Johann H. Duenhoelter

Pregnancy performance of patients under fifteen years of age.

Pregnancy performance of 471 patients under age 15 who delivered between 1968 and 1972 was compared with that of the same number of control patients between 19 and 25 years of age. The control group was selected by the paired method technic, whereby each study patient was paired with a control patients utilizing identical race and contribution to hospital cost as the economic determinant. The results of the study showed that young patients differed significantly from the control group in having an earlier menarche and a greater number of recurring pregnancies within 18 months of the initial one. Pregnancy-induced hypertension and pelvic inlet contraction were pregnancy complications occurring more frequently among study patients than control patients.

Fetal respiration: quantitative measurements of amnionic fluid inspired near term by human and rhesus fetuses.

Observations reported now on primate pregnancies, human and rhesus, combined with earlier studies from this laboratory, demonstrate that normally appreciable volumes of amnionic fluid are inhaled and presumably exhaled throughout much of pregnancy. Through use of isotope-labeled red cells and porcelain microspheres placed at varying times in the amnionic sac, as well as fetal squames already present, it has been shown conclusively that inhalation of amnionic fluid is not necessarily a pathologic event. The volumes of amnionic fluid inhaled per 24 hours by human and rhesus fetuses late in pregnancy were remarkably similar, amounting on the average to at least 200 ml per kilogram. These observations confirm the much earlier qualitative studies of some others that previously had generally been discounted by many fetal physiologists.

An analysis of the utility of plasma immunoreactive estrogen measurements in determining delivery time of gravidas with a fetus considered at high risk

Although maternal estrogen excretion and plasma estrogen levels are widely used to assess fetal health, the utility of these tests in lowering perinatal mortality rates has not been established. In order to ascertain if, with the help of plasma immunoreactive estrogen measurements, a reduction in perinatal deaths could be achieved, a population of women with a fetus at high risk were randomly divided into two groups and studied prospectively: in 315 gravidas, the estrogen results were reported (Group A); in 307, they were not reported (Group B). Nine perinatal deaths occurred in Group A, 10 in Group B. Ten Group B women whose infant ultimately did well would have been delivered 28 days or more prematurely if management had been based solely on the basis of abnormal immunoreactive estrogen levels. Measurement of estrogen levels is of little value in management of women with a fetus at risk; it may even lead to erroneous premature delivery.

Fetal respiration: A review

During recent years respiratory movements by the human fetus have been rediscovered. The types of movements have been defined, and their dependence on some physiologic conditions has been described. Pharmacologic agents influence not only the occurrence of the movements but also their rate and depth. A tidal flow of fluid between lung and amnionic sac has been established, which may play an important role in lung development. Demonstration of this route for exchange of water and soluble substances identifies the lung as an organ very likely involved in exchange between fetal compartments. Additionally, the deposition in the lung of the particulate matter contained in amnionic fluid may not be proof of pathologic aspiration as previously thought.

Interruption of early pregnancy with a silastic device containing (15S)-15-methyl prostaglandin F2α methyl ester: Efficacy and mode of action

Abstract The efficacy of an intravaginally placed silastic device containing (15S)-15-methyl prostaglandin F2α methyl ester (15-Me-PGF2α) in inducing abortion was evaluated in 20 pregnant women who were no more than 50 days beyond the first day of their last normal menstrual period. Eighteen pregnancies were interrupted successfully. In 1 woman in whom an intrauterine pressure gauge had been inserted, abortion failed to occur; in another woman who failed to abort, an ectopic pregnancy was later discovered. All women who aborted developed gastrointestinal symptoms; most had severe abdominal cramping pain necessitating narcotic analgesia. Following insertion of the prostaglandin-containing device, the levels of serum hCG fell rapidly, reaching about one-fourth the baseline level within 24 hours. The fall in plasma progesterone and estradiol levels was less pronounced; plasma 17α-hydroxy-progesterone levels—although quite variable—increased during the first 2 hours but by 24 hours had fallen to an average value of 27.4% of the baseline level. Plasma levels of 15-Me-PGF2α, measured in 6 patients, varied greatly.

Reliability of Sonar Fetal Cephalometry in the Estimation of Gestational Age and in the Diagnosis of Fetal Growth Retardation

The reliability of sonar biparietal diameter measurements and the assessment of the sources of potential error are of great importance in the estimation of gestational age and in the diagnosis of fetal growth retardation. The following study was undertaken to ascertain the reproducibility of several successive steps in the measurement of the biparietal diameter and to compare intrauterine sonar measurements with direct caliper measurements after abortion of delivery. Tables were developed from these data from which it can be ascertained if a growth rate found during a specific period in gestation is above or below the mean or below the tenth, fifth or first percentile.

A Paired Controlled Study of Vaginal and Abdominal Delivery of the Low Birth Weight Breech Fetus

In a paired, controlled, retrospective study, 44 low birth weight breech fetuses delivered vaginally were compared with 44 breech fetuses delivered by cesarean section. Seven deaths occurred in the vaginal delivery group, compared with only 1 in the abdominal delivery group. Asphyxia, trauma, and intracranial hemorrhage were also found more frequently among vaginally delivered fetuses. The authors conclude that for the low birth weight breech fetus, delivery by cesarean section is preferable.

Sonar fetal cephalometry: Comparison of bistable with gray scale and real-time techniques

The fetal biparietal diameter was measured simultaneously with B-scan bistable and gray scale techniques and subsequently with real-time ultrasonography. Measurements were made from outer table to outer table with the bistable technique, which has been proven to be accurate and reliable. With the gray scale and real-time modalities, distances were measured between several landmarks from the same image. Off all measurements taken from gray scale and realtime images, those between the centers of each band outlining the fetal skull showed the best correlation and the closest values to measurements using the standard bistable technique. Discrepancies exceeded 2 mm in only 5% with the gray scale and in 2% with the real-time technique. Using the measurement between outer and inner aspects of the cephalic band, the percentages of discrepancies exceeding 2 mm were 7% with gray scale and 6% with real time.

Human fetal respiration: IV. Failure of severe distress to stimulate aspiration of amniotic fluid by the immature human fetus

Reported herein are studies on fetal breathing, specifically the inhalation of labeled amniotic fluid, by immature human fetuses so severely distressed that they subsequently died in utero. Decreased rather than increased amounts of the amniotic fluid label were found in the lungs of the distressed fetuses compared to the amounts in fetuses of comparable weight that were not distressed. We conclude from this study of the immature human fetus that severe distress depresses rather than stimulates aspiration of amniotic fluid.

Medikamentse Interruptio der Frhschwangerschaft mit intravaginal appliziertem (15S)-15-Methyl-Prostaglandin F2? Methylester (15-S-PGF2?)

10 patients underwent intravaginally (15S)-15-methyl-prostaglandin F2 alpha-methylester application to induce abortion. The last menstrual bleeding had occurred less than 50 days prior to the operation and NCG was determined in urine samples in all cases. The dissolution of the amniotic sac occurred within 4-5 hours after application, and the remains were removed by curettage in 7 cases, usually without narcosis or analgesia. The procedure failed in 2 cases, one due to ectopic pregnancy and one due possibly to bleeding from the uterus after insertion of a catheter, which may have inhibited resorption of the prostaglandin.