Horace E. Thompson

A controlled trial of the differential effects of intrapartum fetal monitoring

A controlled prospective study of the differential effects of intrapartum fetal monitoring on mothers and infants has been conducted at Denver General Hospital, Denver, Colorado. A total of 690 high-risk obstetric patients in labor were randomly assigned to one of three monitoring groups--auscultation, electronic fetal monitoring alone, or electronic monitoring with the option to scalp sample. There were no differences in immediate infant outcomes in any measured category (Apgar scores, cord blood gases, neonatal death, neonatal morbidity, nursery course) among the three groups. There were no differences in rates of infant or maternal infections. The cesarean section rate was markedly increased in the electronically monitored groups, especially in the electronically monitored alone (18%) as compared with the auscultated (6%) (P less than 0.005). In this controlled trial electronic monitoring did not improve neonatal outcomes and the mothers were at increased risk of cesarean section.

The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy

Intrapartum electronic fetal heart rate monitoring of the high-risk obstetric patient is thought to improve the perinatal outcome. A prospective randomized study of 483 high-risk obstetric patients in labor was carried out comparing the effectiveness of electronic fetal monitoring with auscultation of fetal heart tones. The infant outcome was measured by neonatal death, Apgar scores, cord blood gases, and neonatal nursery morbidity. There were no differences in the infant outcomes in any measured category between the electronically monitored group and the auscultated group. The cesarean section rate was markedly increased in the monitored group (16.5 vs. 6.8 per cent in the auscultated patients). The presumptive benefits of electronic fetal monitoring for improving fetal outcome were not found in this study.

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.

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.

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.

The contrast pressure technique for female sterilization

The contrast pressure technique for female sterilization and its app lication are discussed. The technique utilizes a cannula or catheter which is introduced through the cervix and guided toward either cornu of the uterus with an inflatable balloon attached. After inflation of the balloon, fluids introduced into the cornu are confined to the cornu and fallopian tubes. The technique allows the introduction of X-ray contrast medium into the fallopian tubes with minimal peritoneal spillage. In 12 cases, contrast material was successfully introduced, in vivo, in each patient after patency of the tubes had been established by a flow of carbon dioxide. Most of the patients reported uterine cramping of various intensities. The instrument affords the possibility of chemical tubal occlusion by a transcervical approach on an outpatient basis.

Factors contributing to improved maternal care and fetal outcome in a medium-sized city-county hospital

Abstract During the past 5 years the perinatal mortality rate at Denver General Hospital has been reduced from 4.1 to 2.7 per cent. This decrease has been attributed to a number of factors: (1) Federal grant support has made possible the establishment of multiple obstetric clinics throughout the city where comprehensive health care can be obtained along with family planning services; (2) a new, modern hospital has been acquired; (3) there is an increased number of highly competent full-time staff; (4) new concepts of evaluation and management of the high-risk gravida and her infant have been implemented; and (5) a modified therapeutic abortion law is now in effect. These factors along with the effect of a changing obstetric population and the decreased incidence of low-birth-weight infants are discussed. Efforts to improve obstetric care further at this hospital are continuing and are enumerated.

Chemical occlusion at the uterotubal junction in monkeys

Abstract The current population explosion has stimulated interest in finding a simple transcervical approach to female sterilization. This experiment was designed to evaluate the potential of effecting tubal occlusion by producing a chronic lesion in the myometrium surrounding the lumen of the Fallopian tube. The method chosen was the injection of a chronic tissue irritant (paraformaldehyde) transcervically into the uterine cornua. Paraformaldehyde in aqueous suspension, with the use of various concentrations, was injected into the cornual area of monkey uteri. The histologic results were inconsistent and poor. Another group of monkeys was injected with paraformaldehyde suspended in absolute ethanol. This resulted in histologic evidence of an acute and chronic lesion in the myometrium in 90 per cent of the animals treated. The details and results of this experiment are described. The potential of using paraformaldehyde in an absolute ethanol suspension injected into the human uterine cornua as a means of producing permanent sterilization is discussed.

Distribution of liquids introduced into the uterus with a simple “nonocclusive” cannula

Abstract In order to investigate possible reasons for inconsistent tubal occlusion when a suspension of quinacrine is introduced into the uterus, the following radiographic investigations were carried out: 4ml of renografin 60 which has the same approximate viscosity as a suspension of quinacrine, were introduced into the uteri of sixteen normal parous women and the distribution followed by fluoroscopy and x-ray. The same type of instrument which had previously been used to introduce quinacrine, namely, a 3.4mm cannula with no cervical occlusive tip, was employed. The contrast material failed to enter one or both oviducts in four out of sixteen cases (25%), even though subsequent hystero-salpingograms revealed patent oviducts. However, if patients wearing IUDs were excluded, renografin 60 failed to enter the patent oviducts in only one out of eleven cases (9%). A much more viscous contrast material, Salpix, failed to enter patent oviducts in one out of thirteen women (8%) including three who were wearing IUDs. There was less peritoneal spillage with the more viscous contrast material. These studies suggest that failure of a suspension of quinacrine to enter the oviduct is at least one reason for failure of this technique to occlude the fallopian tube. They also suggest that a more viscous preparation may lead to more consistent filling of the oviducts when a cannula without an occlusive tip is used to introduce the preparation into the uterus.