John H. Randall

The hazards of elective induction of labor

Abstract 1. 1. A review of 6,860 cases of electively induced labors has been presented. 2. 2. The most effective method of inducing labor is simple amniotomy. 3. 3. Eighty-two and three-tenths per cent of the patients were in labor within 4 hours, and only 2.3 per cent had a latent period of over 24 hours. 4. 4. Pitocin stimulation was used in patients with prolonged latent periods or desultory labors with intrapartum fever. 5. 5. Serious though must be given to performance of cesarean section when the latent period is prolonged and infection is present, if labor cannot be stimulated within 24 to 36 hours. 6. 6. There was one maternal death related to induction. 7. 7. The principal fetal hazards were (a) prematurity, 3.1 per cent; (b) prolonged latent period, 5.0 per cent; (c) malpresentation, 0.9 per cent; (d) prolapsed cord, 0.3 per cent. 8. 8. There were 6,889 babies born. Of these, 37, or 0.6 per cent, were 9. stillborn, and 55, or 0.8 per cent, died neonatally. The perinatal mortality was 1.4 per cent. 10. 9. Thirty-nine of the perinatal deaths (0.6 per cent of the babies delivered) were directly related to the elective induction. 11. 10. A conservative attitude should be maintained by the specialist toward the elective induction of labor. The average general physician should allow labor to start spontaneously.

Tubal sterilization; a review of 1,169 cases

Abstract During recent years 12 patients who had been sterilized at the University of Iowa Hospitals by the Madlener technique are known to have become pregnant. These failures stimulated this study in which the records of all patients sterilized were reviewed in regard to indications, the various techniques employed, the morbidity, and the end results of operation. An attempt was made to follow each patient by personal interview or letter, and was successful in 68 per cent. The remaining 32 per cent were considered to have been successful since failures of this nature usually are brought to the attention of the institution or surgeon.

Prolapse of the umbilical cord

Abstract Prolapse of the umbilical cord is a complication of parturition which frequently leads to fetal death. For purposes of this study, presentation of the cord is considered to be that condition in which the umbilical cord lies below the presenting fetal part with intact membranes, and prolapse as that condition in which the cord is discovered alongside of or below the presenting part with ruptured membranes. Sixty-three cases of prolapse of the cord occurred among 15,578 deliveries at the State University of Iowa Hospitals between Jan. 1, 1940, and Dec. 31, 1953. This represents an incidence of 0.4 per cent or a ratio of 1 to 250 deliveries. A collection of statistics from 24 different authors showed 4,296 prolapsed umbilical cords in 669,547 deliveries, which is a ratio of 1 to 156. In this review of the literature, the maximum incidence was 1 to 74 in 20,000 deliveries by Cragin 1 and the minimum, 1 to 1,018 by Doerr 2 in 25,461 deliveries.

Experience with extraperitoneal cesarean section at the University of Iowa Hospitals

Abstract 1. 1. A review of fifty-six extraperitoneal cesarean sections is presented. 2. 2. There were no maternal deaths. Three children did not survive, an infant mortality of 5.3 per cent. 3. 3. Our results with the supravesical extraperitoneal cesarean section have been sufficiently satisfactory to justify our continued use of the procedure in grossly and potentially infected patients requiring abdominal delivery.