Kessler I

Prevention of premature labor by 17α-hydroxyprogesterone caproate

Abstract Eighty pregnant women at high risk of giving birth prematurely were divided randomly into two groups. Treatment with either 17α-hydroxyprogesterone caproate, 250 mg by intramuscular injection once a week, or a placebo was given in a double-blind fashion. Imminent premature labor occurred in 29.0% of the treated group and in 59.4% of the control group (p

Ovarian tumors in pregnancy

Thirty‐eight women were operated for an ovarian tumor diagnosed during pregnancy, with an incidence of 1/2328 deliveries. The diameter of all tumors was above 5 cm. Of the 31 women operated before delivery, seven were untreated and 24 received supportive progestational therapy. The rate of abortions was 85.7% in the untreated group and 10% in the hydroxy‐progesterone‐caproate group (HPC) (P < 0.02). When the women received a total dose of HPC of more than 300 mg, 9 of 10 pregnancies reached term with a live child. Two ovarian malignancies were found, 5.3% of all cases. In 42.9% of the women there were fertility problems later in life. Ovarian tumors during pregnancy should be removed as soon as possible, irrespective of the age of the pregnancy. If fully progesterone therapy is given, the danger of abortions is reduced to a minimum. Prophylactic antibiotic treatment should also be administered.

The obstetrical management of patients with immunologic thrombocytopenic purpura

Pregnant women with immunologic thrombocytopenic purpura (ITP) run the risk of complications during pregnancy and labor, mainly due to the possibility of hemorrhage. Antibodies pass through the placenta, causing a transient, but dangerous thrombocytopenia in the fetus and infant. Four women with ITP, having five deliveries, are presented, showing that the modern treatment of these patients includes corticosteroids during pregnancy, thrombocyte transfusion during labor, and splenectomy before or after the pregnancy in selected cases. Cesarean section is not indicated for the disease per se, and fetal scalp blood sampling for thrombocyte count during labor is not necessary. The newborn needs immediate, careful control and, if necessary, thrombocyte transfusion and even steroids. Prolonged follow‐up of the infants is necessary.

Re-evaluation of the obstetrical risk for the older primipara.

The obstetric data relating to 92 older primiparas (OP) treated as regular obstetric patients and data relating to 92 older multiparas (OM) are compared to a previous study of 98 OP, which led to the conclusion that OP should not be managed as high‐risk patients during gestation. No difference was found between the two periods regarding complications of pregnancy, gestational age and birth weight, onset of labor, perinatal morbidity and mortality. Nevertheless, cesarean deliveries were significantly higher in the study group. It seems that the conservative attitude towards OP during pregnancy is justified, but at labor, more rigid indications for cesarean section should be applied to establish objective patient care.

Sinusoidal Pattern of Uterine Contractions in Abruptio Placentae

Three cases of vaginal bleeding during labor associated with high‐frequency uterine contractions (HFUC) in the third trimester of pregnancy are reported. Abruptio placentae was confirmed in all three cases. As HFUC was unrecognized as a sign of abruptio placentae, labor was allowed to continue in the first two cases and fetal demise ensued. The appearance of HFUC with vaginal bleeding in the third trimester of pregnancy should make the obstetrician highly suspicious of abruptio placentae. Labor should be terminated by cesarean section to prevent fetal death in utero.

Complications associated with genital colonization in pregnancies with and without cerclage

Cultures from the cervical milieu were taken from 24 antibiotic‐treated patients (group A) and from 25 patients with no antibiotic treatment (group B). Both groups had undergone cerclage and were compared to 30 randomly chosen pregnant patients without cerclage (group C). Positive cultures were obtained in 70.8% and 48% before cerclage and in 66.7% and 68% after cerclage in groups A and B, respectively. These were not significantly different from group C (56.7%). Escherichia coli was found in over 75% of positive cultures. The rate of premature deliveries and premature rupture of the membranes were significantly higher in the cerclage groups. Maternal morbidity was significantly higher in group A compared to B and C. Our data suggest that bacterial colonization of the cervix and the vagina is not influenced by cerclage and antibiotics. It is concluded that cervical cerclage is associated with increased morbidity, therefore it is indicated only for definite anatomic and/or functional defects.

Maternal Mortality in an Israeli Hospital: A Review of 23 Years

In spite of great strides in obstetrics, maternal mortality has not been completely eliminated. Possible changes in the causes of mortality are examined for three periods of time (1954–1961, 1962–1971 and 1972–1976). The overall incidence was 3.6/10 000, changing through the three periods from 4.9 to 4.3 and finally to 3.0/10 000. Vascular accidents were the cause of death in almost one third of the cases, emerging as the most important etiologic factor. Older age and higher parity did not seem to influence the incidence of obstetric deaths. Cesarean section was involved in ten of 23 cases in which the death was directly related to the pregnancy and delivery. In six patients there was a rupture of the uterus. The number of preventable deaths has decreased steadily, but research into the problem of vascular accidents and a dampening of the enthusiasm for cesarean sections may further improve the situation.

Indications and results of metroplasty in uterine malformations.

During 14 years, 430 women with some type of congenital uterine malformation were discovered by different methods, with a rate of 1 in 137 deliveries. In only 17 was metroplasty indicated, because of very poor reproductive performance; out of 42 desired pregnancies, only 14.3% live births resulted. The abortion rate was 65.2%, and there were 13% premature deliveries. The operations performed included the Strassmann type in 13, the Tompkins technique in three and the Jones operation in one. After the metroplasty, out of 27 completed pregnancies the rate of abortions fell in 14.8% (P<0.00003) and the rate of live births rose to 85.2% (P< 0.00003). There is no doubt that when the indication for metroplasty is strictly imposed, the staff is well versed in the different types of operations and the treatment is done in a center which has acquired competence, the improvement in reproductive performance can be quite impressive.