An undeliverable fetus with an ominous fetal heart pattern: an obstetric dilemma.

An unusual fetal heart rate (FHR) pattern was detected in a patient with sickle cell crisis in early labor. Despite the potentially ominous significance of this pattern, immediate delivery by cesarean section had to be deferred because of maternal contraindications. Institution of treatment directed at possible etiologic factors failed to correct the heart rate abnormalities. An attempt at symptomatic treatment by administration of propranolol to the mother was successful and was associated with good fetal outcome.

The high-risk perinatal registry. A systematic approach for reducing perinatal mortality.

A systematic and comprehensive review of all 320 perinatal deaths occurring in Nassau County in 1973 reveals that one-quarter of these deaths might have been prevented if modalities of care that were known and available at that time had been utilized appropriately. Preventability--the presence or absence of avoidable factors which might have materially lessened the risk of death --was determined for each perinatal death. Preventable deaths were disproportionately higher among postmature (P less than .01) and large-for-gestational-age (P less than .05) perinatal deaths, neonatal deaths after the first day of life (P less than .05), intrapartum fetal deaths (P less than .01), and perinatal deaths secondary to anoxia and idiopathic respiratory distress syndrome (P less than .01). The study concludes that rigorous application of currently available medical knowledge, the establishment of local perinatal mortality review committees, and vigorous outreach to practitioners are urgently needed to bridge the time gap between the development of new modalities of care and their application.

Neonatal survival after traumatic fetal subdural hematoma.

A case is presented of neonatal survival after traumatic fetal subdural hematoma. An unusual fetal heart rate pattern was detected on antenatal monitoring and led to immediate termination of the pregnancy by cesarean section. The fetal heart rate pattern may be secondary to fetal cerebral dysfunction, and its early recognition may result in increased survival when trauma occurs in utero.

Graduate education and postdoctoral training opportunities in history of psychology at North American universities and colleges.

The four reports that follow embody the second installment of a series designed both to provide an orienting overview of education in the history of psychology to prospective students in the field and to characterize one highly significant aspect of the state of the discipline as the century ends. Like those included in the first series, each of these reports effectively conveys an awareness of a program's (or an individual professor's) goals and emphases and (in a number of cases) also provides a sense of how the particular program evolved since its creation. Such historically oriented self-presentations seem especially appropriate for a journal that focuses on psychology's past. Unlike the reports in the previous installment, however, these have had to be condensed, at times significantly, and one or two refer readers to their authors for specific additonal information. A final series of reports will appear in History of Psychology's next issue or (as I noted in the last issue), they will if those invited to submit them meet the journal's deadline.

G. Stanley Hall and the institutional character of psychology at Clark 1889-1920.

This paper identifies the institutional character of pre-1920 psychology at Clark University with founding President G. Stanley Hall's active "patronage" of "outsiders," argues that the origins of this institutional character can be found in Hall's own personal character and temperament, and traces the influence of this institutional character through much of the psychology done at Clark before 1920.

Skin perfusion in pregnancy.

Skin perfusion was monitored by photoelectric flow sensing in 42 pregnant and 20 nonpregnant women to obtain direct objective measurements of skin blood flow changes in pregnancy. The skin perfusion was found to increase significantly at the sixteenth gestational week and this increase was maintained at least 1 week post partum. The maximum increase, which was 3 to 4 times the control values, occurred between the twentieth and thirtieth week of gestation. No significant differences were found between normal and hypertensive pregnant patients, but significant decreases in skin perfusion were found in the supine position in patients with a positive "supine pressor test." These results indicate a pattern of increase in skin perfusion during pregnancy which appears to vary inversely with the reported increase in peripheral resistance.

Neonatal heart rate reactivity following variable decelerations during labor.

The instantaneous heart rate of 65 healthy neonates was continuously monitored during labor and the first 30 minutes of neonatal life. It was found that infants who had moderate or severe variable decelerations in utero had a significantly delayed neonatal heart rate (NHR) reactivity without any evidence of perinatal asphyxia. The NHR pattern of infants with and without variable decelerations is described and possible mechanisms which could explain the delayed NHR reactivity are discussed.

Laboratory instruments in the history of psychology.

The importance of laboratory instruments as sources for the writing of the history of psychology is stressed, and illustrated through the use of examples where their study has been profitable. Most importantly, the role of the Hipp chronoscope in the reaction-time experiment is discussed, and the importance of various changes introduced into its design by James McKeen Cattell is shown. A photograph, first exhibited by the Department of Psychology of Clark University at the 1893 World's Columbian Exposition in Chicago is included, and further illustrates the importance of these instruments to historians.

Pathogenicity of alpha hemolytic streptococci in the neonate.

Alpha hemolytic Streptococcus viridans (AHSV) was found to be the predominant pathogen in neonatal septicemia from 1979 to 1981 at a 1,000-bed voluntary hospital with 5,000 deliveries per year. All but three of the 30 neonates with blood cultures positive for AHSV presented within the first week of life. Most were born at term and had good Apgar scores. The majority of the infants were symptomatic, with respiratory distress being the most common presenting sign. Other common signs included unexplained hyperbilirubinemia and gastrointestinal problems. The one mortality in the group was the smallest and most premature neonate. In the remainder there was good correlation between institution of antibiotic treatment and clinical improvement. Alpha hemolytic Streptococcus viridans should no longer be considered a contaminant if isolated from the blood of a neonate suspected of having sepsis or from cervical or placental cultures in obstetrical patients with complications.