William Droegemueller

Measurement of Umbilical Arterial Blood Flow to the Sheep Placenta and Fetus in Utero: DISTRIBUTION TO COTYLEDONS AND THE INTERCOTYLEDONARY CHORION

A method of estimating the magnitude and distribution of umbilical blood flow by means of radioactive microspheres in sheep fetuses in utero is described. Simultaneous measurements of total umbilical flow by this method and the steady-state diffusion technique showed agreement within ±11%. In 11 fetuses of 90 to 150 days gestational age, the distribution of umbilical flow to the intercotyledonary chorion was 6.2±0.8% of the total. This information has been used to estimate the effect of venous admixture of cotyledonary and noncotyledonary blood on the umbilical vein-uterine vein concentration difference of inert molecules with flow-limited transplacental clearance.

Distribution of uterine blood flow in the pregnant sheep

Abstract Uterine flows in 14 pregnant sheep were determined before, during, and after the infusion of radioactive microspheres into the maternal arch of the aorta. The distribution of microspheres in the endometrium, myometrium, and cotyledons was then measured and the regional blood flows to these structures calculated and related to gestational age and fetal weight. As fetal weight increases, the flow to the cotyledons increases markedly, while the flows to the uterine muscle and endometrium show no significant changes.

Antithrombin III depression and thrombin generation acceleration in women taking oral contraceptives

Abstract The blood clotting systems of 21 women were studied prior to and modified by steroid contraceptives. The oral contraceptives induced a depression of antithrombin III activity and an acceleration of thrombin generation within the first cycle of therapy. These changes are similar to those observed in patients with chronic thromboembolic disease. It is suggested that of all the clotting changes induced by the oral contraceptives the loss of antithrombin III activity may be the one that is the most clinically significant.

The intrauterine device and tubo-ovarian abscess

During the past 4 years, 16 patients have been seen who developed a unilateral tubo-ovarian abscess while wearing, or soon after removal of, an IUD. None of the patients had gonorrhea. There appears to be a prodromal syndrome before abscess formation of 2 to 5 weeks during which the patient complains of vague lower abdominal pain, pelvic tenderness, and dyspareunia. A few patients had a rapid onset of symptoms. The device should be removed when prodromal symptoms arise and the patient should be treated with antibiotics. Should a tuba-ovarian abscess develop, surgical intervention is necessary.

Destruction of the endometrium by cryosurgery

Abstract Eleven patients with dysfunctional uterine bleeding had cryosurgery of the endometrium. Nitrous oxide was used as the cooling agent. Complete histologic ablation of the endometrium was produced in 3 patients. In the remaining women, there were isolated fragments of endometrium in the uterine fundus and cornual regions with homogenous destruction of the endometrium in the corpus and lower uterine segment. None of these patients demonstrated evidence of hemoatometra or pyometra following cryosurgery.

Preliminary observations of cryocoagulation of the endometrium

The histologic changes of the endometrium in 6 patients following cryosurgery are described. The interval between cryocoagulation and hysterectomy varied from 30xa0minutes to 6xa0weeks. Coagulation necrosis which resulted from the procedure was limited to the endometrium with minimal reaction in the myometrium.

Amniotic fluid examination as an aid in the assessment of gestational age

Amniotic fluid creatinine and bilirubin concentrations and percentage of fetal sebaceous cells were determined simultaneously in 65 normal obstetric patients who had a reliable menstrual history. These constituents in the amniotic fluid were then compared to the gestational age determined from the menstrual history and by physical and neurological examinations of the newborn infant. Of the three, amniotic fluid creatinine concentration was the most reliable. After 36 weeks’ gestation, the creatinine concentration was 1.8 mg. per cent or greater.

A primary melanocarcinoma of the cervix

Abstract A 39-year-old, white woman with a primary melanocarcinoma of the cervix is reported. She survived for 14 years. The literature has been reviewed, and 8 other identical malignancies of the cervix have been reported. Diagnosis, prognosis, and therapy for melanocarcinoma are discussed.

Conjugated estrogens and hypercoagulability

A group of 11 menopausal women receiving 1.25 mg. of conjugated estrogens daily had coagulation tests to determine the development of hypercoagulability after taking 5 and 21 tablets. There was no essential change in thrombin generation or fibrinolytic activity as measured by euglobin lysis time. There was a shift toward hypercoagulability in all three parameters of the thrombelastograms. The decrease of the antithrombin III activity was not as pronounced following the administration of conjugated estrogens as had been the change associated with oral contraceptives. Fibrin monomers were observed in some women during the first week of Premarin therapy.

Intrauterine diagnosis: Potential complications

The hazards of amniocentesis for intrauterine diagnosis have yet to be established. We are particularly concerned by the high incidence (7.5 per cent) of postamniocentesis abortions and amniotic fluid leaks in our series. A larger experience is certainly needed before these concerns can be disregarded. Until then, it is important that indications for this procedure be strictly adhered to.