Martin L. Stone

Narcotic addiction in pregnancy

Abstract It is estimated that there are 25,000 female addicts in the Metropolitan area of New York City. As a consequence, we are faced with a significant number of pregnant addicts. Our study of over 300 such patients demonstrates the problems they present. Over 90 per cent of these women had no or inadequate prenatal care. The incidence of maternal complications has been markedly higher than in our general clinic population. Obstetric complications include prematurity, toxemia, breech births, and precipitate labor. As might be expected, prostitution serves as the source of income to support the drug habit, and the incidence of venereal disease and hepatitis is increased. Over 70 per cent of the neonates show congenital neonatal addiction with clinically recognizable withdrawal symptoms. These symptoms suggest hyperactivity of the autonomic nervous system as evidenced by diaphoresis, diarrhea, and rhinorrhea. Hypertonicity and a characteristic high-pitched shrill cry are frequently observed. In addition to being premature by dates, 50 per cent of these infants show evidence of retarded intrauterine growth. The severity of the symptoms seems to be maternal dose related.

Antibodies to spermatozoa: VI. Comparative studies of sperm-agglutinating activity in groups of infertile and fertile women☆

In order to evaluate the significance of sperm antibodies in relation to infertility, studies have been made on both infertile and fertile populations. The infertile population consisted of about 150 couples with long-standing infertility, predominantly of the unexplained type. The fertile population consisted of 78 antepartum women and 35 postpartum women. In all these individuals, sperm antibody was sought by two methods of serum testing, namely, the Kibrick (K-B-M) and the F-D methods of sperm agglutination. In the infertile group, the Kibrich test was positive for 23.1 per cent of the women and 9.6 per cent of the men, whereas the F-D test was positive in 16.4 per cent of the women and 5.0 per cent of the men. In contrast to these values, it was found in the fertile group that the Kibrick test was positive in 2.7 per cent of these women and the F-D test was also positive in 2.7 per cent of them. A number of technical details and precautions have also been emphasized. These principles are intended to minimize the occurence of nonspecific and false-positive results.

Effect of intrauterine stainless steel ring on endometrial structure and function

Abstract 1. 1. Endometrial biopsies were obtained on selected days of the secretory phase before and after insertion of an intrauterine stainless steel ring in 91 fertile women. 2. 2. Hysterectomy specimens from 10 women with intrauterine stainless steel rings in situ were also studied. 3. 3. The tissue was evaluated by standard histological methods as well as P.A.S., Alcian blue, toluidine blue, and alkaline phosphatase technique. 4. 4. There was no evidence of pregnancy or abortion and no increase in incidence of chronic inflammation. 5. 5. There was no disturbance of endometrial function as evidenced by normal cyclic changes and normal glycogen and alkaline phosphatase activity. 6. 6. Failure of depolymerization of mucopolysaccharides of the ground substance was indicated by the persistence of Alcian blue staining during days 22 to 24 in 75 per cent of the postinsertional specimens. 7. 7. The absence of tissue reaction demonstrate the inertness and suitability of stainless steel as a material for intrauterine devices. 8. 8. Biochemical study of endometrial gland secretions was initiated. To date, endometrial mucus specimens obtained from 34 women before and after insertions have been examined for total proteins and carbohydrates. The small number of postinsertional samples examined have shown no significant difference with controls.

Folic acid metabolism in pregnancy.

Abstract There is increasing evidence that folic acid deficiency in pregnancy is more common than previously recognized and that this condition is associated with certain complications of pregnancy, both maternal and fetal. We have evaluated folate deficiency in pregnancy complications, normal pregnancies, and nonpregnant controls, employing the following procedures: (1) blood and marrow morphology, (2) urinary FIGLU excretion after histidine loading, and (3) fasting serum and whole blood L. casei folic acid activity. Results to date indicate that (1) significant folic acid deficiency may be present without overt megaloblastic anemia, (2) the incidence of deficiency in our population group is 22 per cent, (3) the incidence increases at or near term, and (4) the incidence is markedly increased in pregnancy complications, particularly toxemia. The possible maternal and infant hazards of abnormal folic acid metabolism are summarized, and the therapeutic implications presented.

Intensive care of the pregnant diabetic

Over the last 2 years at Metropolitan Hospital Medical Center 245 diabetic women have been seen on the obstetric service. This complication of pregnancy comprises 7.9 per cent of 3,076 deliveries, resulting in an over-all uncorrected perinatal mortality rate of 2.9 per cent. We believe that early detection and strict rigid control of diabetes is the key to improved perinatal outcome. This article presents the classification, diagnosis, and management which have led to these results.

INFREQUENCY OF METASTASIS TO OVARIES IN STAGE I CARCINOMA OF THE CERVIX.

areas), two patients were found to have cytological changes suggestive of dysplasia (IIR) one week later. Histological examination of one of these, two weeks after cauterization, revealed superficial dysplasia. These preliminary observations suggest that silver nitrate cauterization may induce epithelial changes in the cervix similar to those of dysplasia, with the resultant possibility of cytological and clinical concern. The suggestion is offered that at least 6 to 8 weeks are allowed to elapse after silver nitrate cautery before cytological studies are repeated. Table I

Antibodies to spermatozoa. IX. Sperm-agglutination phenomenon in cervical mucus in vitro: a possible cause of infertility.

