Toxemia Of Late Pregnancy Research Articles

THE USE OF ESTRIN IN THE TREATMENT OF ECLAMPSIA

A multitude of theories as to the origin and treatment of eclampsia have been suggested. Recently Smith (1) demonstrated that both the blood and placentae of eclamptic women were characterized by a low estrin content and an excess of the placental or pregnancy-urine gonadotropic hormone. Heim (2), however, observed a very high excretion of both estrin and gonadotropic hormone in the urine of eclamptics. Bickenbach and Fromine (3) could find no increase in the blood content of estrin in 4 cases of clampsia. In the past three years 8 convulsive eclamptics have come under the observation of the author. Only 1 of the 8 displayed an excess of estrogenic substance in the blood. In another case, the only one in which a Friedman test was made, the prolan output in the urine was found to be very high. Mild toxemias of late pregnancy of the abruptio placentae type have been treated with wheat germ oil with striking success (4). Apparently the oil neutralises the estrogenic substance which is found in excess in the ...

A chemical test for pregnancy applied to the determination of estrin in the urine of normal and toxemic patients in the last trimester of pregnancy

1.1. By means of a chemical test for pregnancy6 a definitely lowered level of estrin excretion in the urine has been found in a series of cases in the late toxemias of pregnancy. Determinations upon the urines of normal patients in the last trimester of pregnancy were run concurrently as controls to establish a normal level.2.2. In this series preeclampsia was not subdivided into “low reserve kidney” and preeclampsia. The late toxemias of pregnancy are considered in this paper as: chronic nephritis complicating pregnancy, preeclampsia, and eclampsia. No cases of true eclampsia appear in this series.3.3. Sixty hospitalized patients in the last trimester of their pregnancies were carefully studied clinically, and complete twenty-four-hour urine specimens were examined for estrin.4.4. While the line of demarcation is not sharp in 30 per cent of the cases, it has been possible to divide 70 per cent into those normal patients who were free from any evidences of toxemia; those patients suffering from chronic nephritis complicating pregnancy; and those whose clinical diagnosis was preeclampsia. The average estrin excretion expressed as the “ferric chloride number” for 21 normal cases was 83.30; for 19 cases of chronic nephritis complicating pregnancy 51.67; and for 20 cases of preeclampsia, 36.87.

Progestin and Estrin of Nineteen Placentas from Normal and Toxemic Cases.

The placentas of late pregnancy toxemia cannot be shown by the methods available to differ significantly in content of progestin from those of non-toxemic pregnancy.

Prolan and estrin in the serum and urine of diabetic and nondiabetic women during pregnancy, with especial reference to late pregnancy toxemia

Analyses on 12 nondiabetic women throughout normal pregnancies indicate that the peak in prolan of both urine and serum occurs at approximately two months and that by the beginning of the fourth month this hormone reaches a lower and fairly constant level coincident with an increase in estrin. The most rapid rise in estrin of both urine and serum takes place during the last trimester.The data on 6 cases of late pregnancy toxemia (4 of them diabetics) confirm the previously reported finding of high prolan and low estrin in this condition and demonstrate that the abnormal rise in serum prolan precedes the clinical manifestations by at least six weeks.The curves on 5 diabetic women throughout normal pregnancies are essentially similar to those of the normal nondiabetics. A somewhat later rise in estrin and a less marked plateau of prolan suggests, however, that the high incidence of toxemia in diabetic pregnancies may be linked with a prolan-estrin imbalance which approaches the toxemic borderline.In 4 cases, two diabetic patients, high serum prolan at five to seven months led to the prediction of late pregnancy toxemia. One of these women (diabetic) had a premature delivery at seven and one-half months. The other 3 showed a very marked rise in estrin during the last trimester coincident with a drop in prolan to within the limits of normal and the appearance of only very mild toxic symptoms.Of the 11 diabetic patients followed, 4 had either stillbirths or edematous giant infants. All 4 of these women showed the prolan-estrin imbalance typical of toxemia at five to seven months. The diabetic patients with normal curves for prolan and estrin delivered normal, living infants. Two of the diabetic patients, on the other hand, whose prolan was excessive and who developed severe toxemia, were delivered by cesarean section at seven and one-half months of normal, living infants. Although it might be argued that in these two cases early delivery had preceded abnormal growth of the fetus, the data at hand are too limited to permit the establishment of any connection between the endocrine findings and the type of infant in diabetic pregnancies.

