The role of obstetric factors in perinatal mortality trends.

In the Perinatal Unit of the New Jersey Medical School, Newark the combined neonatal mortality and stillbirth rates declined from more than 51 per 1000 to less than 17 per 1000 between 1971 and 1983. This change is comparable to the reduction of perinatal mortality rates nationwide since the Second World War. Because the improvement in the fetal and neonatal survival rates occurred in a static population and against well identifiable changes in the structure, equipment, policies and management patterns of the obstetric unit, it was possible to assess the impact of various factors upon perinatal outcome. In the environment of this institution adherence to conservative concepts of obstetric management, avoidance of manipulative and extraction procedures, an increase of the rate of cesarean sections from about 7 to 15% and emphasis upon infection control appeared to be the crucially important factors. Antepartum sonography and fetal stress and non-stress testing significantly impacted upon the results. The role of intrapartum electronic monitoring was less clearly definable and seemed to be effective only in the hands of experienced physicians. The results did not seem to be adversely affected by the fact that the program de-emphasized invasive procedures, including fetal scalp pH sampling.

Comparative clinical evaluation of ceftizoxime with clindamycin and gentamicin and cefoxitin in the treatment of postcesarean endomyometritis.

New third generation cephalosporins have been recommended as single agent antibiotic therapy in the treatment of postoperative infections. This study compares the new third generation cephalosporin ceftizoxime with cefoxitin, clindamycin and gentamicin in the treatment of postcesarean section endomyometritis. The results indicate that the clindamycin and gentamicin regimen is more efficacious in the treatment of severe infection after cesarean section than either ceftizoxime or cefoxitin regimens. Therefore, the results of this study suggest caution in substituting single drug antibiotic therapy with cefoxitin or the third generation cephalosporins for the standard clindamycin and gentamicin regimen in the treatment of postcesarean section endomyometritis until more clinical data are available.

Fetal tissue pH-continuous intrapartum monitoring.

The glass tissue pH electrode was evaluated in 42 parturients. The results and technical difficulties are discussed. The fiberoptic tissue pH probe designed like an internal scalp electrode was evaluated in vitro and the results were found to be encouraging.

The rate of early intrauterine growth in twin gestation.

With the use of specimens obtained by induced abortion, the relationships between crown-rump length on the one hand and body weight and menstrual age on the other were investigated in 43 twin fetuses with menstrual ages between 8 1/2 and 21 weeks. This study indicates that the body weight of twins in comparison with length is the same as that of singletons, an indication of the fact that they are not growth retarded. On the other hand, the average crown-rump length when compared with menstrual age is somewhat less than that of singleton fetuses. The possible implications of these findings are discussed in the light of prevailing concepts concerning the growth of twins.

Role of placenta in maternal-fetal vitamin transfer in humans.

Vitamins B12, B6, biotin, folate, thiamine, riboflavin, pantothenate, and nicotinate were determined in maternal and fetal blood and placental tissue of normovitaminemic and hypovitaminemic mothers who disclaimed supplemental vitamin intake during pregnancy. No biotin or pantothenate deficits were observed in the gravidas. Hypovitaminemic mothers transferred less B12, folate, and B6 to the fetus and placenta than normovitaminemic mothers. Vitamins given by mouth increased maternal fetal, and placental levels of folate, but B6 increased only in maternal blood and the placenta; biotin and pantothenate increased only in fetal blood. Except for riboflavin, nicotinate, and pantothenate, the intramuscular administration of vitamins increased the levels of other vitamins in maternal and fetal blood and placental tissue. Results suggest that the placenta stores vitamins and the tissue vitamin receptors must be saturated before adequate transfer of vitamins to the fetus occurs.

Control of perinatal infection by traditional preventive measures.

A 9-year review of nosocomial infections occurring in the department of obstetrics and gynecology of a major teaching hospital demonstrated the dramatic effect of strict asepsis and isolation on postoperative infection rates. With rigidly enforced preventive measures and without the use of prophylactic antibiotics, the rates of wound infection and endometritis and the relative prevalence of gram-negative aerobic organisms cultured from these infections could be reduced substantially. The role of anerobes in these infections was not established, since adequate techniques for the accurate diagnosis of anaerobic infection were not available at the time of this study. The relative importance of the numerous infection-control measures used is unclear. It is apparent, however, that by implementing all traditional methods of asepsis, virtually all types of nosocomial infection could be controlled, and the increased prevalence of gram-negative infections observed during the past decades could be reversed.

The effect of antibody against a purified sperm-coating antigen on human sperm.

A purified fraction of human seminal plasma containing a sperm-coating antigen and two minor contaminants was used to immunize rabbits by intravenous route. An antiserum containing only the antibody against the sperm-coating antigen as examined by immunoelectrophoresis was obtained from one rabbit. The effect of this antiserum on human sperm was examined by sperm-immobilization and sperm-agglutination tests. The results revealed that the antibody against the purified sperm-coating antigen was incapable of immobilzing or agglutinating human sperm. This indicates that the purified sperm-coating antigen is unlikely to be useful as an antifertility antigen for immunologic fertility control.

Purification and characterization of a sperm-coating antigen from human seminal plasma.

A sperm-coating antigen has been purified from human seminal plasma by a combination of fractionation methods including ammonium sulfate precipitation, Sephadex G-100 gel filtration, and diethylaminoethyl cellulose ion-exchange chromatography. The purified antigen was demonstrated to be immunologically identical sperm-coating antigen, not derived from blood serum but having immunologically cross-relating antigens in milk and saliva, and a glycoprotein with a molecular weight of approximately 33,000. The purpose of purifying this antigen was discussed.

Changing attendance patterns to sex therapy programs as a function of location and personnel.

This paper explores innovative treatment modalities that may encourage the participation of lower socioeconomic minority clients in sex therapy programs. It suggests the consideration of informal therapeutic settings, flexible hours, and an immediate contact with the therapist. It lends support to the concept that equal time be given to education and communication skills in counseling. It also stresses the necessity of directive yet permissive techniques to bridge the communication gap by identifying areas of commonality, especially when confronted with the lower socioeconomic minority client. The paper compares this approach with a sex therapy approach more oriented to the middle class.

Vitamin profile of 174 mothers and newborns at parturition.

Thiamin, biotin, B12, folate, pantothenate, riboflavin, nicotinate, B6, vitamins A, E, C, and beta-cartene was estimated in the blood of 174 mothers and in the cord blood of their neonates at parturition. A vitamin profile of normal preganancy was established for mother and neonate. This was based on values obtained from 95 percent confidence limits in 74 mothers not taking oral vitamins and 133 mothers ingesting various vitamin supllements. Circulating vitamin levels in 38 neonates born to mothers with no laboratory evidence of hypovitaminemia was persented. The higher incidence of hypobitaminemia in gravidas not taking vitamins was folate, thiamin, vitamins A, C, B12, BL and nicotinate in descending order. Ingestion of vitamins supplements reduced the incidence of hypovitaminemia. A similar relationship held for neonates from these mothers. However, despite vitamin ingestion thiamin, folate, vitamins C, A, B6, B12 and nicotinate hypovitaminemia was evident. There was an approximate 1:2-5 ratio between mother and neonate blood vitamins; vitamins A, B6, E, and beta-carotene were exceptions. Vitamin B6 ran parallel, while vitamins A, B6, E, and beta-carotene ratios reversed in favor of the mother at an approximate ratio of 2:1, 4:1 and 7:1, respectively. It is concluded that vitamin profile for mother and neonate, taking into account values established from a lorge gravid population, should now permit an evaluation of the effects of hypoviteminemia on the outcome of pregnancy and infant health.