed for periods varying from two and one-half to seven years. 4. 4. Seventy-seven per cent of results were entirely satisfactory; 14.6 per cent were less than satisfactory anatomically but were asymptomatic, and 8.4 per cent were anatomically unsatisfactory and symptomatic.

A correlation of the cytology of the urinary sediment with endometrial histology.

I N A previous paper weI have reported changes in the cytology of the urinary sediment that correspond to various levels of estrogen and progesterone during the female reproductive cycle. Other,+ 3 have also studied the morphology of the desquamated cells of the urinary tract in relation to hormonal variations. Papanicolaou2 was the first to recognize the influence of estrogen upon such cells. South American worker9 have placed the emphasis upon changes in cells from the anterior urethra, while we have studied cells from the bladder and upper urinary tract. The present study is concerned with a correlation of the cytology of the urinary sediment with the morphology of the endometrium in various normal and pathological states. It is our purpose to demonstrate the response of the urinary smears to the cyclical variations of the female reproductive life by comparison with tissue sections of endometrium obtained at the same time. This study also gives some insight into the hormonal variations in certain pathological states. Methods A total of 53 patients were studied, including 27 women with normal menstrual cycles and 8 postmenopausal women. Pathologic states included 7 patients with anovulatory bleeding, 4 with endometrial hyperplasia, 5 with adenocarcinoma of the uterine fundus, one with ectopic pregnancy, and one with a masculinizing tumor of the adrenal. Specimens of endometrium were obtained by dilatation and curettage of the uterus except in two instances where endometrial biopsies were obtained by means of a Novak curette. At the time of the curettage a ,catheterized urine specimen was obtained. The urine (60 cc.) was centrifuged, and the sediment was smeared and stained by a modification of Papanicolaou’s method.4

A critical analysis of local anesthesia as an agent for the relief of pain in vaginal delivery

Abstract Four hundred seventy-nine unselected vaginal deliveries have been studied for the purpose of estimating: first, how often can local anesthesia be used; and second, if it is used, how efficient is local anesthesia as an agent for the relief of pain? Local anesthesia was used in every case of the 479 patients where possible. All of the patients were questioned within a forty-eight-hour period post partum to obtain their estimate of the local anesthesia used. The results of the analysis showed that one-fourth of the patients admitted to the hospital for vaginal delivery were cases for which local anesthesia was not applicable. This one-fourth of patients either delivered too quickly for the operator to give local anesthesia or the patient was too uncooperative due to her previous analgesic medication. Of the cases in which a pudendal block anesthesia was used, 75 per cent were successes and 25 per cent were failures from the viewpoint of the patients when interviewed. Since local anesthesia is being advocated as a simple and efficient method of pain relief for vaginal delivery, an objective study was undertaken to determine the limitations and general efficiency of local anesthesia in obstetrics.

Estriol production rate measurement studies in pregnant women

Abstract The results of some measurements of estriol production rates in women in the third trimester of pregnancy are described. As is the case with measurement of urinary estriol excretion rates and blood estriol concentration, the range of variation of estriol production rate in the normal subjects is rather wide but the subjects with abnormal gestation so far studied are clearly distinguishable by this measurement. With further experience, this new measurement may prove to be very useful to the clinician.