Young Primigravida Research Articles

Letter: complications of prostaglandin-induced abortion.

I read with great interest the letter of Professors S.M.M. Karim and S.S. Ratnam (October 19, p.161) on cervical rupture during abortion induced by intraamniotic prostaglandins (PGs). The authors state rightly that this type of trauma is secondary to excessive uterine stimulation in the presence of unusual cervical resistance and that it is encountered mainly in young primigravidae. The lesion, however, is not limited to patients given PGF2alpha; cases have already been reported after intraamniotic instillation of PGE2. It is therefore unlikely that the latter compound exerts any protective action in this respect. It is necessary to point out that 2 very different lesions are encountered. The 1st occurs at the level of the thinned out posterior isthmic wall before any cervical dilatation has taken place. It presents as a transverse tear through which fetus and placenta are expelled into the vagina. The tear may extend into the lateral aspects of the isthmic region, leading to partial annular detachment of the cervix. Even when repaired, this lesion may fail to heal and a fistulous tract may develop which interferes with later reproductive performance. The complication can be prevented by examination of the cervix at regular intervals during the course of abortion and, in those cases at risk, by insertion of 1 or more laminaria tents into the cervical canal. In cases of impending rupture, gentle instrumental dilatation of the cervix should be performed immediately. Very different and of less consequence is the longitudinal tear involving the lateral aspect of an insufficiently dilated cervix during expulsion of the conceptus. This lesion, somewhat comparable to a Duhrssen's incision, is easier to repair and, if it does not reach the uterine isthmus, should not be a cause of cervical incompetence. To the best of my knowledge, not a single instance of either type of traumatic lesion to the cervix has been reported after extraamniotic administration of PGs. It is possible that the Foley catheter, usually utilized with this route, has a "ripening effect" on the cervix which facilitates dilatation.

Cervicovaginal fistula: An apparent increased incidence with prostaglandin F2α

Cervicovaginal fistula is a rare, but difficult to treat complication of midtrimester abortion. The incidence appears to be much higher with the use of prostaglandin F2α (PGF2α) than with saline in our patients, having risen from less than 1:1,000 with saline infusion to more than 1 per cent with PGF2α. Our patients at risk appear to be young primigravidas; if they received saline, they also had oxytocin augmentation of labor. Case histories are presented, and it is suggested that those patients at risk require mechanical dilatation of the cervix through the use of laminaria tents or Foley catheters.

A CASE OF ABORTION CONSEQUENT UPON INFECTION WITH BRUCELLA ABORTUS BIOTYPE 2

The case described here is that of young primigravida in normal health who, on serological evidence, contracted acute brucellosis, and subsequently aborted spontaneously, Br. abortus biotype 2 being isolated from the amniotic fluid.

A case of abortion consequent upon infection with Brucella abortus biotype 2.

The case described here is that of young primigravida in normal health who, on serological evidence, contracted acute brucellosis, and subsequently aborted spontaneously, Br. abortus biotype 2 being isolated from the amniotic fluid.

Bell's palsy and pregnancy.

Bell's palsy seems to occur during pregnancy and the puerperium more frequently than expected by chance. In particular there seems to be a distinct group of young primigravidae in whom Bell's palsy appears during the week preceding delivery, and who have a normal glucose tolerance test. These women have a good prognosis, with regression of symptoms during the fortnight following childbirth. It is suggested that in these cases Bell's palsy may result from ischaemia of the nerve, due to fluid retention and extracellular oedema. Diabetic angiopathy does not seem to be important in the aetiology of Bell's palsy appearing shortly before or after delivery, but may play a part in other cases of Bell's palsy during pregnancy.

The changing incidence of twinning in Scotland in 1939-1968.

The rate of twinning, both MZ and DZ, as determined by the Weinberg formula, remained fairly static in Scotland up to 1958, when it fell (Fig. 1), due to a fall in the DZ twinning rate. These figures are based on the returns from the Registrar General for Scotland.As age has a marked influence on the incidence of twinning, it was thought that the difference might be due to a reduced number of older women having babies. However, this does not seem to be the whole answer (Fig. 2). The most marked change would be expected in the women over 35, but this did not occur. It was not possible to look at other factors such as parity, social class and height in the figures for Scotland. The details of all births in the City of Aberdeen are known because of the very high hospital delivery rate, and more detailed studies have been made on the twinning rates for Aberdeen.These figures, again, showed that from 1959 onwards there was a fall in the twinning rate in Aberdeen and this was due to the fall in the number of DZ twins. The fall in incidence occurred both in Primigravidae and in multigravidae (Tab. I), and more in older than in younger Primigravidae (Tab. II), but there was little difference by age in the fall in multigravidae (Tab. III).Another factor which is related to the incidence of twinning is the height of the mother. This, in turn, reflects the social class, as tall women are more commonly from the upper, and small women from the lower social classes. The rate of twinning in Aberdeen was highest in the tall women before 1954 (Tab. IV). The rates in all women fell from 1954 onwards, but most dramatically in the tall women. The rates from 1959 onwards show very little difference according to height.

