Lance Townsend

The induction of ovulation

A treatment plan utilizing placebo, cyclical steroid therapy, clomiphene citrate, and human pituitary gonadotropin is outlined for the induction of ovulation in carefully selected potentially fertile women. Such a plan minimizes any risk with the potentially hazardous ovulatory stimulants. A total of 220 patients with secondary amenorrhea were studied and an etiologic basis for the condition was found in 98 (45 per cent). Of the 220, 190 were found suitable for the induction of ovulation, and together with 145 patients with oligomenorrhea and 17 patients with anovulation, entered the treatment plan. Ovulation was successfully induced in 351 of the 352 (99.5 per cent) and pregnancy in 218 (61.9 per cent). The success rates for the agents in the various conditions are presented and discussed.

The Physiology of Pregnancy

From the first day of the last menstrual period the average duration of pregnancy is 280 days. As ovulation usually takes place on the 14th day of the cycle and fertilization one day after this the actual duration is about a fortnight less.

The diagnosis of pelvic tuberculosis.

I HAVE been interested in tuberculosis of the female genitalia for the last 7 years. During this time I have personally looked after 30 patients with this disease. Most of these were admitted to hospital because of a n acute gynaecological condition. Four came from the Fertility Clinic at the Womens Hospital, Melbourne, in 2 of which the diagnosis of tuberculous endometritis was made on histological examination of the endometrium. The other 2 cases were diagnosed later, 1 when a plastic operation was about to be done on the tubes, and the other during an attack of acute salpingitis following endometrial biopsy. In the last 18 months at the Fertility Clinic a t the Womens Hospital 3 cases of tuberculous endometritis were diagnosed in 430 new patients, an incidence of 1 in 143. I do not propose to discuss in this paper the problem of the patient who is attending a Sterility Clinic and in whom a diagnosis of tuberculous endometritis is made from an endometrial biopsy. I propose to discuss one aspect of pelvic tuberculosis, namely, its diagnosis. I have chosen this aspect because I consider the diagnosis of the condition particularly difficult. Of the 30 cases under discussion, the provisional diagnosis on admission to hospital is shown in Table I. In only 1 case was a correct provisional diagnosis made and this was in a patient who had had tuberculous meningitis previously and who presented as a definite general peritonitis. General or pelvic peritonitis was diagnosed in

Abnormal Uterine Action

Any classification of abnormal uterine action is inevitably subject to criticism. The following one at least has the virtue of simplicity.

Feeding the Infant

The feeding of an infant has implications that extend far beyond the mere provision of adequate amounts of fluid and nutrients. For the baby, feeding should be a time of unmitigated pleasure. For the mother this important part of her role should be satisfying and reinforce the strong emotional ties with her infant that are so important to the future of the entire family unit. All too frequently the experience with infant feeding in hospital and in the following weeks and months at home is unsatisfactory. Sometimes the mother is apprehensive, indecisive or is frankly rejecting her baby. The behaviour of the infant may likewise interfere with the establishment of a normal feeding pattern and, incidentally, reinforce the mother’s feelings of frustration and inadequacy.

Termination of Pregnancy

When a pregnancy is artificially terminated before 20 weeks it is termed a therapeutic abortion. When labour is induced after 20 weeks it is termed an induction of premature labour and, when done at term, an induction of labour.

Other Disorders of the Newborn

Vomiting occurs very frequently in newborn infants, and the reason is often either trivial or unknown. However, occasionally an important cause exists and must be diagnosed and treated appropriately to avoid serious consequences. A serious cause is suggested if there is excessive weight loss, or if the vomitus is copious or green in colour. Contact of the acid gastric contents often results in ‘acid burns’ around the mouth of a vomiting baby. Vomiting may be due to one of the following conditions:

Faults in the Passengers

This is when the membranes rupture before the end of the first stage of labour. It can occur before or during labour.

Pre-Eclampsia and Eclampsia

This chapter will consider the conditions of pre-eclampsia, eclampsia and superimposed pre-eclampsia on chronic hypertensive vascular disease and chronic renal disease. The term ‘toxaemia of pregnancy’ is no longer in use. In the past it was used to include a number of conditions with obscure aetiology in which it was presumed that some toxic substance associated with pregnancy was the cause.

Immature and Low Birth Weight Infants

This chapter concerns infants who are unusually small at birth or are born some time before the expected date of delivery. A disproportionate number of neonatal deaths occurs in these minority groups, and the likelihood of handicaps in the survivors is greater than in the remainder of the population.