Abstract A total of 450 infertile women were studied for sperm antibody activity in cervical mucus extracts in vitro over a three year period. Most of the patients had unexplained infertility. Twelve women, or 2.7 per cent, were found to have the sperm-agglutination phenomenon in the cervical mucus extract by means of a microscale test (MIS-agg). This incidence is minimal, since the early cases did not involve the more thorough analysis of later work. Nine of these patients were found to possess similar microscopic sperm agglutination in the sera. In the remaining three patients, the sera failed to show this activity; this could suggest the local production of sperm agglutinin. Careful clinical analysis of these 12 couples strongly suggests that the sperm agglutination in the cervical mucus is the sole reason for infertility of these couples. Cervical mucus extracts from five patients were dialyzed and showed no loss of activity. Follow-up results of six months to three years revealed three pregnancies. Two of these three women were pregnant because of condom therapy. The cervical mucus extracts of 58 women known to be fertile showed no microscale sperm agglutination. These findings suggest that microscale agglutination test phenomena in cervical mucus extracts are linked to immunologic infertility.

Endometrial Enzyme Histochemistry in Oral Contraceptive Therapy

Alkaline phosphatase (ALP) activity of endometrial tissue secretion and of the luminal border of the glandular epithelium in 40 women using no contraception was greatest during the secretory phase of the cycle indicating that ALP facilitates secretion across the cell membrane. Among 36 women following a combined estrogen-progesterone contraceptive regime luminal border and secretion ALP activity was greatest in the early cycle while ALP activity of the glandular epithelium base was negative throughout the cycle. Among 93 women receiving sequential therapy ALP activity in the three tissue components rose with addition of progesterone. Acid phosphatase (ACP) activity of the glandular epithelium base and luminal border was slight during endogenous and exogenous estrogen phases and rose after endogenous or exogenous progesterone stimulation or during the exhaustion phase of combined therapy. ACP may be related to cellular regressive phenomena. Activity of beta glucuronidase (BGC) which perhaps catalyzes the synthesis or hydrolysis of conjugated glucuronides a site of estrogen action was absent during combined therapy present during estrogen administration on the sequential regime and present in the proliferative phases of untreated women. The activities of succinic dehydrogenase involved in the Krebs cycle and lactic dehydrogenase a DPN-linked enzyme in the glycolytic system appeared inconstant and at low levels in treated women. Women on sequential therapy had lower SDH activity than expected from histological examination. Two patterns of enzyme behavior arose after daily chlormadinome therapy in 45 women: changes to those observed with combined therapy suggesting non-ovulation and patterns like those in untreated women suggesting ovulation. Enzyme activity apparently reflected total cellular function rather than specific estrogen or progesterone stimulation.

CERVICAL CARCINOMA IN PREGNANCY.

Abstract 1. 1. Sixty-four cases of cervical carcinoma in 18,200 deliveries are presented, 51 in situ and 13 invasive. 2. 2. Invasive cervical carcinoma, in the pregnant patient, is diagnosed 15 years earlier than in the general population. 3. 3. Full cervical examination in the prenatal patient is mandatory at any time of gestation including cytologic screening and necessary punch biopsies and conizations. 4. 4. Patients with carcinoma in situ of the cervix during pregnancy should be delivered vaginally. The only definitive therapy is total abdominal hysterectomy with a wide vaginal cuff. Any other therapy carries a potential risk. 5. 5. The treatment of invasive cervical carcinoma is dependent upon the stage of the lesion and the trimester of gestation. Delivery of the infant should be by classical cesarean section. 6. 6. Pregnancy only alters the prognosis of invasive cervical carcinoma if the lesion is not diagnosed prior to delivery.

Observations on the use of the intrauterine pessary, with special reference to the Grafenberg ring

Experience with the Grafenberg type of intrauterine ring which was inserted in 128 pateints from 1949 to 1960 is related. The patients were under observation for from 1 to 11 years. Their parity ranged from 1 to 4. In 527 exposure years 6 pregnancies occurred. In only 1 case was the ring found in the uterine cavity remaining there with the pregnancy. The ring was removed in 13 cases because the patients contemplated pregnancy and conception followed readily in all cases. In 5 cases there was excessive menstrual bleeding. Spontaneous expulsion of the ring occurred in 5 cases within 3 months after insertion. Dysmenorrhea pelvic inflammatory disease and pelvic malignancies were not present in the series. The mode of action of the Grafenberg ring as an effective contraceptive is not clear but it does appear that the ring discourages implantation of the ovum preventing nidation rather than fertilization. There was 1 case of tubal pregnancy in the series which might support this theory. An addendum notes that no further pregnancies have occurred in 648 total exposure years.