ABSTRACT
The origin, background, and mechanism of operation of the Maternal Mortality Study Committee in Wisconsin is outlined. Its value as a teaching vehicle is emphasized. Trends in maternal mortality in Wisconsin and the continued decline are presented, with 45 per 100,000 live births in 1953 to 9.2 per 100,000 live births in 1975. An appeal for standardization of terms and definitions and a continuation of these studies in each state is made. Study committees in many states are inactive. It is suggested that chairmen of maternal mortality committees in many states are inactive. It is suggested that chairmen of maternal mortality committees and representatives meet in geographic areas comparable to Districts of The American College of Obstetricians and Gynecologists to compare trends and statistics. Hemorrhage, once considered the important cause, has decreased from 56.4% of maternal loss to a low of 12.1% in 1975. Presently, a category listed as "other causes"--that is, other than hemorrhage, sepsis, and toxemia--account for approximately 60% of deaths. This group includes anesthesia, emboli and coincidental disease involving kidneys, heart, malignancy, and diabetes. An appeal is made to continue these studies.
Subject(s)
Maternal Mortality , Adult , Female , Gynecology , Humans , Obstetrics , Pregnancy , Societies, Medical , WisconsinSubject(s)
Abortion, Habitual/etiology , Abortion, Habitual/drug therapy , Counseling , Female , Humans , Physical Examination , PregnancyABSTRACT
PIP: This report is based on 502 culdotomies performed by the author and his associates. The method is commonly but erroneously called colpotomy . Of the 502 culdotomies, 293 were performed for tubal interruption, 209 were done for diagnosis and other surgical procedures. There were 9 complications, 3 requiring abdominal intervention. The operation is an incision into the cul-de-sac and is a practical means of investigating the pelvis to determine the status of the uterus, tubes, and ovaries. It has been the first step in vaginal hysterectomy technique. In the uncomplicated cases patients for tubal interruption were discharged from the hospital 42 hours after admission. No pregnancies have followed. W hen the operations were done for other purposes the hospital stay averag ed 72-96 hours. Preliminary evaluation includes a Papanicolaou smear. Chronic or recent pelvic inflammatory disease must be eliminated. Preoperative vaginal preparation with Gantrisin cream has been used. The operation may be done with a general or local anesthetic, preferably with an analgesic such as Demerol or morphine. Iv lactated Ringer's solution is also given and Valium at intervals. A transverse incision is made through the cul-de-sac. Unclotted blood encountered may indicate the existence of an ectopic pregnancy. Details of the technique are described. Approximately 30 minutes are required for the operation. Postoperatively the patient uses the Gantrisin cream 3 times weekly. Culdotomy is considered an efficent and practical approach to the pelvis for diagnosis and therapy. Discussion of the paper by others follows.^ieng
