Vincent Tricomi

Aspirin and indomethacin: Effect on instillation/abortion time of mid-trimester hypertonic saline induced abortion

Abstract Two acidic non steroid anti-inflammatory drugs, aspirin (acetylsalicyclic acid) and indomethacin were administered to patients undergoing mid-trimester saline induced abortion, to test their analgesic properties and to observe their effect on the instillation/abortion time interval. Both drugs when administered to patients undergoing mid-trimester saline abortion prolong significantly the instillation/abortion interval. These observations on human mid-trimester saline induced abortion treated with aspirin and indomethacin correspond with experimental data recently published relative to the antiprostaglandin activity of acidic non steroid drugs. The analgesic properties of both aspirin and indomethacin are difficult to assess accurately because of the highly emotional state of the patients studied; indomethacin, however, appears to be more effective for the prodromal abortion type of pain experienced by the patient but is still inadequate for sedation for the pain resulting from strong uterine contractions.

Fetal death in utero

Abstract 1. 1. In a review of 16,057 deliveries at the Kings County Hospital 165 cases of fetal death prior to the onset of labor were found, an incidence of 1.03 per cent. 2. 2. There was no difference between the patients history and the physical examination with regard to dating the time of fetal death. 3. 3. The patients in the study group had an older age distribution than the clinic population though there was no difference in parity. 4. 4. Seven per cent of the fetuses were retained for 22 or more days; the longest period of retention was 120 days. 5. 5. There was no difference in incidence of postpartum hemorrhage between the study group and the clinic at large. 6. 6. Premature separation of the placenta was associated with 32 per cent of the fetal deaths, toxemia was implicated in 21 per cent, and diabetes in 11.5 per cent; a true knot of the umbilical cord was encountered in 3 instances. In none of these cases was syphilis the cause of death. 7. 7. Thirty-six per cent of the fetal deaths were thought to be preventable; the responsibility was equally divided between patient and physician. 8. 8. There was one maternal death (0.6 per cent) following spontaneous rupture of the uterus prior to labor. 9. 9. The data in this study support the concept of conservative management and abstinence from interference in cases of prolonged retention (more than 21 days) of a dead fetus.

The effect of anti-inflammatory drugs on parturition parameters in the rat

Abstract Four anti-inflammatory drugs, 3 acid non steroid and one steroid, and an hypnotic drug were administered orally to pregnant rats during the 19th to 21st day of gestation and their effect on time of onset of parturition (TOP), duration of parturition (DOP), bleeding during parturition and perinatal mortality were noted. Our results indicate that acetylsalicylic acid, salicylic acid, and cortisone acetate (in high dosage) all delay significantly the (TOP) when compared to controls. Sodium salicylate and cortisone acetate (in small doses) did not delay the TOP. The acid non steroids prolong the parturition time, DOP, but the cortisone treated rats have the same DOP as the controls. A marked increase of bleeding at parturition was evident in the acid non steroid treated group with only a slight increase in the cortisone treated group. The acetylsalicylic acid (2 day treated), salicylic acid, and cortisone treated rats showed no increase in the number of pups born dead/total pups, but the sodium salicylate and acetylsalicylic acid (3 day treated) rats showed an increase in the number of fetal deaths. Phenobarbital had no effect on the TOP, DOP, bleeding during parturition nor the number of pups born dead to total pups delivered when compared to controls. Extrapolation of the data to human gestations warrants a cautious approach to consumption of these drugs by pregnant women at or near term. Further, the significance of the usage of these drugs for prevention of pregnancy wastage as obtains with spontaneous abortion and prematurity should not be overlooked.

Mid-trimester hypertonic saline-induced abortion: Effect of indomethacin on induction/abortion time

Abstract The oral administration of indomethacin to patients undergoing hypertonic saline-induced mid-trimester abortion prolonged significantly (p

Urinary digoxin-like immunoreactive substance in pregnancy: Relation to urinary electrolytes

