Obstetric Point Of View Research Articles

Obstetric Viewpoint on Cerebral Palsy

Modern organisation and techniques of obstetrics have largely eliminated the dangers to the baby of mechanical birth trauma and of late pregnancy anoxia. There is still, however, a great deal that the obstetrician and gynaecologist can contribute in preventing damage to the baby. He should first of all accept that cerebral palsy, epilepsy, mental defect, etc. are problems within his direct field. Because of his interest in infertility, abortion, pregnancy and labour, he should be a leader in research studies directed towards the investigation of the aetiology of such defects, and, therefore, assist in formulating techniques to minimise such dangers. Most of the current inadequate information is due to poor clinical records and to lack of appreciation that there are aberrations in pregnancy and labour, of little apparent importance at the time, which can affect the subsequent development of a child.SUMMARYThere is still, despite over‐population, urgent need for elucidation of the aetiological factors of pregnancy wastage. The obstetrician/gynaecologist should be u leader in such studies.Cerebral palsy is said to arise from mechanical birth trauma or from late pregnancy or intrapartum anoxia. Modern obstetrical techniques should lead to the disappeaiance of such cases. Prematurity is a much more difficult problem. The obstetrician must seek the causes and attempt to minimize the risks to the foetus.Present research is handicapped by lack of available obstetrical information. Many and vanedaetiological factors can cause the same lesion. In field research lesions of widely different aetiological background are studied together as if they were one syndrome.Much research needs to be done. The obstetrician should lead, should welcome into his clinics workers from other disciplines, and should guide their studies in so far as clinical experience is essential.RESUMEL'infirmité motrice cérébrale point de vue obstéfricalII y a encore, malgré une sur‐population, un besoin urgent de mettre en lumière les facteurs étiologiques du gaspillage des grossesses. L'obstétricien/gynécologue est appeléà conduire une telle recherche.On considère comme causes de l'infirmité motrice cérébrale les lesions obstétricales mécaniques, les grossesses tardives, l'anoxie pendant le travail. Mais il y a tout lieu de penser que l'obstétrique moderne aura raison de ces cas. La prématurité est un problème bien plus difficile. L'obstétricien doit en chercher les causes et essayer de réduire les risques encourus par le foetus.L'absence de renseignements obstétricaux gěne considérablement la recherche actuelle. Une měme lésion peut avoir été causée par des facteurs étiologiques nombreux et variés. Dans le secteur de la recherche, des lésions d'origine tout à fait différentes font partie de la měme étude comme si elles ne for‐maient qu'un seul syndrome.Un grand travail de recherches doit ětre fait. L'obstétricien doit guider et acceuillir dans sa clinique les chercheurs de disciplines différentes et doit orienter leurs études dans le mesure ou l'expérience clinique est le fait essentiel.ZUSAMMENGFASSUNGDie zerebrale Kinderlähmung vom Gesichtspunkt der Geburtshilje aus angesehen.Trotz der Ubervölkerung, bleibt es noch dringend nötig, die ätiologischen Faktoren der Vergeudnung der Schwengerschaften zu erschkiessen. Dem Geburtschelfer und Frauenarzte steht es bei, diese Forschungs‐arbeit zu leiten. Man nimmt als Ursachen der zerebralen Kinderlähmung mechanische Schädigungen, späte Schwangerschaften, Anoxämie während der Entbindung an. Man kann aber denken, dass die moderne Geburt‐shilfe solche Fälle überwinden wird. Die Früburt ist ein viel schwierigeres Problem. Der Geburtshelfer muss ihre Ursachen suchen und versuchen, die Gefahren die der Fötus läuft, zu vermindern.Die Abwesenheit obstétrikaler Angaben stört die jetzigen Forschungen beträchtlich. Dieselbe Schädigung kann durch viele und mannigfaltige atiölogische Faktoren hervor‐gerufen werden. In diesem Forschungs‐bezirk sind Schädigungen ganz verschie‐denen Ursprunges in denselben Studien einbegriffen, als ob sie ein einziges Syndrom bildeten.Eine grosse Forschungsarbeit muss unter‐nommen werden. Der Geburtchelfer muss in seiner Klinik Forscher verschiedener anderer Fächer empfangen und leiten und muss ihre Untersuchungen, soweit die klinische Erfahrung die Hauptsache ist, beeinflussen.

“Pre-diabetic” period from obstetric point of view: Hagbard: p. 497

“Pre-diabetic” period from obstetric point of view: Hagbard: p. 497

The pre-diabetic period from an obstetric point of view.

The pre-diabetic period from an obstetric point of view.

