Does hydatidiform mole predispose to preeclampsia-eclampsia? (a study of 85 cases of hydatidiform mole)

Out of 85 cases of hydatidiform mole, 54 or 63.5 had normal blood pressure and normal urinalysisThirty one cases had a blood pressure ranging from 130/80 to 200/100mm. Hg. Two patients had a blood pressure respectively of 174/120 and 180/102 mm. HgThe age of amenorrhea in both the normotensive and hypertensive groups ranged from 2 to 7 monthsThe height of the fundus uteri in the normotensive group ranged from 6 cm. above the symphysis to 2 cm. below the umbilicus except in 9 cases or in 16.7 where it reached the level of umbilicusThe height of the fundus in all of the 31 cases in the hypertensive group was at or above the level of the umbilicusTen of the 31 cases of hypertension had also albuminuria, cylindruria and red blood cells in the urine. Three of these cases had also edema of the lower extremitiesTwo of the cases that showed edema, albuminuria and cylindruria died. They had no convulsions but their autopsy showed the liver lesions of eclampsia. One of them also showed cerebellar hemorrhageThere was no correlation between the age of amenorrhea and hypertension. There was correlation, however, between the hypertension and the height of the fundus uteri. (Summary)

Studies on microscopically diagnosed chorioepithelioma from twenty-seven cases admitted to the Philippine General Hospital from 1950-1954 (in three sections)

The study presented the histories of chorioepithelioma cases which were grouped into three sections namely: chorioepithelioma deaths due to neglect or to belated treatment, (2) chorioepithelioma deaths that were unavoidable, and (3) cases of chorioepithelioma that recoveredOf the 27 cases of microscopically diagnosed chorioepithelioma, 8 (30%) recovered because of early treatment while 18 (67%) died. One was a case of doubtful recovery because of the absence of follow up. The tumor occurred in women between 19-48 yrs of age. The gravidity and parity in the 27 cases are given. The antecedent pregnancy was hydatidiform mole in 63%, early abortion in 18%, full term labor in 4%, and ab initio in 15%It was noted that a great majority of the patients could have been saved if they were diagnosed and treated early specially when the chorionic malignancy was still confined in the uterus

Stillbirths and neonatal deaths in the Philippine General Hospital after liberation (April 5, 1945 to April 4, 1946)

1. The stillbirth rate for 895 full-term babies born at the Philippine General Hospital during the first year after liberation is 3.12 per cent. The full-term neonatal deaths is 1 per cent. The gross full-term fetal mortality is 4.12 per cent2. Prematurity from seven to eight months has a gross fetal mortality rate of 53.57 per cent. This includes the stillbirths and neonatal deaths3. Cephalopelvic disproportion malformations are the outstanding causes of full-term stillbirths4. Placenta previa, chronic nephritis, syphilis, and eclampsia are the most frequent causes of premature stillbirths5. Syphilis and chronic nephritis are the most frequent causes of premature macerated stillbirths. Syphilis as a cause of stillbirth was a rare phenomenon before, but it has become prominent after the liberation. (Summary)

Studies on hydatidiform mole

1. Excessive uterine enlargement or its sudden occurrence in a mole has the tendency to become malignant2. Every case of mole should be examined by early microscopy for malignancy. Benign cases should be followed up in young women for three months, and in women approaching menopause, for three years, for clinical evidence of chorioepithelioma. (Conclusion)

Cesarean section in the Philippine General Hospital

An analysis of the cesarean sections and hysterectomies in the obstetrical department of the Philippine General Hospital during the two years following liberation is presented.The incidence of cesarean section among 3,749 viable births is 123 cases or 3.28 per cent.The complication that caused the greatest number of cesarean sections is placenta previa. None of the mothers died; but, out of 48 infants, 18 or 37.5 per cent either were stillborn (9) or died after birth. Sixteen infants or 88.88 per cent were premature.Dystocia, because of disproportion or malpresentation, was the next outstanding indication for cesarean section. There was no maternal mortality; but 3 out of 36 infants died, and 2 were stillborn. Two of the infant deaths were caused by hydrocephalus which were not diagnosed before the operation. One infant died of bronchopneumonia. Of the two stillbirths, one was a case of anencephalus with a large body, and the other was a severed after-coming head which could not be extracted below. The corrected fetal mortality of this complication is 1 death or 2.76 per cent.Cesarean section was performed in 7 cases of severe preeclampsia that failed to improve with conservative treatment, and in 91 cases of severe eclampsia where the fetus was alive and the cervix was either closed or dilated 1-2 cm. The maternal mortality of preeclampsia was 14.28 per cent, and that of eclampsia 22.22 per cent. We agree with those who believe that the best treatment for eclampsia, next to prevention, is the conservative treatment.Traumatic rupture of the uterus was caused by neglected transverse presentation in 41.5 per cent, and by pituitrin and salag or by pituitrin alone in 33.33 per cent. The high incidence of these causes calls for greater attention to, and proper management of, malpresentations and fetopelvic disproportion; and for more efficient instruction to those dealing in midwifery on the danger, limitation, and contraindications of pituitrin and salag.Rupture of the uterus through the cesarean section scar has been found in 4 cases (2.5 per cent), all of which were of the classical type. Because of the fibrotic condition of the scar and its lessened blood supply, the morbidity of such a type of rupture is relatively lower than when the rupture occurs in a noncesareanized uterus. Though all the babies were stillborn, all the mothers recovered; whereas from the traumatic rupture the maternal mortality was 41.66 per cent.The relative morbidity of the mothers exposed to infection operated on by extraperitoneal cesarean section and those operated on by laparotrachelotomy in conjunction with penicillin and the sulfa drugs is discussed.From 15 to 30 years dystocia was the most frequent indication for cesarean section, its incidence being 30%. But, after 31 years, placenta previa was the most frequent complication, its incidence being 46.87 per cent.Beginning from Para II to Para V, placenta previa was the highest indication for cesarean section, its incidence being 36.8 per cent. But from Para VI onwards, the incidence of placenta previa as indication for cesarean section is as high as 66.66 per cent. (Summary and Conclusion)

