Edward A. Graber

A sign of placental separation

Abstract 1. When using ergonovine at the end of the second stage of labor, the mechanism of delivery of the placenta is different. The placenta separates almost immediately. It is, therefore, mandatory that it be removed soon after separation, otherwise the incidence of incarceration increases markedly. 2. The classic signs and symptoms of separation of the placenta described in the standard textbooks do not apply when ergonovine is used in the second stage. 3. A simple sign is described which will aid in determining when the placenta is to be delivered. Simple palpation of the placenta within the lower uterine segment when moderate pressure from above is used on the fundus is indicative of placental separation. This is the only reliable sign. Delivery of the placenta by expression or the Brandt maneuver should be carried out forthwith.

The case for and against estrogen therapy.

Advertisements for estrogens frequently show a middle-aged woman in the kitchen being kissed by a middle-aged man. The implication obviously is that this happy state results because she has had an adequate daily dose of estrogen. Estrogens should be and have been prescribed for more than 35 years for menopausal women for severe symptoms of estrogen withdrawal. However, a few gynecologists have suggested that the menopause is a deficiency disease, and that estrogen should be given from the onset of the menopause until death to reverse this abnormality. Thus, automatically one would remain young, healthy, sexually attractive, desirable, youthful, and sensuous. Their therapeutic enthusiasm and evangelistic preaching in the lay press is based on assumptions that ca not be scientifically substantiated. Facts about the prophylactic use of estrogen must be examined in the light of presently known facts. Aging cannot be prevented by estro-

Questions and answers on ovarian cancer

Accidental rupture of the smooth surfaced, freely movable cyst will proba bly have little unfavorable effect on prognosis. The exception may be the mu cinous cystadenoma or carcinoma whose fluid content varies from a stringy, sticky mucus to a secretion the consistency of wet glue. It is this adhesive property that creates pseudomyxoma peritonei following rupture or spillage from the cyst. Rupture of a soft vascular ovarian tumor which is densely ad herent and directly infiltrated suggests a poor prognosis. Obviously, prognosis represents the extent of disease and is not directly related to spillage.

A clinical test for pregnancy

It was also found that the clinical effects of the 0.07 mg. ethinyl estradiol sequential therapy on cyclic regulation of menstruation, dysmenorrhea, and the skin approximated the data obtained in the 0.1 mg. ethinyl estradiol regimen.3 Although the incidence of side effects was unchanged by lowering the dosage, there was a mollifying effect upon the intensity of untoward symptoms. The study, therefore, showed that the consistently effective minimum daily dose of ethinyl estradiol would be higher than 0.07 mg. for the purpose of conception control.