Lars Engström

Fibrinolytic Activity in Plasma of Newborn Infants

Fibrinolytic activity-that is the ability to dissolve fibrin-is a property of the plasma which occurs when the proenzyme plasminogen is activated and converted into plasmin. Fibrinolysis is observed in many conditions such as long operations, exercise, injections of adrenaline etc. [I, 2 , 7, 131. During normal pregnancy and delivery no fibrinolyt,ic activity is found in the maternal blood. On the other hand in cases of premature separation of the placenta, amniotic fluid embolus or intrauterine death (if the fetus has been dead for about six weeks before delivery), fibrinolysis may involve maternal risks. Fibrinolysis in these cases is secondary to intravascular blood coagulation caused by free thromboplastin (thrombokinase) in the blood. Both placenta and amniotic fluid contain large amounts of thromboplastin. There have been several investigations of fibrinolytic activity in umbilical cord blood of healthy normally delivered infants. Beller [4] found that in 20-30% of infants fibrinolysis occurs in the cord blood whilst a t the same time no fibrinolytic activity is present in the mother’s blood. Ciulla et al. [lo, 111 found 96% of infants to have some fibrinolytic activity in the cord blood and stated that the activity was more pronounced in premature and stillborn infants. Chaplin [9] compared the fibrinolytic activity in umbilical artery and umbilical vein blood, and found fibrinolysis in 90% of the arterial blood samples and in 24% of the venous blood samples. Berglund [5] investigated the iimbilical cord blood in 143 cases using the fibrin plate method described by Astriip & Miillertz 131. She found a weak or moderate fibrinolytic activity in half of the cases. The activity disappeared during the first three days after birth. No correlation was found between the fibrinolytic activity of the mother’s blood and that of the cord. Thus it appears that the fibrinolytic principle is not transferred from mother to child, but arises independently in the fetus or in the placenta. The factors provoking fibrinolytic activity in the cord blood are not yet known. In earlier investigations as a rule the umbilical cord blood was taken after clamping of the cord, giving a mixture of arterial and venous blood after cessation of the placental circulation. The aim of the present investigation was to study the fibrinolytic activity in the circulating blood of the infant shortly after birth.

Concentration of fibrinogen in the plasma of healthy and of erythroblastotic and hyperbilirubinemic newborn infants.

The concentration of fibrinogen in the plasma of 39 infants during the neonatal period was determined by Morrisons syneresis method as modified by Blom‐back. The samples were drawn from the umbilical vein by catheterization. The results, expressed in mean and standard error of the mean, were as follows:

Primary Carcinoma of the Fallopian Tube

Primary carcinoma of the Fallopian tube is the most unusual form of female genital carcinoma. The first case of primary carcinoma of the Fallopian tulle was described by O r t h m a n in 1886. Since then, according to G o t , (1955), a further 577 cases have been reported. Reports of follom-ed-up cases where uniform treatment had been given, have heen made by B l o c k (1947, 16 cases), Hu et al. (1950, 12 cases), B o s c h a n n (1952, 17 cases), B e h r e n s (1953, 29 cases), and K r e m e r et al. (1955, 25 cases). According to W e e k e s et al. (1952) primary carcinoma of the Fallopian tube constitutes one half to one per cent of the malignant tumours of the female reproductive organs. M i l l e r (1948) reported an incidence of only 0.1 per cent. At the Department of Women’s Diseases of the Karolinska Sjukhuset the diagnosis of primary carcinoma of the Fallopian tube has been made only once since 1940. During the same period about 500 cases of malignant tumours of the reproductive organs were treated at the clinic. This single case of primary carcinoma of the tube is nowhriefly reported.

ASCENDING INFECTION IN LABOUR. ITS EFFECT ON MOTHER AND CHILD

The risk of intra-uterine infection in the newborn child was pointed out at the end of last century (Kiistner, 1877; Geyl, 1880). In 1915, Slemons reported bacteria in the subamniotic space at the attachment of the umbilical cord after prolonged labour. Douglas and Stander (1943) showed that mortality and morbidity among infants are higher the longer the course of labour. They stressed the significance of infections in this connection. The therapeutic and prophylactic use of chemotherapy and antibiotics during labour has been recommended by many authors (FihrCus, 1946; Keettel and Plass, 1950; Siddal, 1950; von Friesen, 1951; and others). The studies reported by these authors, however, were based on comparisons of treated and untreated cases and were incomplete from the bacteriological aspect. A leading article in The Lancet in 1955 stated that insufficient attention has been paid to the role of intra-uterine infection in perinatal mortality. In histological studies of stillborn infants and neonatal deaths Labate (1947) found signs of infection in 8 per cent of 868 cases and Corner et al. (1951) in 6.6 per cent of 1,233 cases. Penner and McInnis (1955) were able to cultivate bacteria from the lungs of infants dying as a result of prolonged labour. The most commonly encountered bacteria ac

Infection of the foetus during labour.

S. Jaykka, Finland. I would like to contribute to our knowledge of circulation conditions in the lungs with a few anatomical data: According t o v. Hayek, there is a ))short circuit)) past the capillaries. I t travels via pulmobronchial anastomosis and flows into the venous plexus of the bronchus under the mucosa. If Indian ink is injected into the pulmonary artery in a ))respiratory distress)) lung i t can be seen to travel via w. Hayek’s short circuit)) in the atelectatic parts of the lung. I t seems to me tha t theoretically artificial respiration is hardly beneficial for impaired diffusion when the capillaries are not perfused. Ventilation may be justified when the child has apnoea. I would, however, prefer for theoretical reasons Ylppo’s old method of applying oxygen via the digestive tract.