High concentrations of digoxin-like immunoreactive substance (DLIS) have been identified in amniotic fluid and in blood during pregnancy. In this study, urine from healthy women was analyzed for DLIS during pregnancy and following delivery, and levels were related to various clinical and urinary findings. Urinary DLIS increased progressively during pregnancy, having a linear relation to gestational week (DLIS = 0.032 week + 0.46, Syx = 0.52, r = 0.46, p less than 0.01), and fell to nonpregnant values during the first postpartum day. The urinary DLIS level correlated with urinary creatinine (r = 0.50, p less than 0.01) and urinary calcium (r = 0.56, p less than 0.01) levels. When adjusted for the gestational week, the urinary DLIS level also correlated with urinary potassium (r = 0.48, p less than 0.01), creatinine (r = 0.55, p less than 0.01), and magnesium (r = 0.55, p less than 0.01) levels. After adjustment for the urinary creatinine level, only the relation of urinary DLIS and urinary calcium levels remained significant (r = 0.44, p less than 0.05). The urinary DLIS level was not found to be related to systemic blood pressure. The ratios of sodium to potassium (r = -0.43, p less than 0.05) and calcium to magnesium (r = 0.37, p less than 0.05) were also related to gestational week but were independent of the urinary DLIS level. Thus, urinary DLIS increases progressively during pregnancy and falls to nonpregnant values on the first postpartum day, the urinary DLIS level can be related to urinary creatinine, urinary potassium, and urinary magnesium levels, and when adjusted for the urinary creatinine level, the urinary calcium level relates independently to the urinary DLIS level.

Prolongation .of gestation time in rats by unsaturated fatty acids

THE DELIVERY of a healthy term live infant is the expectation of every pregnant woman. Premature delivery of a baby results in a high perinatal mortality and morbidity rates and may impair the future mental and motor development of the child. Attempts to delay or stop premature labor by a variety of drugs ranging from ethanol and sympathomimetic fi-receptor-stimulating agents to nonsteroid anti-inflammatory drugs have not been entirely satisfactory. Recently, it has been found that prostaglandins, C20 fatty acids, are intimately associated with reproductive physiology and have been utilized to induce firstand secondtrimester abortions as well as for the induction of preterm and term labor.’ Since prostaglandins produce uterine contractions necessary for the expulsion of a conceptus, the logical approach to prevent delivery of a premature baby appears to be a search for agents which might suppress prostaglandin biosynthesis OI inhibit its release. Immunoreproductive exploration of fetal allograft retention in utero to term indicates that maternal sera contain glycoproteins which inhibit lymphocyte transformation by mitogens-a protective mechanism against allograft rejection.’ We report here the prolongation of the period of gestation in rats treated with unsaturated fatty acids during the last 2 days of gestation.

Prolongation of rat gestation time by unsaturated fatty acids

Arachidonic, linoleic, linolenic, and oleic acids, administered to Sprague-Dawley rats on Days 20 and 21 of gestation prolonged the gestation time; neither the duration parturition, parturitional bleeding, nor the perinatal mortality rate was affected. Since arachidonic acid is the obligatory precursor of prostaglandins E2 and F2 alpha, currently believed to be associated with the initiation of labor, and polyunsaturated fatty acids inhibit the cell-mediated immune response in vivo, the precise role of prostaglandins and their precursors in the initiation of parturition must be critically examined.

The effect of analgesic drugs on the instillation-abortion time of hypertonic saline induced mid-trimester abortion.

Abstract Three drugs, a non-steroid anti-inflammatory drug sodium salicylate, an analgesic propoxyphene hydrochloride and an antipyretic-analgesic acetaminophen were administered orally to patients undergoing mid-trimester hypertonic saline induced abortion to determine analgesic potency and the effect on the instillation/abortion time interval (I/ATI). Sodium salicylate (structurally related to acetylsalicylic acid, aspirin) and propoxyphene hydrochloride did not prolong the I/ATI. Acetaminophen, reportedly free of anti-inflammatory activity, prolonged the I/ATI. Clinically, acetaminophen and propoxyphene appeared to provide better analgesia than sodium salicylate. The hypothesized relationship of the three drugs to suppression of prostaglandin biosynthesis is presented.

Applications of the Reserve Midget machine in obstetrical anesthesia: Preliminary report☆

Abstract A series of 63 consecutive obstetrical patients managed with the Hingson Reserve Midget machine is presented. The study is too small to arrive at any definitive conclusion. It appears, however, that this compact unit may merit a place in the field of obstetrical anesthesia. The machine is easy to handle and explosion hazards are markedly reduced. Despite these advantages the dangers inherent in the administration of any and every anesthetic agent remain.