James E. Fitzgerald

Extrauterine pregnancy: A clinical study of 500 cases

Abstract 1. 1. A series of 500 extrauterine pregnancies is presented. 2. 2. A long period of sterility preceding the extrauterine pregnancy was not the rule in this group. 3. 3. Pain of some type was the most common symptom. In two-thirds of the patients sudden, severe pain was noted. 4. 4. In the majority of the unruptured cases the pain was of a cramping character. 5. 5. Abnormal bleeding was present in a majority of the patients. 6. 6. Approximately one-third of the patients had missed no menstrual period. 7. 7. Severe collapse occurred in 18.2 per cent. 8. 8. Fainting was noted in 29 per cent of the patients. 9. 9. Over half of the patients had a temperature above normal. 10. 10. Extreme pelvic tenderness was present in nearly three-fourths of the cases. 11. 11. The mortality rate was 7.8 per cent. 12. 12. Blood transfusion is the most important single factor in the treatment of cases in collapse.

The management of pregnant women with heart disease

Abstract A series of 126 women with severely damaged hearts has been under observation and strict control during 192 pregnancies. No patient died during pregnancy or labor. One died six weeks postpartum from an acute bacterial endocarditis which developed after labor. One died nine months postpartum at the age of forty-five. No patient was delivered by cesarean section because of the heart condition. The most important factor in the care of these patients is the prevention of heart failure. In this effort the cooperation of an internist and an obstetrician, both of whom have had wide experience in observation of these patients, is invaluable. When heart failure is prevented during pregnancy, disaster during labor or in the postpartum period is a very rare occurrence. It has been our experience that in the absence of obstetric complications necessitating other procedures, delivery per vaginam produces results that are extremely gratifying.

Continuous caudal anesthesia with pontocaine: Obstetrician's viewpoint

Abstract 1.1. Two hundred cases of continuous caudal anesthesia are presented and discussed mainly from the viewpoint of the obstetrician. 2.2. Pontocaine-suprarenin-saline solution has proved a safe agent for this method providing 3 to 5 hours of relief from the first dose, and 1 or more hours of relief from subsequent injections. 3.3. Certain precautions are outlined, but the detailed technique is reserved for another publication. Adherence to a strict regime is advised. 4.4. Tables are given quoting figures on duration of labor under caudal anesthesia and time required to complete cervical dilatation. We find that cervical dilatation is not accelerated in this series. 5.5. The incidence of operative deliveries is increased. 6.6. Several disadvantages of caudal anesthesia are discussed. 7.7. The results and complications are classified, including 1½ per cent total failures, and 13 per cent additional not completely satisfactory. One hundred seventy-one of 200 cases were completely satisfactory. One prolonged neurological complication is reported. 8.8. There was no maternal mortality. Fetal mortality was 3.0 per cent. ∗ ∗See Discussion on Symposium on Obstetrical Anesthesia, page 85.