Ralph W. Hale

Massive fetomaternal hemorrhage preceded by decreased fetal movement and a nonreactive fetal heart rate pattern.

Background: Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern. Cases: Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer‐Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively. Conclusion: A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer‐Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability. (Obstet Gynecol 1993; 82:711‐4)

Funded in part by a grant from Kapiolani Medical Center for Women and Children, Honolulu, Hawaii. Presented at the Fifty-ninth Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Ojai, California, October 1118, 1992.

Objectives: We reviewed current sexual and contraceptive behavior of college-age men and women and compared the findings with those of similar studies in 1974 and 1979. Study Design: A randomly selected population questionnaire was provided to students registered in the spring 1991 semester. Of the 1921 survey forms mailed, 772 (40.2%) were returned. The CHIFIT test was used to determine representativeness of sample population to target population. Results: Proportionately more women than men responded, although the age grouping and academic standing were consistent with the university population. Of the 772 responses, 84.2% were sexually active with a mean age at onset of 17.8 years. Half (50.3%) always used contraception with oral contraceptives as the first choice and condoms second. Sexually transmitted diseases were reported by 19.1 %. More than one fourth (27.8%) had been tested for human immunodeficiency virus or acquired immunodeficiency syndrome. Fifteen percent (15.1 %) reported being forced to have sex, and 50% of these incidents had occurred before age 19. Conclusions: On a comparison with findings in 1974 and 1979, more students had participated in sexual activity beginning at a younger age with slightly less use of contraception. (Am J Obstet Gynecol 1993;168:1833-8.)

RITODRINE AND TERBUTALINE COMPARED FOR THE TREATMENT OF PRETERM LABOR

Abstract. A prospective study comparing intravenous rito‐drine and terbutaline was initiated to assess the efficacy of each drug in arresting preterm labor. Delivery was delayed for 25.8 days in patients treated with terbutaline and 13.0 days in patients treated with ritodrine. Patients treated with terbutaline gave birth to infants with a mean birthweight of 2 588 grams and 60% achieved a gestation of 36 weeks. Patients treated with ritodrine gave birth to infants with a mean birthweight of 2 392 grams and 39% achieved a gestation of 36 weeks. From this study it is evident that parturition was more effectively delayed in women treated with terbutaline than in a similar group of women treated with ritodrine.

Histopathologic evaluation of uteri curetted by flexible suction cannula.

A prospective study was undertaken to evaluate the use of the flexible plastic cannula for obtaining endometrial specimens for diagnostic purposes. Suction curettage was performed immediately prehysterectomy, the specimens evaluated, and then compared to similar specimens obtained by a metal curette. Another group of patients had suction curettage performed as an office procedure 24 to 72 hours before hysterectomy. The results of our study confirm the adequacy of this method for obtaining endometrial samples.

Medical Liability: An Ongoing Nemesis

M liability and its effect on the practice of obstetrics and gynecology is one of the most important issues that face the specialty and each practitioner today. As a result, the American College of Obstetricians and Gynecologists (the College) has worked hard to achieve reform, especially at the national level. On five separate occasions during the 110th Congress (2007–2008), the College facilitated the passing of a bill by the House of Representatives that, if passed by the Senate, would have reduced the level of noneconomic liability significantly. In essence, these bills reduced the noneconomic awards that plaintiffs could receive. The bills were patterned after the Medical Injury Compensation Reform Act in California, which mandates a

The effects of oral contraceptives on respiration

250,000 cap on “pain and suffering.” Before the Medical Injury Compensation Reform Act, the increasing costs of insurance in California resulted in increased patient costs and physicians moving out of state, culminating in reduced access to ob–gyns for patients. In all five attempts, the bills died in the Senate without even coming up for a vote because there was insufficient support to prevent a filibuster. In the current Congress, which is immersed in health care reform, one of the College’s major efforts is the inclusion of liability reform. At this writing, the only possible prospect appears to be modestly funded demonstration projects at the state level. President Obama, in his presentation to the American Medical Association House of Delegates in June 2009, clearly stated that he would support alternative approaches to liability reform as part of health care reform because he recognized the need.1 However, he stated that this would not include “a cap on noneconomic damages.” Several states have developed and implemented legislation to enact liability reform. The most recent are Texas, where the legislature enacted a

Office termination of pregnancy by “menstrual aspiration”

250,000 cap on noneconomic damages, and Oklahoma, where a cap of

Exercise, sports, and menstrual dysfunction.

400,000 went into effect. On appeal by trial lawyers, the Supreme Court of Texas ruled the legislation unconstitutional. Texas physicians and patients initiated a campaign to pass a constitutional amendment to make the law constitutional. The passage of this legislation has resulted in an increase in liability insurance carriers, reductions in premiums, a decrease in liability lawsuits, and increased access to care, providing evidence that reform can work. As a top priority of the College, the reform of the current liability system in the United States includes both national and state-by-state action plans. The current situation is causing physicians to change their practices, for example, by retiring early, ceasing to provide obstetric care or to treat high-risk obstetric patients, and engaging in defensive medicine.

Intra-amniotic prostaglandin PGF2a (tham salt) and the laminarta tent in midtrimester termination of pregnancy

The effect synthetic progestins found in current oral contraceptives may exert on respiratory function has not been thoroughly investigated. This study monitored potential changes in respiratory parameters 3 and 6 months subsequent to beginning administration. Static and timed spirometric maneuvers showed significant increases in only tidal volume (P = 0.01). Ventilatory response to treadmill exercise monitored the oxygen uptake, CO2 elimination (VCO2), minute ventilation (VE), and respiratory exchange ratio at each of four workloads. An analysis of the covariance (ANCOVA) for the slopes revealed no significant variation between test periods. The ANCOVA for the means showed increases in VE and VCO2. These results suggest a stimulatory role for synthetic progestins, although ventilatory performance in response to moderate exercise does not appear compromised.

Histopathologic changes associated with prostaglandin induced abortion

A program of office menstrual aspiration was initiated in our institution in 1972. Since that time 1,443 patients have been admitted into the study. These patients were evaluated by age, marital status, gravidity, repeat pregnancy terminations, complications, and detailed tissue analysis as well as contraception utilized at the time of conception and following counseling after the procedure. A majority of these patients were less than 25 years old and single; 28% had had a previous termination and 51% a previous pregnancy. Pathologic evaluations revealed Arias-Stella reaction in 78%. When these data were compared to those of a similar group of women whose pregnancies were terminated in the hospital by suction curettage, it was found that the office procedure is comparatively safe and should therefore be the therapy of choice.