Juan M. Jimenez

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.

A prospective study of angiotensin II pressor responsiveness in pregnancies complicated by chronic essential hypertension

The present study was designed to (1) outline, in a prospective manner, vascular responsiveness to angiotensin II (A-II) in gravidas with essential hypertension and (2) ascertain if increased sensitivity to infused A-II could be detected before worsening of hypertension developed in those women who were destined to develop superimposed pregnancy-induced hypertension (PIH). Sixty-three women with chronic essential hypertension were studied sequentially throughout pregnancy and two groups of patients were defined on the basis of clinical outcome and serial measurements of vascular reactivity to exogeneously administered A-II. The first group consisted of 29 gravidas with chronic hypertension alone and the second group was composed of 34 patients with chronic hypertension who were destined to develop superimposed PIH. Vascular resistance to infused A-II (more than 7 ng. per kilograms per minute required to increase diastolic blood pressure 20 mm. Hg) was observed from weeks 21 to 27 of gestation in both groups of patients. In the gravidas with essential hypertension alone, resistance to A-II persisted throughout the remainder of pregnancy. However, in those women destined to develop PIH, an increased sensitivity to A-II developed after week 27 of gestation and the differences in mean values between the two groups of patients became highly significant after week 30 of gestation (P less than 0.025). although individual determinations obtained in both groups of patients between weeks 28 and 32 of preganncy suggested that pressor responsiveness to A-II might be used as a screening technique to identify those women destined to develop PIH, additional studies conducted between weeks 28 and 32 of gestation will be required before the efficacy of such a screening technique is clearly established.

PHOSPHATIDIC ACID PHOSPHOHYDROLASE AND PHOSPHOLIPIDS IN TRACHEAL AND AMNIOTIC FLUIDS DURING NORMAL OVINE PREGNANCY

Summary: Samples of amniotic fluid and fetal tracheal fluid were obtained from 36 ovine mancies which were studied either acutely or chronically during the last two-thirds of ation (65 to 149 days). The specific activity of phosphatidic acid phosphohydrolase (Pase), disaturated lecithin (DSL), total phospholipids (TPL), and the L/S ratio were Eyed in the amniotic and tracheal fluids. There was a significant and progressive ease in the specific activity of PAPase in trache3 fluid beginniqaher 110 days, easing from 66 t 7 nmoles phosphate released x mg-1 protein x hour-1 (Mean ± S.E.M.) I days, to 107 ± 6 at 111 to 120 days, and to 277 ± 70 at 131 to 144 days. The rise in case specific activity was followed by a parallel rise in the DSL fraction of the TPL DS-L/TPL ratio), increasing from a DSL/TPL ratio of 0.06 ± 0.01 in fetuses ≤ 120 days, 0.29 ± 0.06 at 121 to 130 days, and to 0.50 ± 0.18 at 131 ± 135 days. The PAPase specific activity and the L/S ratio in amniotic fluid did not change during pregnancy.Speculation: Neonatal respiratory distress syndrome is the result of inadequate production of race active material by the fetal and neonatal lung. The enzyme PAPase occupies a tral role in the biosynthesis of the glycerophospholipids, and increases in the specificity of PAPase in human amniotic fluid and in fetal rabbit lung tissue precede or are parallel with the increase in the L/S ratio and pulmonary surfactant synthesis, reactively. We have shown that this sequence is also demonstrable in ovine fetal heal fluid, thus providing an animal preparation in which the formation and speculation of surfactant biosynthesis during fetal lung maturation can be investigated in vivo.

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.