Maternal morbidity and mortality in the Philippine General Hospital - From July 1, 1945, to December 31, 1951

The incidence and mortality of the different obstetrical complications at the Philippine General Hospital is presented and compared with those of other countriesThe incidence of 1.2 per cent of eclampsia is high when compared with the 0.04 per cent incidence in the Malay States, or the 0.06 per cent in the British Isles, or the 0.15 per cent in the United States, or even the 0.88 per cent in Japan. Eclampsia exacts the highest death toll among our parturients. Though the percentage of mortality in eclampsia at the Philippine General Hospital has been much lowered, it is till high, it being 17-43 per cent. In the United States, the percentage of mortality in eclampsia has been reduced to 6.34 per centPlacenta previa, hydatidiform mole, chorionic malignancy, ectopic pregnancy, and uterine rupture have a high incidence among the patients admitted to the Philippine General Hospital, the incidence being respectively 1:50 deliveries, 1:145 pregnancies, 1:220 pregnancies, 1:41.35 pregnancies, and 1:600.5.(Summary)

Can metastatic choriocarcinoma occur without a primary growth in the uterus?

Six cases of metastatic choriocarcinoma without a primary growth in the uterus are presented. Three cases followed early abortion, two cases after term pregnancy, and one case after hydatidiform moleTheories as to the occurrence of metastatic choriocarcinoma without primary lesion in the uterus are presentedThe normal chorionic cell has no inherent property of malignancy. It has an invasive property, it is true, but only to a limited extent for the implantation and nourishment of the fertilized ovum. When detached from the ovum and carried away by the circulation, the normal chorionic cell in time disintegrates and is eventually absorbed. When the fetus dies or is expelled, the normal chorionic cell degenerates and is eventually absorbed or discharged from the uterine cavityChorionic malignancy results from the abnormal chorionic cell produced by a defective gene. It has an inherent property of malignancy which may be potential (where malignancy is manifested after some time) or actual. The abnormal chorionic cell occurs only in certain specific cells among myriads of normal chorionic cells of a given pregnancy. The presence of the actually malignant cell in a given pregnancy explains the co-existence of choriocarcinoma and normal pregnancy with a living fetus and normal placentaThere are different degrees of malignancy. The highly malignant type manifest itself earlier than that of lesser malignancy, and it is most resistant to any form of treatment.(summary)

Observation in the use of enovid in a case of endometriosis

A case of a 48 yr old patient, clinically diagnosed as having uterine fibroma complicated by endometriosis is reported. The patient, who received a total of 2,240 mg of enovid (a synthetic preparation with progestational action), was relieved from pain during the first two months of its administration. However, endometriosis was not removed. Operation was performed and operative diagnosis was fibroid uterus; external and internal endometriosis. The patient had an uneventful recovery. Treatment with enovid must continue for 5-6 months to obtain cure. Early surgery is noted to be the best treatment for endometriosis

The importance of the early diagnosis of choriocarcinoma

The importance of early diagnosis and early adequate treatment of choriocarcinoma is emphasizedThe factors that predispose to the development of chorionic malignancy are mentioned so that when they are present, great vigilance should be made in the follow-up for the detection of chorionic malignancyThe methods of early detection of chorionic malignancy are outlined and evaluated. (Summary)

Is syncytial endometritis (syncytioma) always benign?

Since syncytial endometritis or syncytioma does not invariably pursue a benign course, as shown by the above cases, it behooves the physician to follow-up patients having such histology report for possible abnormal symptoms and signs indicating chorionic malignancy and to treat them accordingly before the irreversible stage is reached. (Conclusion)