Antenatal diagnosis of large sacro-coccygeal teratoma with foetal cardiomegaly and hydrops

We report the case of a young primigravida who presented with a 20 weeks pregnancy with a previous diagnosis of uterine fibroid. However, ultrasound evaluation revealed the presence of a large sacro-coccygeal teratoma in the foetus which was heterogeneous with cystic areas and calcific foci, and showed increased vascularity. There was also evidence of foetal cardiomegaly and hydrops foetalis, indicated by subcutaneous oedema in the foetus,thickened placenta and polyhydramnios. The presence of hydrops with sacro-coccygeal teratoma has a grave prognosis for the mother and child; hence termination of pregnancy was done. A 20 weeks old foetus with a huge sacro-coccygeal mass, which was ruptured at many places and showed areas of active bleed, was expelled.

Relationship between length of gestation and cervical dilatation, uterine contractility, and other factors during pregnancy

The relationship was examined in healthy young primigravidas between the length of gestation and several factors measured during pregnancy, including the physical and chemical state of the cervix, uterine contractility, smoking, and sexual intercourse. Cervical dilatation and effacement during pregnancy relate to the time in gestation at which labor starts. For example, at the thirty-second week the internal cervical os was one fingerbreadth dilated in all patients who subsequently were delivered before the thirty-eighth week, but in only 10 per cent of those delivered after the forty-first week. The concentration of cervical hydroxyproline did not relate to gestation at labor nor to the physical state of the cervix. There was a highly significant negative correlation between the activity of the uterus at the thirty-sixth week of pregnancy and gestation at the onset of labor. The proportion of patients delivered before the end of the thirty-ninth week was significantly greater for smokers that for nonsmokers. However, the relationship between the length of gestation and cervical dilatation and uterine contractility in pregnancy remained significant in nonsmokers. The frequency of sexual intercourse during pregnancy did not influence the time in gestation when labor began.

Obstetrics in the adolescent: a clinical survey.

A clinical survey was undertaken in South Sydney Australia in an attempt to clarify knowledge of the obstetric behavior of adolescent females. An essentially homogeneous group of unmarried young women who were looked after and cared for in the home attached to the South Sydney Womens Hospital was selected. The control group of young primiparas aged 19 to 21 years contained females largely belonging to the same social strata as those in the studied group. Over 1/2 of these patients were unmarried. The youngest patient was age 13. The young primigravidas in the survey all received regular antenatal care. The home offered better discipline better diet and more opportunity for rest and exercise than the patients would have received outside. Pre-eclamptic toxemia occurred 1 and 1/3 times as often in the adolescent group as in the control group. There was no significant difference between the group in the mode of delivery except for cesarean section which was performed twice as often in the control group as in the adolescent group. There was no significant difference in the duration of labor and the average weight of the infant. Prematurity and malformation were not found to be more common in the adolescent group. There was no significant difference in the rate of postpartum hemorrhage or the course of the puerperium.

THE NEPHROTIC SYNDROME DUE TO PRE-ECLAMPTIC NEPHROPATHY; REPORT OF A CASE.

Case Studies1 August 1964The Nephrotic Syndrome Due to Pre-eclamptic NephropathyReport of a CaseHARRY E. SARLES, M.D., MAURICE E. HERRING, M.D., TREVOR F. WATSON, M.D., RAYMOND L. GREGORY, M.D., PH.D., F.A.C.P., AUGUST R. REMMERS, M.D.HARRY E. SARLES, M.D.Search for more papers by this author, MAURICE E. HERRING, M.D.Search for more papers by this author, TREVOR F. WATSON, M.D.Search for more papers by this author, RAYMOND L. GREGORY, M.D., PH.D., F.A.C.P.Search for more papers by this author, AUGUST R. REMMERS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-61-2-300 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe development of the nephrotic syndrome during pregnancy is an uncommon occurrence (1, 2). We have recently observed a young primigravida who developed severe pre-eclampsia with massive proteinuria which was followed by the classic features of the nephrotic syndrome. Detailed observations of this patient, including serial renal function studies and renal biopsies during her pregnancy and for 1 year post partum, form the basis of this report. This is the second report of a case of histologically proven pre-eclamptic nephropathy leading to the nephrotic syndrome, the first having been reported by Hopper and associates (3).CASE REPORTA 22-year-old Negro...

Congenital cervical incompetence in primigravidas

Moderate or severe congenital cervical incompetence occurred in 14 of the 716 primigravidas in this study; none had any history of prior cervical trauma. Sixteen other primigravidas showed a mild, but demonstrable, tendency toward incompetence. The cervices were congenitally eroded, patulous, thin walled, and infantile. Younger primigravidas seem to be more severely affected. Congenital cervical incompetence may be hereditary.The major treatment in this series was thorough cautery of cervical erosions and patulous canals. All posttreatment pregnancies have been longer than pretreatment pregnancies and all posttreatment babies have been larger than earlier siblings.

