Keith P. Russell

The aggressive management of ruptured membranes

Abstract Experience with a program of active management of ruptured membranes during the last month of pregnancy has been assayed as it relates to amnionitis, maternal mortality, perinatal mortality, and cesarean section. It is felt that there are distinct benefits from such a program to the patient population of this study.

Political participation and income level: An exchange

Let us first consider voting behavior. Freys explanation seems to imply one (or more) of several things: (1) that high income individuals are more efficient in the consummation of voting, where the act includes getting to the polling place, deciding upon whom to vote for, etc.; (2) that voting involves activities somewhat akin to those undertaken by high income individuals in the course of their daily business; or (3) that high income occupations involve relatively higher mental effort and lower physical effort than low income occupations.

The transverse incision in pelvic surgery.

Abstract A discussion of the use of the transverse incision in pelvic surgery is presented. The anatomic and physiologic bases for the advantages of this incision are discussed and the technique, including cutting of the rectus muscles, described. Personal experience with 621 cases in which this incision was utilized is reviewed.

Thyroxine-binding capacity of serum of mothers and newborn infants after normal pregnancies

Abstract Determinations of the thyroxine-binding capacity (TBC) of simultaneously drawn maternal and cord blood specimens at term in normal pregnancy have been carried out by means of a simplified technique. Proteinbound iodine (PBI) estimations were performed on the same specimens. Although both maternal and cord readings were consistently elevated above normal nonpregnant levels, the maternal readings were regularly greater than those of the newborn infant as regards both TBC and PBI. The explanation of the increased PBI in pregnancy as being due to increased binding capacity for thyroxine of a specific alpha globulin moiety in serum is further confirmed. Binding capacity commonly increased in greater proportion than hormone-iodine levels. The value of matched maternal and cord specimens in these studies is emphasized.

Office gynecology: fibroids-when not to operate.

The mere presence of uterine fibroids is not, since qua non, an indication for their surgical removal. Knowing when not to operate is probably more important for the physician than knowing when to operate. It is easy to fall into diagnostic and therapeutic traps when uterine fibroids are known to be present, especially when they occur concomitantly with a condition such as irregular uterine bleeding, infertility, or pregnancy. The contributions of such conditions to problems in diagnosing and managing fibroids must be kept in mind by the prudent physician; a decision in favor of medical rather than surgical management is often best.

Current trends in indications for female sterilization

Over the last 20 years in the U.S. the incidence of female sterilization procedures has increased gradually and the array of conditions regarded as indications has broadened. The increase and broadening are even more meaningful when the falling birth rate is considered (down 20% in the last 8 years). Medical social and legal factors have contributed to the sterilization trends. The guidelines for advisability of voluntary sterilizations in the Manual of Standards of the American College of Obstetricians and Gynecologists have been accepted by most major hospitals. According to this guide voluntary sterilization is permissible in a woman of age 25 who has or will have 5 living children in a woman of age 30 who has or will have 4 living children and in a woman of age 35 who has or will have 3 living children. Hospital staffs need to invoke as much uniformity as possible in sterilization policy.