Kenneth R. Kellner

The forgotten grief: A review of the psychology of stillbirth.

Recognizing that grieving occurs in parents of stillborn infants, attention is focused on aspects of grief, both similar to others bereavements and particular to perinatal loss. Processes in perinatal bereavement, pathological variants of perinatal grief, and the conditions and interventions affecting the outcome of grief at stillbirth are considered. Suggestions for further research are offered.

Congenital herpes simplex type II infection.

A case of congenital herpes simplex virus type II infection acquired in utero is reported. The issue of congenital infection due to the herpes simplex viruses is discussed.

Perinatal mortality counseling program for families who experience a stillbirth

The emotional impact of a stillbirth on a family has only recently begun to be appreciated. Literature regarding the grieving process in these families has been relatively scant and does not often facilitate applied approaches. The Perinatal Mortality Counseling Program (PMCP) at Shands Teaching Hospital, Gainesville, Florida, provides crisis intervention and support for these families as well as serving a research function. This article outlines the program, including its history, composition, procedures, and research.

Assessment of fetal lung maturity: a comparison of the lecithin/sphingomyelin ratio and the tests of optical density at 400 and 650 nm.

Seventy-eight amniotic fluid samples were obtained by transabdominal amniocentesis and were analyzed for their L/S ratio and optical density at 400 and 650 nm. The L/S ratio was considered to be mature if the values were greater than 2.0. The optical density of the fluids decreased with prolonged refrigeration. With freshly centrifuged samples, the OD650 reading of greater than 0.15 gave the best correlation with the mature L/S ratio. There were 3.8% false positive results and 14.1% false negative results. The study confirms that the OD650 test on fresh amniotic fluid is a rapid and inexpensive way to determine fetal maturity. All samples with values of less than 0.15 must, however, also be tested for their L/S ratio since some of the infants with these values may also be mature.

Effect of obstetrics-gynecology clerkship duration on medical student examination performance

Objective To compare medical student performance on the obstetrics and gynecology national board subject examination during two different clerkship rotation formats. Methods We compared medical student performance on the National Board of Medical Examiners (NBME) subject examination in obstetrics and gynecology for 2 years before and 2 years after the length of the clerkship at the University of Florida was decreased from 8 to 6 weeks. Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) step 1 and step 2 scores were used to assess comparability between groups. Student t test and χ2 analysis were used as appropriate. Results Medical school classes were similar with respect to MCAT and USMLE step 1 and step 2 scores. Collectively, 231 students who completed the 8-week clerkship scored significantly higher on the subject examination than 239 who completed the 6-week clerkship (618.6 versus 593.5, P = .001). When analyzed by semester, students who completed the clerkship in the second half of the academic year scored similarly regardless of clerkship length (630.6 versus 616.7, P = .11); however, students who completed the clerkship during the first half of the academic year scored significantly higher with the 8-week than the 6-week clerkship (607.3 versus 569.7, P < .001). Students who took the clerkship in the last half of the academic year scored higher than students who took the clerkship in the first half for both the 8-week (630.6 versus 607.3; P = .02) and 6-week (616.7 versus 569.7; P < .001) formats. Those differences persisted on examination letter grade assignment. Conclusion Decreasing the duration of the obstetrics-gynecology medical student clerkship resulted in lower subject examination scores, especially for students who matriculated in the first half of the academic year.

Oxytocin challenge test results compared with simultaneously studied serum human placental lactogen and free estriol levels in high-risk pregnant women

Three perinatal health indicators (serum human placental lactogen [hPL] levels, serum free estriol [E3] levels, and OCT) were simultaneously completed in 149 high-risk women who were more than 34 weeks pregnant. There was a significant correlation between the hPL and E3 results (r = 0.28, p less than 0.01). There was a 15.4% positive OCT result rate and the blood hormone values for the negative and positive OCT groups were compared. There was a significantly lower hPL value in the positive OCT group (4.7 +/- S.E.M. 0.4 vs. 6.2 +/- S.E.M. 0.2 micrograms/ml for positive and negative groups, respectively), whereas the free E3 levels were not different in these two OCT groups (14.8 +/- S.E.M. 1.5 vs. 16.3 +/- S.E.M. 0.7 ng/ml for positive and negative groups, respectively). The free E3 value did not help in predicting the OCT result as the low free E3 subgroup had the same frequency of positive OCT result as did the over-all group. There was a highly significant increase in the positive OCT results (42.9%) in women with a low hPL value (p less than 0.01). In those women with an hPL value of 6.0 microgram/ml or more there were only 8% positive OCTs. It is concluded that on hPL test at about 34 weeks of gestation could be used to screen pregnant women, and if the value were low (less than 4.0 microgram/ml) an OCT evaluation test would be indicated, for there is a very high frequency of positive results in that subgroup of women.