Primigravidas under age 14

This study determines if there was an increase in fetopelvic disproportion in young primigravidas (< 14 years of age) secondary to pelvic immaturity and compares the pregnancy in this group of patients with those in previous studies of young primigravidas. Records of 50 cases of pregnancy in girls (< 14 years of age) including 46 patients who were 13 years old and 4 who were aged 12 for an incidence of 1:1.735 were reviewed. 89% were blacks and the same percentage were unmarried; 65% had prenatal care which included 2 or more visits. There was a high incidence of prolonged labor (18%) and of toxemia coupled with an equally high incidence of anemia. There was no increase in fetopelvic disproportion because of pelvic immaturity. Social; economic and psychological factors (eg hostile and unsympathetic family or environment) have a potential for damaging permanently any unstable and even some stable emotional personalities. The role of the physician in alleviating some of the problems of teenage pregnancy is briefly discussed.

Medico‐Legal Commentary

BJOG: An International Journal of Obstetrics & GynaecologyVolume 59, Issue 3 p. 363-367 A YOUNG PRIMIGRAVIDA† Medico-Legal Commentary J. R. E. James M.B., F.R.C.S., M.R.C.O.G., J. R. E. James M.B., F.R.C.S., M.R.C.O.G. Consulting Obstetrician and Gynaecologist to the West Wales Group of HospitalsSearch for more papers by this authorH. Edmund Davies Q.C., LL.D., B.C.L., H. Edmund Davies Q.C., LL.D., B.C.L. Recorder of SwanseaSearch for more papers by this author J. R. E. James M.B., F.R.C.S., M.R.C.O.G., J. R. E. James M.B., F.R.C.S., M.R.C.O.G. Consulting Obstetrician and Gynaecologist to the West Wales Group of HospitalsSearch for more papers by this authorH. Edmund Davies Q.C., LL.D., B.C.L., H. Edmund Davies Q.C., LL.D., B.C.L. Recorder of SwanseaSearch for more papers by this author First published: June 1952 https://doi.org/10.1111/j.1471-0528.1952.tb04134.xCitations: 2 A Case Record AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume59, Issue3June 1952Pages 363-367 RelatedInformation

Pregnancy and the Adolescent

An analysis of 634 young mothers 16 years of age or under who were delivered in the 3-year span including 1945 1946 and 1947 at the Gallinger Municipal Hospital of Washington D.C. was conducted. Almost 99% of the young mothers were black. Only 15% were married. Prenatal care was considered generally good or adequate. Only 34 of them or 5.3% had no antepartum care. The most important phase of their management was found to be in the antepartum course. The incidence of maternal complications before the baby is born is high. Of the 211 complications the toxemias comprised 60%. The younger the mother the higher the incidence of the toxemias. Of the 125 instances of this complication almost 3/4 were classified as mild pre-eclampsia about 1/5 of them as severe pre-eclampsia and 5.6% were eclampsia. 85.2% of this group of young mothers were delivered at term about 12% prematurely and about 3% had previable infants. The importance of good prenatal care for the young primigravida cannot be overemphasized. The duration of labor was found shorter the incidence of cesarean section lower the complications of the puerperium no greater and the infantile and maternal mortality decreased.

"SPLENECTOMY IN PREGNANCY COMPLICATED BY THROMBOCYTOPENIA PURPURA HEMORRHAGICA"

To the Editor:— am interested in the article by Dr. Polowe in the March 18 issue entitled Splenectomy in Pregnancy Complicated by Thrombocytopenia Purpura Hemorrhagica. The author says I believe this is the first case to be reported. wish to point out that the case reported is not the first case of its kind treated successfully by splenectomy. A few years ago in civilian practice had under my observation a young primigravida who in her fifth month of gestation developed clinical and laboratory signs of thrombocytopenic purpura hemorrhagica. well recall the recurrent nosebleeds, bleeding gums, purpura, thrombocytopenia, and the anxious night calls. After a short trial of snake venom therapy at home the patient was admitted to the ward medical service of the Mount Sinai Hospital, New York, where she received additional snake venom and transfusion therapy prior to operation. Dr. Rosenthal recommended splenectomy, which was

Hydatidiform Mole in a Young Primigravida.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 41, Issue 3 p. 420-421 Hydatidiform Mole in a Young Primigravida. Probodh Chandra Das M.B. (Calcutta)., Probodh Chandra Das M.B. (Calcutta).Search for more papers by this author Probodh Chandra Das M.B. (Calcutta)., Probodh Chandra Das M.B. (Calcutta).Search for more papers by this author First published: June 1934 https://doi.org/10.1111/j.1471-0528.1934.tb08779.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume41, Issue3June 1934Pages 420-421 RelatedInformation