The causes of fetal mortality at the sloane hospital for women, 1940 to 1949

1.1. The fetal mortality on the ward and private services at the Sloane Hospital for Women for the years 1940 to 1949 has been reviewed.2.2. There has been a slight decrease in fetal mortality on both services during this decade, but the decrease is not statistically significant.3.3. There is a statistically significant difference between the fetal mortality rates on the ward and private services. This difference appears to be due to the better health of the private patients, and better obstetrical care on the private service.4.4. The causes of fetal mortality have been listed according to the obstetrical point of view, and the possibility of improving the results under each cause has been discussed.5.5. A division has been made into degrees of preventability within the limits of our present knowledge. It appears that 28 per cent are probably preventable, 33 per cent are possibly preventable, and 39 per cent are not preventable. Ideal obstetrics, as understood at present, would thus produce a fetal mortality of 13.0 per thousand on the ward service and 8.7 per thousand on the private service. This difference in the “ideal” figures (ideal at present) between the ward and private services expresses a lack of knowledge concerning certain causes of death which cannot be filled in at present.

The rooming-in plan for mothers and infants: An appraisal from the obstetric viewpoint of one year's experience at the Grace-New Haven Community Hospital (University Service)

R OOMING-IN is a term applied to that form of hospitalization in which the mother and newborn infant room together and the mother takes as much care of the baby as possib1e.l For purposes of study and evaluation, this plan has been carried out since Oct. 29, 1946, at the Grace-New Haven Community Hospital in a four-bed unit adapted for the purpose. The development of the plan was a cooperative effort shared by the Departments of Pediatrics and Obstetrics and Gynecology of the Yale School of Medicine, the Yale School of Nursing, and the Grace-New Haven Community Hospital. The work of the unit is under the supervision of a committee representing these divisi0ns.i It may be useful to consider some of the thinking which led to the study of this plan of hospitalization. It is not a new procedure, for in certain European countries it still exists in many modern hospitals. In this country, however, this obviously natural arrangement was abandoned in favor of the hospital nursery system, which was developed to improve the standards of infant health. This improvement has been realized to a great degree. Nevertheless, it is the belief of many that the present system of separation of the infant from its mother may interfere with certain essential needs of both mother and child and that the present rigid infant-feeding schedule is a considerable factor in the background of so-called problem children.

The elderly primigravida

The obstetrician is called upon from time to time to assume responsibility of a case of pregnancy when the woman is having her first baby late in her reproductive life. Both common teaching and experience have led to the belief that the elderly primigravida will have a difficult labor. It has been our experience, however, that because the bony pelvis, from an obstetric point of view, is fixed by the time the young woman enters the childbearing period and the soft parts likewise retain their texture during the entire reproductive period, mere age has a trivial influence on the type of labor.This study was made in a voluntary hospital with a closed staff (where the majority of cases are handled by general practitioners), in an effort to determine whether there is an increased risk in the labor of the “elderly primigravida.” In this group is included the woman thirty-five years of age or over who is pregnant for the first time.

Diabetes in pregnancy from the obstetric point of view

Diabetes in pregnancy from the obstetric point of view

"MATERNITY WARDS IN GENERAL HOSPITALS": A REPLY

To the Editor: —Dr. J. B. DeLee states that the article Maternity Ward of the General Hospital, published in the January 7 issue ofThe Journal, is his reply to resolutions and editorials evoked by his recent publications on the subject. His reply consists of two principal portions: A series of quotations from various writers expressing their criticisms of modern hospital obstetrics as being more dangerous than home deliveries, and of the general hospital as being less safe, from the obstetric point of view, than the specialized maternity hospital. A collection by Dr. DeLee and his co-author, Dr. Siedentopf, from apparently all available sources, of a series of so-called puerperal epidemics occurring in hospitals. They stress the fact that thirty-five such epidemics occurred in general hospitals, while only three such epidemics occurred in specialized maternity hospitals. The Cleveland Hospital Obstetrical Society, organized for the purpose of studying the obstetric

The position of the uterus based on a study of spinal-pelvic relationship: A study of 500 cases

While the human spine has been studied roentgenologically to determine the presence of any anomaly, injury or disease, the paucity of the literature on any study of the relation of the spine to the pelvis from a gynecologic and obstetric point of view is the reason for presenting the results of this study.The attention of the profession has been called to the different anatomic types among the human race by a number of writers who treated this subject from their own specialistic viewpoint, but a gynecologic and obstetric study of the varied anatomic types has not been reported. This study aims to establish what may be considered the normal relation between the spine and the pelvis, to note the prevalence of any particular variation from the normal, also to observe the position of the uterus in the standard normal type and to compare this with the position of the uterus in the patients who have a variation in the relation of the pelvis with the spine.Once the attention is called to the existence of varied anatomic types, one can readily observe, in his immediate surroundings, persons who are tall, others who are short; some who are stout and others who are thin. These different individuals have no doubt developed under some varied physiologic influences. A study of the peculiarities of each type may lead to a better understanding of them. The difficulty in these studies, however, is to establish what characteristics shall constitute and individual of the normal type. Once the normal is established, then persons having similar abnormalities may be classed as belonging to a common type. From a gynecologic viewpoint the so-called “abnormalities” will really not be considered as abnormalities, but as normal characteristics of a special type. According to Sturmdorf there are several types of women whom he classified by the consideration of their posture based on the measurement of the depth of the lumbosacral curve, as belonging to the normal, to the exaggerated type or to the infantile flat type.

Scientific Serials

Scientific Serials