Henryk Zuckerman

Further study of the inhibition of premature labor by indomethacin Part II double-blind study

In the etiology of premature labor prostaglandins fulfill a significant role. It is known that indomethacin is a strong inhibitor of prostaglandin synthesis. The effect of indomethacin on premature labor was studied in a prospective randomized double-blind study in 36 patients. Eighteen patients received indomethacin and eighteen received placebo. 200-300 mg of indomethacin was the total dosage in a 24 hours period. The activity of the uterus was monitored with a cardiotocograph. The mean duration of pregnancy and the mean birth weight in indomethacin group (36.4 weeks, 2833 g) were both significantly greater (p less than 0.001) than that in placebo group (31.2 weeks, 2028 g). In the indomethacin group 3 children weighted less than 2500 g compared with 14 in placebo group. In 15 of 18 indomethacin treated patients (83.3%) premature labor was arrested after indomethacin treatment compared with 4 of 18 in the placebo group (22.2%). The indomethacin group had a mean 1 minute APGAR score of 9.3 +/- 0.2 whereas the placebo group showed a score of 7.8 +/- 0.5 (p less than 0.01). Three infants died from respiratory distress syndrome; one in the indomethacin group (1810 g) and two in the placebo group (600 and 1450 g). Autopsies in the infants demonstrated a typical picture of pulmonary atelectasis and hyaline membranes. There was no evidence of premature closure of the ductus arteriosus or pulmonary hypertension. 2 mothers in the indomethacin group suffered minor discomfort i.e. nausea, vomiting and vertigo.(ABSTRACT TRUNCATED AT 250 WORDS)

Further study of the inhibition of premature labor by indomethacin. Part I

Prematurity still remains one of the unsolved problems in obstetrics and is responsible for a majority of cases of perinatal morbidity and mortality. The use of indomethacin to stop uterine contractions and prevent premature delivery is based on the observation that indomethacin inhibits the release of prostaglandin which is assumed to play a role in the induction and continuation of labor. The effect of indomethacin as an antagonist to prostaglandin was evaluated in a series of 297 women in premature labor. The gestational age at admission varied between 24 and 34 weeks of pregnancy (120 primiparas and 177 multiparas). In 83% of cases there was complete cessation of labor for a period of 1 to 12 weeks, in 10% of cases from 2 to 7 days and in 7% there was no effect. The delay of premature labor for 2 to 7 days allowed the administration of betamethasone in an attempt to improve fetal lung maturity. The total daily dose needed for successful treatment was between 200-300 mg indomethacin. Dilation of cervix beyond 4 cm was associated with successful treatment in 58% compared to 90% if cervix was dilated 3 cm or less. In comparing women with intact membranes to women with ruptured, the success rate in suppressing premature labor was significant; 88% versus 53%. In 49 patients delivery was delayed 11-12 weeks. Fifty-one babies were born in spite of therapy, and of these 15 with birth weights of 700-1500 g suffered from respiratory distress syndrome and died. All the rest (36 premature and 246 mature infants) showed no ill effects related to the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound determination of fetal sex.

The technique of specific mixed agglutination to detect small populations of Rh-positive blood cells was described in detail by Greendyke and associates. This technique has been modified by Sebring and Polesky3 and applied to the detection of fetomaternal hemorrhage. The specific mixed-agglutination technique can theoretically detect a fetomaternal bleed of as little as 0.02 ml of Rh-positive fetal blood in the circulation of a 60 kg Rh-negative woman.• 3 In the case reported here, the negative specific mixed-agglutination test indicated that the supposed fetal cells in the maternal circulation were Rh negative. These hemoglobin F -containing cells may have been either fetal or maternal in origin; in neither case was Rh-IG administration indicated. We recommend the use of the specific mixedagglutination technique to determine the fetal Rh blood group in Rh-negative women who appear to have experienced fetomaternal bleeding. In the future it it likely that maternal blood samples will be evaluated more frequently for the presence of fetomaternal hemorrhage. The specific mixed-agglutination technique may be used to guide the management of Rhnegative pregnant women who appear to have fetal blood in the circulation.

Pelvic Inflammatory Pseudotumor (Xanthogranuloma)

Abstract. A case is presented of a patient with xanthogranulomatous pseudotumor in the pelvic region. The pseudotumor was probably the result of inflammatory reaction in both tubes and in the uterine cavity, with pyometra. The condition is very rare and only 5 cases could be found in the literature.

Obstructive Renal Failure and Pleural Effusion Caused by the Gravid Uterus

Acute renal failure due to ureteral obstruction by the gravid uterus is considered to be a rare complication of late pregnancy. Pleural effusion caused by urinary tract obstruction is also extremely uncommon. This presentation reports what is believed to be the first case in which both these complications appeared at the same time in a pregnant patient.

Assessment of gestational age by ultrasonic measurement of the femur length

Abstract. The effectiveness of ultrasonic femur length measurement from 12 to 40 weeks gestation, as a means of assessing fetal age, was tested and compared with that of bi‐parietal cephalometry. The femur length and biparietal diameter (BPD) were obtained from 471 measurements, from pregnant women with confirmed datings, using real‐time scanning with a 3,5 mHz transducer frequency. Using a freeze frame and electronic calipers, the mean value of three consecutive measurements of the femur, when vizualized with its characteristic appearance, was recorded. Linear regression analysis with the correlation coefficient of the femur growth‐curve (r = 0.989, p<0.001) and that of the BPD (r = 0.985, p<0.001) showed that the former is as good as the latter. The femur growth‐curve from 12 to 40 weeks gestation with a mean ±2 SD was constructed. Estimation of fetal age by femur length measurement was compared with that assessed by the BPD in a further 54 women. A close correlation was found (r = 0.993, p<0.001). Measurement of the fetal femur appears to be a reliable method for assessing gestational age, which can compensate for the limitations of the BPD method.

Prenatal Ultrasound Diagnosis of Intestinal Calcifications with Imperforate Anus

The ultrasonic findings in low gastro-intestinal tract obstruction have been described as “dilated loops of bowel”, (2) a condition which may occasionally also be seen in normal pregnancies (5) . This case report describes a rare entity of an imperforate anus in association with recto-urethral fistula, and with intraintestinal sonoreflective calcifications which suggested the low gastro-intestinal tract anomaly.

Estrogen-producing Sertoli cell tumor of the ovary—A case report

Estrogen-secreting Sertoli cell tumor of the ovary is rare. The few cases reported were characterized by metrorrhagia suggesting the hyperestrogenic state. An additional case of Sertoli cell tumor is reported in which the clinical picture is of secondary amenorrhea followed by metrorrhagia. The endocrinological status was investigated by hormonal assays showing a high level of estradiol, which was consistent with endometrial biopsy. A review of the literature together with a discussion on the histogenesis and diagnosis of the tumor is presented.

Midtrimester diagnosis of endocardial fibroelastosis and atrial septal defect: A case report

We present a case report of endocardial fibroelastosis combined with atrial septal defect in which the diagnosis was strongly suspected at 25 weeks of gestation. To our knowledge the only previous report of prenatal diagnosis of endocardial fibroelastosis was of one made at 36 weeks of gestation.

Serum ovarian steroids, prolactin and prostaglandin metabolites in women using the inert intrauterine device

Serum levels of 17β estradiol, progesterone, prolactin and metabolites of prostaglandins E2 and F2a were investigated in 18 healthy women before and after insertion of a Saf‐T‐Coil intrauterine device. The results suggest that the presence of an intrauterine device may cause hormonal changes affecting the luteal phase of the menstrual cycle.