Changes in Plasma Fibrinolytic Activity of Newborn Infants during First Hour after Birth

The occurrence of fibrinolytic act i r i t j in plamia from umbilical cord blood has heen established by several authors 12. 3 . 6. 71. The fil)rinolytic activity IS not transferre(1 from mother to infant but arises indepcndently in the fetus or placenta. The initiating factors are iinkno\\ n. In a previous study [ t i ] it I! as shov 11 that in most healthy fullterm infanti a \ipnificant fibrinolytic activity is found in the. plasma TI ithin one hour after birth. Hlootl from vena porta or inferior veiia c a m \ \as analysed using tlie method descrihed by Blomhack [ 5 ] . It i \as even ohservcd that the fibrinolytic activity \\ a\ rn~ore 1)ronouriced if the in oitro incubation \\a\ lmformed a t a lower pH (6.3) tlian a t a higher pH (7.1). Also in a similar invcstigation (in patients suffcring from liver cirrhosis) increased fihrinolytie activity nt n loicpr pH \

The Effect of Relaxin on the Duration of Labour Induced by Oxytocin

as observed, explnrlied I)y the authors as possibly due to an enhanced activation of plasminogen to plaimin a t a lower pH than a t a higlier one [4]. The differences in fibrinolytic activity bet\\ ccn the single individuals in our previoiisly presented investigation [8 ] may he caused by blood sampling a t different points of time during the first hour after hirth. Rerglund [3] has shomn that the fibrinolytic activity of plasma disappears coinpletely during the first three da j s after hirth a i d it is possible that the diminution is considerable already n ithiri t lw first hour. In order to evaluate h o \ 4 fast the &minution in fihrinolytic activity is during the first hour after birth folloir ing invest1g-nt ion as performed.

Obstetrical Views on Prospective Prenatal Studies of Foetal Damage

In recent years, particular attention has been given to the uterus in investigating the effect of relaxin on the reproductive organs. The results of these studies indicate that the mode of action of this hormone during pregnancy and labour is a very complicated process. This explains why the reports on the results of the clinical trials have often been conflicting or confusing. It has been reported that in cases of premature labour relaxin effects either a decrease in the intensity of uterine contractions or causes their arrest (Abramson and Reid, 1955; Folsome, Harami, Lavietes, and Massel, 1956; Majewski and Jennings, 1955, 1957; McCarthy, 1957). Eichner, Waltner, Goodinan, and Post (1956) found it had a similar effect in patients at term whilst Kelly and Posse (1956), Stone, S edlis, and Zuckerman (I958), Decker, Thwaite, Bordat, K ayser, Harami, and Campbell (1958), and Dill and Chanatry (1958) were unable to confirm this observation. Stone et al. (1958) and Maclure (1957) maintained that oxytocin is more effective in patients at term, or in cases of missed abortion, if it is combined with relaxin. Birnberg and Abitbol (1957) found that relaxin shortens the duration of the second stage of labour, whilst in the opinion of Javert (1958) it leads to prolongation rather than shortening of labour.

Acid-Base and Electrolyte Balance in Infants of Diabetic Mothers: Vaginal Delivery versus Caesarean Section

cannot of course form the basis of a deduction regarding the topical, important problem, viz. factors related to the occurrence of early foetal damage. The material is being analysed, so that at the present time we are unable to submit any final figures or state any conclusive results. The course of delivery was accurately recorded and the infants were followed at short intervals. In 10% spontaneous abortion occurred. The circumstances of the abortions were analysed, and the expelled parts of the ovum with the placenta preserved for pathological investigation. Among the 92 children who were followed, 6 were premature including 2 sets of twins -, one has encephalopathy, 3 have heart disease, and one congenital dislocation of the hip. The course of pregnancy in their mothers was subjected to a closer study. Broadly speaking, it may be said that a study of this nature can no doubt be performed on a larger scale. The brunt of the burden will be with the antenatal clinic, but we are convinced that a considerably more intensive control within the first trimester is possible even now within the scope of the present organization of prenatal care.

Induction of Labour Around Full Term Especially by Means of Synthetic Oxytocin in Intravenous Drip

Abstract. The acid‐base and electrolyte balance of 30 women was studied at delivery and in their infants during the first 48 h. 18 women were diabetics, 10 of these were delivered vaginally (DMvag) and 8 by elective caesarean section (DMcs). 12 healthy women were vaginally delivered (HMvag). The infants of diabetic mothers (IDM) received active infusion therapy. At birth the DMvag and their infants (IDMvag) had a more pronounced metabolic acidosis than the DMcs and their babies (IDMcs). The largest metabolic acidosis occurred, however, in the group of HMvag and their infants (IHMvag). After birth no significant differences were obtained in the acid‐base and electrolyte balance between IDMvag and IDMcs. The plasma potassium level remained lower in IDM than in IHM. The study stresses the importance of adequate management of diabetes in pregnancy in combination with active intravenous therapy during delivery and to the infant in the immediate neonatal period. The slightly larger metabolic acidosis seen in combination with vaginal delivery suggests that this mode of delivery should not be attempted uncritically in diabetic women.