William F. Mengert

Placental Transmission of Erythrocytes

Summary With the aid of washed donor erythrocytes tagged with Fe 59 and injected into pregnant women, we were able to demonstrate significant amounts of radioactivity in the blood of their fetuses, in 25 of 29 subjects. The average amount of radioactivity represented the tagged cells which would have been found in 4.4 ml. of whole maternal blood. Two pregnant women at term were given blood from donors with sickling trait but without sickle-cell anemia. Sickle cells were thought to be demonstrated in the blood of the fetuses after appropriate technical treatment. No sickle cells were seen in the blood or umbilical cord of two fetuses serving as controls.

Pregnancy toxemia and sodium chloride

Summary Forty-eight consecutively admitted patients with acute, vasospastic toxemia of pregnancy were a lternately given diets with 10.0 to 11 .5 Gm. of sodium chloride and 0.9 to 1.7 Gm. of sodium chloride daily. There was no discernible ffect on the clinical course of the toxemia.

Prolapse of the umbilical cord

Abstract Prolapse of the umbilical cord is an infrequent complication of labor, which becomes significant because of the resultant high fetal mortality rate and the employment of radial operative procedures that increase the maternal hazard. Little is known about its etiology except that conditions which interfere with the proper filling of the pelvic cavity by the presenting part conduce to its development. This study was undertaken to ascertain whether any other factor, possibly nonpreventable in character, could be recognized as favoring funic prolapse.

Diagnostic dilatation and curettage as an outpatient procedure

The data for this study is based on 403 women undergoing dilatation and curettage and representing all aspects of an average clinic population cross-section in age parity and health. This method (dilatation and curettage) is extensively used for detection of cancer of the corporeal endometrium. Exposure of the cervix and vaginal fornices was the biggest problem in terms of applying the technique. There were basic contraindications to office curettage including intact hymen marked obesity of the patient leading to difficult positioning inebriation etc. Generally the patients agreed that the operation was less painful than the extraction of a tooth. 91% of the patients did not have any complications. There were 2 uterine perforations and one cervical laceration.

Graphic portrayal of relative pelvic size

Abstract A method of graphic portrayal of size and approximate shape of inlet, mid-, and outlet planes is presented. This is accomplished by diagramming each plane on a graphic outline of its normal counterpart. Six measurements, the anteroposterior and transverse of the inlet and midplane, and their point of intersection, and the posterior sagittal and transverse of the outlet are sufficient for graphic portrayal. Four of the six measurements can be obtained, or closely estimated, manually. Roentgenographic mensuration is necessary for the transverse diameter of the inlet, the anteroposterior of the midplane, and the determination of the point of intersection of the two basic diameters of each of these levels. It is desirable for determination of the transverse diameter of the midplane. When roentgenographic mensuration is performed, it is obviously better to make all measurements from the films than to depend in part upon manual mensuration. By means of graphic portrayal of relative pelvic size, accurate prognosis is possible. It is also possible to make precise prognosis of modifications of the course of labor occasioned by mild cephalopelvic disproportion.

Recognition of midpelvic contraction

A LTHOUGH pelvic contraction was recognized at least as early aa the sixteenth century, it was not until 1861 that Litzmanns set forth practical criteria for evaluating the inlet. Outlet contraction, mentioned occasionally through the years, received serious attention only after Williams’ exposition,‘X almost fifty years later. There has been a similar delay in the general acceptance of the concept of midpelvic contraction. Although occasional reference has been made to the obstetric significance of the pelvic midplane for at least fifteen years, the subject continues to receive scant attention, and the majority of recent writers ignore it. A single paragraph on the effect of “prominent ischial spines ’ ’ appears in one of four standard obstetric texts. It is strange that midpelvic capacity should be ignored or its importance denied, since for years this level has been known as “the plane of least pelvic dimensions. ” Published reports, on the contrary, indicate that interspinous measurements below the generally accepted normal of 10.5 cm. are relatively common. By manual mensuration, Hanson5 found 16.1 per cent of 1,120 obstetric patients with interspinous diameters 9.5 centimeters or less, using a specifically designed instrument. Others29 3* ‘if *O have repeatedly called attention to the frequency of midpelvic contraction. Obviously, one would expect to find midpelvic contraction in association with caontracted inlet and outlet. On the other hand, it can occur with normal inlet and outlet, according to the criteria of Litzmann and Williams. The difference between average pelvic measurements and those at the lower limits of normal demands emphasis at this point. With average manual measurements, it is doubtful that midpelvic dystocia will result. With manual measurements at. t,he lower limits of normal, serious, and even insurmountable midplane disproportion is not only possible theoretically, but also actually does occur, as exemplified by the ensuing report :

Etiology of premature separation of the normally implanted placenta: Preliminary observations

Abstract Two mechanisms were discovered to impede venous flow from the uterus in late pregnancy: compression of deep veins by the lower uterine segment and obstruction of veins at the lateral pelvic walls by collapse of the flaccid uterus in an accordian-like fashion along its long axis. The implications of this observation are discussed in relation to the etiology of premature separation of the placenta.

PREGNANCY AFTER BILATERAL LIGATION OF THE INTERNAL ILIAC AND OVARIAN ARTERIES

Reports of 5 women who bore a normal child successfully after bilateral ligation of the internal iliac arteries are given. Three of these women also had bilateral ligation of the ovarian arteries. Even after bilateral ligation of both internal iliac and both ovarian arteries there was sufficient pelvic blood supply to support and provide normal development of a termsize child.

Pelvic Pain in Women

In the majority of cases, pelvic pain in women has no anatomic basis, yet the desire to eliminate pelvic pain motivates more gynecologic surgery than any other single reason. Only a few of the female genitalia actually have end organs for pain. True causes of pelvic pain arising from the genitalia and other sources are irritation of the peritoneum, traction on a mesentery, distention of a viscus or tissue space, pressure, and spasm or rupture of a viscus.Physicians cannot always diagnose the cause of pelvic pain, but they can refuse to operate when a pelvic lesion is not found. Only in this way can the common neurotic fixations and chronic pelvic invalidism be prevented.