Attitudes toward Stillbirth and Death Threat Level in a Sample of Obstetricians.

The exact attitudes that physicians hold toward stillbirth have never been empirically explored. Seventy obstetricians and obstetrical residents were polled on their attitudes regarding stillbirth. Physicians simultaneously were assessed for their level of death threat as measured by the Threat Index. No effect of death threat level on attitudes toward stillbirth was observed, even when extreme scores were isolated and compared. Possible reasons for the lack of findings is discussed. Patterns of physicianss responses about perinatal grief are presented. Further dissemination of information on the grief following perinatal loss is encouraged.

an evaluation of a continuous tissue pH monitor in the fetal and neonatal goat

The validity of continuous tissue pH measurements was established in the fetal and neonatal goat model. Simultaneous determinations of tissue, arterial, and venous pH were done during alterations in acid-base status. A highly significant correlation was found between tissue and blood pH levels (r = 0.89, p less than 0.001). These data confirm the accuracy of the tissue pH instrumentation in predicting core blood pH status and support the potential usefulness of the instrumentation in perinatal medicine for continuous fetal acid-base monitoring.

Evidence that adenovirus type 2 can infect human placenta in vitro.

Of the more than 80 identified serotypes of adenovirus (Ad), 31 are known to infect humans. These viruses cause respiratory infections and may persist in lymphoid tissue without causing recurrent illness. Types 1, 2 and 5 are commonly found in adenoids in latent form, and a high proportion of the population has serum antibodies to them. Indeed, antibodies to types 1 and 2 have already developed in three-quarters of all children by the age of five years (Oswald and Frey, 1962). Thirteen of the 51 human Ad have been classified into groups according to their oncogenic potential (Green and Mackey, 1977). Group A (Ad 12, 18 and 31) are highly oncogenic and rapidly produce tumours in most inoculated baby hamsters. Group B viruses (Ad 3, 7, 11, 14, 16 and 21) induce tumours in only a small fraction of inoculated test animals. Group C viruses (Ad 1, 2, 5 and 6) are not oncogenic in newborn rodents but have been shown to transform cells in culture (Green, 1970). Because of the widespread existence of the adenoviruses in the human population and their oncogenic potential, the possibility exists that these viruses may be responsible for some human tumours. An extensive search for viral sequences in human cancer tissue has been conducted employing the rationale that, like Ad-induced hamster tumours, Ad-induced human tumours should contain viral DNA sequences. The emphasis of this work has been on group A Ad (Mackey, Rigden and Green, 1976). However, searches for group BAd sequences (Mackey et al, 1979; Wold et al, 1979) and group CAd sequences (Green and Mackey, 1977) in human turnouts have also been carried out. To date, no adenovirus-related sequences have been detected in DNA isolated from human tumours. Although none of the adenovirus genome has been found in human tumours, there is some evidence for the presence of some or all of the adenovirus genome in apparently normal mammalian tissue. Analysis of human tonsil DNA by Green et al (1979) revealed multiple copies of the entire Ad 5 genome free in the cells, as well as some Ad 5 sequences possibly integrated into the cellular genome. Furthermore, in a recent report, Frolova and Georgiev (1979) demonstrated the presence of Ad 5-related sequences in the genome of normal rat liver cells. By digesting the cellular DNA with restriction endonuclease Bam HI, separating the fragments on agarose gels and then hybridizing 32P-labelled Ad 5 restriction fragments to the cellular DNA immobilized on nitrocellulose filters, these authors were able to detect at least three regions of homology between the Ad 5 genome and cellular DNA.

Vaginal Delivery Impeded by a Large Fetal Sacrococcygeal Teratoma: Anesthetic Considerations

A large sacrococcygeal teratoma of a fetus can unexpectedly impede vaginal delivery after the fetus has been delivered up to the umbilicus. This rare occurrence-less than 1 in 400,000 births (1)-is associated with high fetal mortality and poor maternal outcome. Recently, obstetricians have attempted retrograde extraction of an infant via cesarean section (1). The only recommendation for anesthesiologists in such cases has been intubation of the fetus before the retrograde extraction (2). The present case report details the anesthetic problems and techniques for completing delivery of a fetus under these conditions.