Robert E.L. Nesbitt

High-risk obstetrics: II. Value of semiobjective grading system in identifying the vulnerable group

An arbitrary system of levying penalties against all presumed adverse obstetric factors was devised. Abnormal conditions were grouped into eight categories and degrees of anticipated perinatal vulnerability were expressed as a numerical value resulting from the sum of all such penalties subtracted from a perfect score of 100. Index scores assigned to 1,001 consecutive ward service patients at the time of their initial prenatal visit permitted three general groupings: a high-risk group with scores of less than 70, 299 patients; a moderate-risk group with scores of 70 to 84, 390 patients; and a low-risk group with scores of 85 or over, 312 patients. There was a consistent trend for patients with the lowest scores to yield the poorest obstetric results. In general, the risk of antenatal and intrapartum complications as well as of poor perinatal outcome among the low scoring patients (29 per cent of the total) was twice as great as that observed in the remaining 71 per cent. This obstetric approach which includes aggressive laboratory investigation can be expected to identify in a broad sample of pregnant women a group of approximately 30 per cent who will give rise to 60 per cent or more of all pathologic outcomes. Gradations of risk occur even within socially deprived groups and the use of a simple, relatively sensitive screening device of the type presented permits a sharper focus of attention and intensification of effort upon the most vulnerable minority.

Influence of estradiol-17β on the acetylcholine content of the lung in the rabbit neonate

The influence of estradiol-17 β on the acetylcholine content of the lungs was studied in rabbit neonates born to oophorectomized mothers. It was found that 10μg of crystalline estradiol-17 β administered subcutaneously to newborn rabbits doubled the acetylcholine content of their lungs as compared to littermate controls. These findings suggest a mechanism whereby estradiol-17 β may affect the degree of vasodilatation in the vessels of the lungs.

High-risk obstetrics: I. Perinatal outcome in relation to a broadened approach to obstetric care for patients at special risk☆

Abstract A special clinical facility was set up to provide exemplary, individualized care to high-risk obstetric patients and to serve as a model to test the effects of broadening the scope and intensity of obstetric supervision. A method of identifying patients at risk was devised and an intensified screening and diagnostic program was instituted. Even among the disadvantaged groups, gradations of risk and variable demands for intensified and expanded care were demonstrated. Previously undetected, underlying ills were encountered in almost one third of the patients. More than one-quarter required antepartal hospitalization for diagnostic work-up and treatment. The finding of improved perinatal salvage rates based on a comparison with this vulnerable groups past obstetric record would seem to justify extending prenatal investigations and concentrating greater effort on those patients at risk.

High-risk obstetrics. IV. Estrogen-creatinine ratios in routine urine samples as a method of screening a high-risk obstetric population.

Abstract The value of urinary estrogen excretion determinations in high-risk pregnancies is well established. Methodologic and motivational factors, however, often contribute to making serial 24 hour excretion measurements impractical. An alternate approach of potential significance utilizes estrogen/creatinine ratios in single voided specimens. If the validity of single specimen estrogen/creatinine ratios can approach that reported for 24 hour estriol excretion, the technique can be of major clinical importance. In the present study, 42 24 hour specimens were obtained from 16 high-risk adolescent patients antepartally, and 392 single voided specimens were obtained from 84 similar patients. Twenty-four hour collections were frequently inaccurate and even falsified. Where accurate, values were consistent with those reported for more adult patients. The curves for estrogen/creatinine ratios for single voided specimens throughout pregnancy closely approximated, in direction and slope, those previously found for 24 hour urinary estriol excretion. The normal hormonal patterns obtained seemed correctly to have forecast the favorable obstetric outcome achieved in this group of closely supervised teen-age gravidas.

High-risk obstetrics: VI. An evaluation of the effects of intensified care on pregnancy outcome

Abstract The effects of intensified obstetric care were evaluated in a sample of 98 Caucasian and 55 Negro patients. Patients were selected who had experienced a minimum of 2 previous conceptions and for having their initial visits to the High-Risk Clinic before the week of termination of their 2 preceding pregnancies, which were employed as the standard of comparison. In the Negro sample, only random differences were observed among the 3 pregnancies, i.e., the first high-risk-care pregnancy and the 2 prior gestations. However, in the Caucasian sample the results revealed that a higher proportion of pregnancies receiving intensified care achieved more than 35 weeks of gestation and resulted in live births than in either of the 2 control pregnancies. In both instances, the differences among the proportions in the three pregnancies are statistically significant, thus indicating the positive influence of specialized care on pregnancy outcome in this sample.

High-risk obstetrics: V. Cytohormonal and interhormonal relationships in normal and abnormal pregnancy☆

Abstract One hundred and forty-four pregnant subjects consisting of 20 controls, 93 problem cases with normal pregnancy outcome and 31 problem cases with abnormal pregnancy outcome were intensively studied with serial estriol, pregnanediol, and chorionic gonadotropin excretion and simultaneously obtained hormonal vaginal cytology as determined by the KPI. The resulting data were analyzed to correlate KPI findings with HCG, pregnanediol (P) and estriol (E) excretion, P + E and P/E ratio. A general correlation of KPI to E, P, P + E, and P/E ratio was found in decreasing order of relationship. Elevated KPI (10 per cent) is most closely related to low or falling estriol excretion. The sensitivity of elevated KPI is only 10 to 15 per cent among all cases of depressed hormonal excretion in the last trimester of pregnancy. However, the reliability of an elevated KPI being associated with depressed hormonal excretion is relatively high and is highest with depressed estriol excretion. Although a general correlation was noted between HCG and E, P, and P + E, HCG was a relatively insensitive indicator of fetoplacental status. Like KPI, when the HCG was elevated it carried about as good a reliability rating as either estriol or pregnanediol excretion. No predictable relationship could be established between HCG and the KPI or P/E ratio. A hypothesis capable of explaining these interrelationships is discussed and its clinical implications are presented.

Urethrovesical malfunctions and urinary incontinence in female children and adolescents.

The conditions which evoke urinary dysfunction are legion. A brief review of the maturational physiology of the bladder and the orderly development of urinary control mechanisms is followed by discussion of various causes of enuresis and urinary incontinence.