E.Stewart Taylor

Fetal development as determined by ultrasonic pulse echo techniques

Abstract 1. 1. The biparietal diameter has been shown, by ultrasonic methods, to increase approximately 1.8 mm. per week during the last trimester of pregnancy. 2. 2. In 68 per cent of patients, by measurement of the biparietal diameter of the fetus by the A-scan, it is possible to estimate within ± 484 grams of the actual weight of the infant. In 91 per cent, when the fetal biparietal diameter measures 8.5 cm. or more, the fetus will weigh in excess of 2,500 grams. 3. 3. Use of the calculated circumference of the fetal thorax for estimation of fetal weight gave an error of as much as 500 grams in 20 per cent. Improved techniques may eliminate much of this error. 4. 4. By using the combined estimation of biparietal diameter and chest circumference, it is possible to estimate within 400 grams of the actual weight except in large babies where the tendency is to underestimate the weight.

The intrauterine device and tubo-ovarian abscess

During the past 4 years, 16 patients have been seen who developed a unilateral tubo-ovarian abscess while wearing, or soon after removal of, an IUD. None of the patients had gonorrhea. There appears to be a prodromal syndrome before abscess formation of 2 to 5 weeks during which the patient complains of vague lower abdominal pain, pelvic tenderness, and dyspareunia. A few patients had a rapid onset of symptoms. The device should be removed when prodromal symptoms arise and the patient should be treated with antibiotics. Should a tuba-ovarian abscess develop, surgical intervention is necessary.

Breech delivery: Evaluation of the method of delivery on perinatal results and maternal morbidity☆

A retrospective study of 460 single-gestation infants in breech position was conducted at the University of Colorado Medical Center to assess the impact of a policy for the selection of cases for vaginal delivery. Among infants weighing more than 2,500 grams, there was an increase in the cesarean section rate from 13% to 54%, with an associated increase in maternal morbidity from 7% to 15%. This occurred with no significant reduction in adverse perinatal outcome. However, a case-by-case review suggests that more frequent and timely cesarean sections would have further reduced perinatal morbidity and deaths among term infants. Among the infants weighing 2,500 grams or less there was an increase in cesarean births from 5% to 55% following the introduction of the strict criteria for vaginal delivery. Among the infants weighing 1,501 to 2,500 grams there was no significant difference in survival between the cesarean and vaginally delivered patients. Although infants weighing 501 to 1,500 grams delivered by cesarean section survived more frequently than did those delivered vaginally, the differences in perinatal deaths may have been due to a higher birth weight in the cesarean-delivered infants or an over-all improvement in neonatal intensive care for infants of very low birth weight.

The treatment of premalignant and malignant lesions of the vulva

Abstract We have reviewed our treatment of premalignant and malignant disease of the vulva in 78 patients seen at Colorado General Hospital since 1955. Premalignant lesions can be managed conservatively. Wide local excision or local 5-FU cream usually arrests premalignant disease without further surgery. Patients with premalignant disease treated by one of these methods need to be followed closely in order to detect recurrence. Microinvasive lesions can be treated by wide local excision in selected cases; in others simple vulvectomy is the treatment of choice. Forty-three patients with invasive vulval carcinoma were treated by radical vulvectomy and removal of lymph nodes. Extension at the operation to include the deep retroperitoneal nodes aided in the cure of but one of the 43 patients. Thirty-four patients (79 per cent) are alive and free of disease three to 18 years after radical vulvectomy. Patients with metastasis to regional lymph nodes had a 40 per cent survival rate. If the patients had Stage I, II, or III disease, the presence or absence of positive lymph nodes did not affect the prognosis in our series. All patients with Stage IV disease had positive nodes and eight of nine died.

Hemolytic disease of the neonate secondary to anti-Fya

A case of hemolytic disease secondary to anti-Fya in a neonate requiring exchange transfusion is presented. A review of the literature reveals 18 previous cases, with 32 per cent requiring exchange transfusion and a 16 per Fya-b- or Fya-b+ blood can be obtained for exchange transfusion if indicated.

Ultrasound as a diagnostic aid in diseases of the pelvis

Abstract This study is an evaluation of the usefulness of pulsed echo ultrasound as a diagnostic aid in diseases of the pelvis. The results of the use of this technique in 100 patients, with suspected gynecologic lesions, are presented. Ultrasound appears to be a valuable aid when used in conjunction with other diagnostic procedures. By this method it is possible to outline and define soft tissue pathology not easily detectable by x-ray, and it provides a cross-sectional presentation, thus giving information in a different dimension than is exhibited by other techniques. This procedure is particularly helpful in differentiating between solid and cystic tumors, benign and malignant disease, and free and encysted fluid in the abdominal eavity.

The first year of experience in Colorado with the new abortion law

Abstract On April 25, 1967, Colorado was the first state to enact a modern abortion law. During the first 12 months experience under the new law 407 therapeutic abortions were performed. Two hundred and ninety-one were performed for psychiatric reasons. These were followed in frequency by fetal indications, 47 patients; rape, 46 patients; and the physical health of the mother, 23 patients. The medical, social, and legal aspects of the problem and the methods that Colorado physicians have used for solving the problems are discussed.

Clinical use of ultrasound in obstetrics and gynecology

Abstract During the past three years ultrasound diagnostic procedures have been significant and useful aids in the clinical practice of obstetrics and gynecology at the University of Colorado Medical Center. The technique has had its most important applications in the preoperative diagnosis of hydatidiform mole, in the estimation of fetal maturity, and for localization of the placenta. Other areas of clinical application are in the diagnosis of multiple pregnancy, fetal position, and intrauterine fetal death. Approximately 10 per cent of our obstetric patients receive ultrasound diagnostic procedures. Ultrasound is used much less frequently in gynecology but does have value in the differential diagnosis of ascites, abdominal cysts, and peritoneal carcinomatosis.

Surgical treatment of complications resulting from irradiation therapy of cervical cancer

Abstract The surgical principles involved in the diagnosis and correction of necrotic lesions following irradiation therapy have been discussed. These include skin necrosis, irradiation proctitis, irradiation necrosis of the cervix and vagina, and multiple genital fistulas. Illustrative cases of each category have been presented and the method of treatment used covered in detail.

The first year of the residency program in obstetrics and gynecology

Abstract In order to make the 3 year residency in obstetrics and gynecology most profitable to our residents, a didactic course is offered one afternoon a week throughout the first year of the program which covers the elements of our specialty that should be known to all first-year residents as a basis for further clinical training. This course includes pelvic anatomy, x-ray pelvimetry, ultrasound, gross and microscopic obstetric and gynecologic pathology, endocrinology, and surgical techniques in the dog surgery laboratory. All first-year residents in obstetrics and gynecology take this course. We have found that the effort of providing our residents with this information early in their specialty education has been helpful to them and also beneficial to the program since further experience within the residency can be progressive and all residents then have the same basic orientation.