[THE USE OF THE VACUUM EXTRACTOR].
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A retrospective analysis of 8,839 singleton deliveries was undertaken to determine the relationships of maternal age, maternal hemoglobin concentrations, and past obstetric performance to the incidence of low-birth-weight (LBC) delivery. Patients under 19 years of age and patients with hemoglobin values less than 9.0 Gm. per 100 ml. were found to have significantly higher incidences of LBW deliveries. In addition, the incidence of LBW delivery was found to vary in proportion to the number of previous LBW deliveries and inversely with the number of previous term deliveries.
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The regulatory signals responsible for the increased biosynthesis of prostaglandins during parturition have not been established. Because interleukin-1 is capable of stimulating prostaglandin production by intrauterine tissues and is an inflammatory mediator, we propose that interleukin-1 may act as a signal for the onset of human labor in the setting of intrauterine infection. The purpose of these studies was to determine interleukin-1 activity in amniotic fluid and to establish its relationship with the onset of term and preterm labor. Amniotic fluid from 182 patients was assayed for interleukin-1 activity. Cell-associated interleukin-1 activity was detected in fluid obtained in the third trimester but not in fluid obtained in the second trimester of pregnancy, suggesting a maturational event in interleukin-1 production. The factor responsible for interleukin-1 activity had biochemical characteristics of interleukin-1 alpha (estimated molecular weight of 14 kilodaltons, isoelectric point = 4.9), and its activity was blocked with an anti-interleukin-1 alpha antisera. Women in spontaneous labor at term were likely to have fluid phase interleukin-1 activity in amniotic fluid than women who were not in labor at term. Preterm labor in the setting of intraamniotic infections was associated with significant interleukin-1 activity in amniotic fluid. This bioactivity was predominantly attributable to interleukin-1 beta. A strong correlation between interleukin-1 and amniotic fluid concentrations of prostaglandin E2 and prostaglandin F2 alpha was found in women in preterm labor. These findings support the hypothesis that interleukin-1 may play a role in the initiation of preterm labor associated with intraamniotic infection.
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In a case-control study on 79 cone biopsy treated women under 35 yr of age the subsequent pregnancies were followed. The women of the control group were matched to maternal age, parity and the time of delivery. There were more 'abnormal' deliveries in the surgical treated group such as more bleedings, more cervical insufficiencies and a faster descent-time curve of the presenting part of the fetus. The premature frequency was 13.2% in the conized group and only 3.8% in the control group. The study gives support to a primarily more conservative policy in young women with positive smears.
Ultrasonography should benefit many pathological events which occur in delivery rooms. The authors analyse the scarce literature about this subject and propose indications in which this complementary examination seems to be interesting.
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