The early diagnosis of abruptio placentae and its treatment with wheat germ oil

1.1. Many cases of abruptio placentae are overlooked because the early symptoms are not recognized.2.2. The early symptoms are described in detail, stressing localized uterine tenderness and sacral backache.3.3. The marginal retroplacental hemorrhages and clots are described briefly.4.4. Seventy-eight per cent of 82 cases of mild and severe abruptio placentae showed serologic evidences of deficiency of vitamin E.5.5. Wheat germ oil, therefore, was used prophylactically and therapeutically. The results were very satisfactory.6.6. The relationship of this new evidence to the problem of the toxemias of late pregnancy is discussed.

Modern prenatal care

Prenatal care is an essential feature of good obstetrical care. If one wishes to convince himself of the value of prenatal care by cold, hard figures he need only consult the reports of maternal mortality in Philadelphia (1931–1933), 9 the Fifteen States report, 10 and others of similar nature. All show that maternal deaths are associated with inadequate or no antenatal care in a large percentage of the cases. Having consulted her physician and being willing to cooperate, the patient has done her part, in a manner of speaking. It is then up to the physician to see that she gets the benefit of proper examination and care according to the principles set forth. Proper prenatal care involves: 1. 1. Medical care from a very early period of pregnancy, in case continuance of the pregnancy is inadvisable; 2. 2. Complete history and physical examination, both general and obstetrical, in order that the patient's physical status may be fully appreciated, and in order that the development of abnormalities may be anticipated as much as possible; 3. 3. Acquaintance of the patient with the danger signals, in order that she may call her doctor at once; 4. 4. Instruction of the patient regarding the proper regulation of diet, exercise, rest, bowels, sexual intercourse, and general mode of living; 5. 5. Regular follow-up examinations becoming more frequent as term is approached, in order that the physician may discover deviations from the normal as early as possible; 6. 6. Appreciation of the complications which are more or less closely related to pregnancy, their suggestive symptoms, methods of diagnosis, in order that they may be forestalled or treated in their very early stages. The complications referred to are syphilis, gonorrhea, pyelitis, hyperemesis, the late toxemias of pregnancy and hemorrhage, particularly. 7. 7. Knowledge of the minor complications and what may be done for them.

Evidence for the placental origin of the excessive prolan of late pregnancy toxemia and eclampsia: Smith, Geo. Van S., and Smith, O. Watkins: Surg. Gynec. Obst. 61: 175, 1935

Evidence for the placental origin of the excessive prolan of late pregnancy toxemia and eclampsia: Smith, Geo. Van S., and Smith, O. Watkins: Surg. Gynec. Obst. 61: 175, 1935

The mild toxemias of late pregnancy: Their relation to cardiovascular and renal disease

The mild toxemias of late pregnancy: Their relation to cardiovascular and renal disease

The toxemias of late pregnancy

The toxemias of late pregnancy

STUDIES IN GLUTATHIONE: II. RELATION BETWEEN REDUCED AND OXIDIZED GLUTATHIONE AND THE OXYGEN CONTENT AND CAPACITY OF BLOOD

Abstract Recent evidence indicates that glutathione may be intimately concerned in intracellular oxidation because of its facility for taking up and liberating hydrogen. This substance is present in both the reduced and oxidized forms in various tissues and in red blood cells, but not in the plasma. In view of Rodenacker's 1 findings that the oxidizing power of blood and presumably of the tissues decreases slightly toward the end of normal pregnancy, and in eclampsia falls far below the normal level, it seemed that blood glutathione studies combined with oxygen content and capacity determinations in such individuals might give valuable information. Deficient oxidation has been cited by Hochenbechler 2 as the cause of the lowered bicarbonate reserve of the blood in eclampsia, and Stander, 3 in discussing the significance of increased lactic acid of the blood in eclamptic women, argued that whatever theory ultimately explains the etiology of this disease, decreased or deficient oxidation must be taken into account, since he considers this phenomenon the most fundamental yet discovered. The purpose of the present study was to determine the concentrations of reduced and total glutathione, the oxygen content and capacity, and the cell volume in the blood of nonpregnant women, in normal women during pregnancy, labor and the puerperium, and in individuals suffering from the toxemia of late pregnancy.

