P.V. Dilts

Tuberculosis complicated by pregnancy

Abstract Ten cases of tuberculosis during pregnancy are presented and discussed. The literature is reviewed and recommendations for therapy are presented.

Placental transfer of ethanol

Placental transfer of 10 per cent ethanol infused at a rate of 15 ml. per kilogram per 2 hours (0.125 ml. per kilogram per minute) was investigated in pregnant sheep. Fifty-four paired uterine arterial and umbilical vein blood alcohol levels from 15 sheep were analyzed. The lag in umbilical vein alcohol levels below maternal arterial is 15 to 30 mg. per cent. Umbilical artery versus umbilical vein and uterine vein versus maternal artery levels are also discussed.

Effect of ethanol on maternal and fetal acid-base balance

Abstract Ten per cent ethanol in 5 per cent dextrose and water was given intravenously to 20 pregnant ewes under either spinal or pentobarbital anesthesia at a rate of 0.125 ml. per kilogram per minute for 2 hours (15 ml. per kilogram per 2 hours). Blood gases, pH, and base excess were determined in both mother and fetus. When alcohol was infused at this rate, no ill effects on either maternal or fetal pCO 2 , pH, or base excess could be demonstrated.

Placental transfer of meperidine HCl

Meperidine HC1, injected intravenously (0.85–2.5 mg/kg) into the pregnant ewe, was transferred rapidly to the fetus. Fetal serum levels of meperidine were usually higher than but parallel to maternal levels. Both maternal and fetal meperidine serum levels peaked prior to 10 minutes postinjection, and umbilical venous levels were 11 μg% or less 50 minutes after injection. A gas-liquid chromatography method for meperidine analysis, using a 3–4 ml serum sample, is described and is considered advantageous because other alkaloids do not interfere.

Unusual complication of an intrauterine contraceptive device.

Abstract Two cases of serious pelvic infection complicating IUD contraception are presented. The etiology of these problems and suggestions for management are discussed.

Appendectomy incidental to postpartum sterilization procedures

Abstract Despite many studies advocating incidental appendectomy, many physicians continue to fear intra-abdominal infection. Patients who have previously had cesarean sections or postpartum sterilization procedures without appendectomy may later present with appendicitis or symptoms which require that appendicitis be included in the differential diagnosis. The morbidity with and without appendectomy following cesarean section, cesarean tubal ligation, cesarean hysterectomy, postpartum tubal ligation, and postpartum hysterectomy is presented. No significant difference in morbidity with or without appendectomy was found in this series. Indications for routine performance of incidental appendectomy are presented.

Comparative morbidity of postpartum sterilization procedures.

The records of 354 bilateral tubal ligations, 123 cesarean tubal ligations, 57 cesarean hysterectomies, and 37 postpartum hysterectomies were reviewed. A comparison of cesarean tubal ligation with cesarean hysterectomies shows that none of the factors was found to be significantly different except that estimated blood loss and patients transfused were significantly higher (p less than .005) for the latter group. Postpartum tubal ligations vs. postpartum hysterectomies show postpartum hysterectomy patients had significantly more blood loss and transfusions (p less than .005), postoperative hospital days (p less than .01) and morbidity. Cesarean hysterectomy is considered an acceptable elective sterilization procedure, and may be especially acceptable for low-income, high-parity patients who have an increased incidence of uterine and cervical disease later in life. No justification was found for postpartum hysterectomies. Recommended procedures would be postpartum or interval tubal ligation or interval vaginal hysterectomy.

Placental perfusion device

A P L A c E N T A L perfusion device is presented which offers several significant improvements over previous devices1T5: 1. Venous drainage is through outlets evenly distributed among the spiral arterioles rather than by means of a “marginal sinus.“6 2. Spiral arteriole input is through 121 coneshaped apertures which empty into the intervillous space. Cannulas which may perforate the placental substance are avoided. 3. It is simple to construct.

Some effects of meperidine hydrochloride on maternal and fetal sheep

Abstract Single intravenous injection into the pregnant ewe of meperidine HCl in dosages of 0.85 to 2.5 mg. per kilogram of maternal weight and 14.7 to 76.9 mg. per kilogram of fetal weight was not associated with significant effects on maternal and fetal arterial blood pressure and heart rate. Furthermore, no significant changes could be found in maternal arterial, fetal arterial, and umbilical venous blood gas values or acid-base values. The mean dosage of lidocaine HCl in milligrams per minute required for satisfactory continuous spinal anesthesia in the pretest period was 3.66 times that required following the injection of meperidine HCl.

Bilirubin transfer across the human placenta

Abstract Crystalline (unconjugated) bilirubin transfer across the human placenta was studied in a placental perfusion device. Bilirubin transferred readily from the fetal to the maternal circulation, while no detectable transfer from mother to fetus occurred in 130 min. With the use of heparinized saline as the perfusate, water moved from fetus to mother at a faster rate than bilirubin. Bilirubin transfer and erythroblastosis are reviewed.