Studies in glutathione: I. Total and reduced glutathione, oxygen content and capacity, and cell volume of blood in nonpregnant and pregnant women, with special reference to the toxemias of pregnancy

Recent evidence indicates that glutathione may be intimately concerned in intracellular oxidation because of its facility for taking up and liberating hydrogen. This substance is present in both the reduced and oxidized forms in various tissues and in red blood cells, but not in the plasma.In view of Rodenacker's1 findings that the oxidizing power of blood and presumably of the tissues decreases slightly toward the end of normal pregnancy, and in eclampsia falls far below the normal level, it seemed that blood glutathione studies combined with oxygen content and capacity determinations in such individuals might give valuable information. Deficient oxidation has been cited by Hochenbechler2 as the cause of the lowered bicarbonate reserve of the blood in eclampsia, and Stander,3 in discussing the significance of increased lactic acid of the blood in eclamptic women, argued that whatever theory ultimately explains the etiology of this disease, decreased or deficient oxidation must be taken into account, since he considers this phenomenon the most fundamental yet discovered.The purpose of the present study was to determine the concentrations of reduced and total glutathione, the oxygen content and capacity, and the cell volume in the blood of nonpregnant women, in normal women during pregnancy, labor and the puerperium, and in individuals suffering from the toxemia of late pregnancy.

The relationship between the early and late toxemias of pregnancy

The relationship between the early and late toxemias of pregnancy

Starvation hypoglycemia in late pregnancy

The Gibson (Folin-Wu) method for blood sugar gives results comparable to those obtained with the Somogyi (Shaffer-Hartmann) technic. Both methods evidently exclude the determination of nonsugar reducing substances, and therefore apparently give true sugar values.In pregnant women near term starvation for twelve hours leads to blood sugar reductions similar to those observed in nonpregnant individuals, but fasting for fifty hours reduces the blood sugar to levels considerably below those recorded for the nonpregnant. In 14 among 53 such patients the blood sugar fell to less than 40 mg. per cent, and in one case to 30 mg. per cent.Development of a marked starvation hypoglycemia with acetonuria produces no signs or symptoms of toxemia of late pregnancy, except that mild transient headaches are occasionally noted.Starvation for fifty hours in the last month of pregnancy is frequently (30 per cent) followed by the (otherwise spontaneous) onset of labor.

Excessive Anterior-Pituitary-Like Hormone and Variations in Oestrin in the Toxemias of Late Pregnancy

Quantitative determinations of the anterior-pituitary-like gonad-stimulating hormone and of oestrin have been made on the sera and urines of 27 women, both normal and toxemic, during late pregnancy, i. e., from 7 1/2 months to term. The Ascheim-Zondek and Allen-Doisy methods have been employed. Ten cases were normal, 14 were diagnosed toxemia without convulsions and 3 had eclampsia.The following procedure was carried out in every instance. A mixed 24-hour specimen of urine was collected and measured. Forty cc. of blood were allowed to clot and the serum separated. For the Ascheim-Zondek test the amounts of urine and sera to be assayed were precipitated with 5 volumes of 95% alcohol, allowed to stand overnight and centrifuged. The precipitate was washed with ether and taken up in saline for injection into female rats 3 weeks old. A test was considered positive only if corpora lutea were grossly visible. In establishing the hormone content of each urine and serum 5 to 20 rats were used, depending upon how w...

Report of the Committee of the Obstetrical Society of Philadelphia upon the Incidence and Treatment of the Toxemia of Late Pregnancy in Philadelphia

Report of the Committee of the Obstetrical Society of Philadelphia upon the Incidence and Treatment of the Toxemia of Late Pregnancy in Philadelphia

Sodium amytal in the treatment of the late toxemias of pregnancy

Sodium amytal in the treatment of the late toxemias of pregnancy

The acid-base equilibrium of the blood in the late toxemias of pregnancy

The acid-base equilibrium of the blood in the late toxemias of pregnancy

The phenoltetrachlorphthalein test of liver function in the late toxemias of pregnancy

The phenoltetrachlorphthalein test of liver function in the late toxemias of pregnancy

The weight factor in pregnancy

Although the series of cases studied was not large, the average gain of 23.2 pounds by healthy pregnant women coincides with that observed by Davis and others. The number of toxemic patients is also small (twelve), but they fall in very definite weight groups. Noted in conjunction with careful urinalyses and the blood pressure readings, the amount and rate of increase in weight should aid materially in foretelling the toxemias of later pregnancy and make it possible to ward them off. With the increase in the number patients who are applying for, and who are interested in, antenatal care, the physician will be placed in a position to study such patients. This being true, no method should be slighted that will aid in reducing the toxemias of late pregnancy to a minimum.

The aftereffects of the late toxemias of pregnancy: Harris, John W.: Bulletin of the Johns Hopkins Hospital, 1924, xxxv, 103

The aftereffects of the late toxemias of pregnancy: Harris, John W.: Bulletin of the Johns Hopkins Hospital, 1924, xxxv, 103