Obesity in the Jamaican parturient

The reproductive performance of one hundred obese negro women was compared with that of an equivalent number of negro women of average weight. The main hazards of obesity were hypertension and diabetes mellitus. The incidence of prolonged labour was not increased, and there was a low incidence of prematurity. The infants were significantly larger in the obese group but despite this, disproportion seldom occurred. The obese patients gained less weight antenatally, and lost more in the puerperium, than the controls. There was an age-related difference in mean antenatal weight-gain and puerperal weight-loss in the obese, but not in the controls.(Summary)

Autotransfusion in ruptured ectopic pregnancy

In a fourteen year period 1055 cases of ruptured ectopic pregnancy were operated on at one hospital in the West Indes. 76 percent of these patients required transfusion, and 530 were given their own blood collected from the intraperitoneal cavity, with or without donor blood. In 424 other cases the blood collected in this way was unsuitable for autotransfusion. On blood culture only "air contaminants" were found. There were only two complications (fever in one case and hypotension in another) and no deaths related to transfusion. In view of the hazards of transfusion of donor blood and the shortage of such blood in many centres, a plea is made for the reintroduction of this procedure in the management of ruptured ectopic pregnancies (AU)

Cytogenetic and clinical observations on West Indian patients with primary amenorrhea

Forty-seven patients with primary amenorrhea, oligomenorrhea, and secondary amenorrhea were investigated by chromosome examination, and laparotomy was performed in six. Thirty-six percent of patients with primary amenorrhea showed sex chromosomal abnormality, and two cases showed autosomal anomalities. We feel that undetected mosaicism was present in some of the sexual infantile patients with apparently normal complement; probably, several of this group have gonadal dysgenesis. No abnormality was detected in patients with virilization. However, we now believe that any patient without adrenal hyperplasia should have laparotomy and removal of abnormal gonadal tissue. Laparotomy and gonadal extirpation may be considered for patients with streak gonads without virilization. Patients with normal secondary sexual development deserve full and early investigation of the genital tract, as they may have congenital anomalities associated with normal ovaries (Summary)

Attitudes to post partum sterilization and results of this procedure - abstract

This study was designed to examine the problems of post partum sterilization at the University Hospital, Jamaica. From 1953 to July, 1968, there were 2,150 post mortem sterilizations of a total of 31,000 deliveries. The frequency rose from less than 1 percent in 1953 to 9.1 percent in 1957. All patients were multiparae and 77 percent of all cases were sterilized by the Pomeroy technique. Multiparity was the sole indication in 68 percent. The average age was 35 and parity 6.1. There was an overall failure rate of 0.14 percent. One hundred women were interviewed two years after sterilization in order to assess the after effects of the process. In 27 percent there was an increase in sexual frequency which was described in 12 percent. Another survey was carried out on 100 women offered sterilization in 1968. All were over 30 years old and had at least 7 children. Fifty two rejected the proposal immediately and fear was the major deterrent. Among antenatal patients knowledge of family planning was good and all patients were aware of at least 2 methods. These data indicate the attitude of patients to sterilization and the increase of this method of family limitation in the appropriate circumstaces (AU)

Chromosome studies in primary amenorrhoea - abstract

Between April, 1964 and December, 1968, we have performed buccal smears and chromosome studies on a total of 46 patients with primary and secondary amenorrhoea and oligomenorrhoea. RESULTS: (1) Secondary amenorrhoea - 4 cases. All had normal chromosomes, all were over 62" in height, with normal build and sexual development. (2) Oligomenorrhoea - 10 cases. Five had moderate degrees of virilisation. One of these had chromosomal findings suggestive of XX/XO mosaicism. Five patients had normal secondary sex characteristics and had normal chromosomes. All 10 patients were 60" or more in height. (3) Primary Amenorrhoea 32 patients. These can be divided into 3 clinical groups. (a) Those with sexual infantilism - 21 cases. Of these, 10 showed sex chromosomal abnormalities. Six of these were less than 60" and hibited other features suggestive of gonadal dysgenesis. Of the 11 with normal chromosomes, 4 were under 57" in height and 3 of these were mentally retarded. (a) Those with sexual infantilism - 21 cases. Of these, 10 showed sex chromosomal abnormalities. Six of these were less than 60" and exhibited other features suggestive of gonadal dysgensis. Of the 11 with normal chromosomes, 4 were under 57" in height and 3 of these were mentally retarded. (b) Patients with virilisation - 7 cases. All these patients were small in size, around 60 to 63 inches in height, but were not dwarfed. Two were found to have congenital adrenal hyperplasia. The others have not all been fully investigated for this condition. (c) Normal secondary sex characteristics - 4 cases. Three had normal chromosomes. One patient had 46xx but a small line showed a small chromosomal fragment. Laparotomy revealed normal ovaries. Two other patients in this group had atresia of the vagina and cervix. CONCLUSION: 34 percent of patients with primary amenorrhoea have chromosmal abnormalities. Chromosome studies are, therefore, indicated in all such patients and probably some with oligomenorrhoea. All patients except those found to have congenital adrenal hyperplasia should have either full genital tract examinations or gonadal exploration, the former being indicated if there are normal secondary sex characteristics, and the latter if there is infantilism or virilisation not explained by congenital adrenal hyperplasia (AU)

Pelvic inflammatory disease

Pelvic inflammatory disease (P.I.D.) is believed to be a very common condition in Jamaica. All persistent lower abdominal symptoms are attributed to this condition. And yet, very little is known about its aetiology, the epidemiology, morbid anatomy, diagnosis, treatment, as well as the sequelae of the acute episode. This study was undertaken to investigate some of these facets. The programme was started on February 1, 1966. The first phase was restricted to the study of chronic cases and included social studies, clinical evaluation, microbiological, pathological and radiological investigations and drug trials. The patients came from two sources. The majority were seen at Casualty Department, University Hospital of the West Indies. Only a few patients were referred from the Gynaecological Outpatient Department. A separate P.I.D. registration was instituted to ensure a speedy turnover. This is a preliminary communication outlining our experience of this condition (AU)

The treatment of post-operative anaemia

The treatment of 35 patinets with ruptured tubal pregnancy who had undergone salpingectomy or salpingo-oophorectomy, with iron dextran infusion is described. The necessity for treatment was evidence of iron deficiency and a haemoglobin of between 8 and 10 g/100 ml. Dosage of iron dextran was calculated from a formula supplied by the makers of the preparation. The haemoglobin levels rose in all cases by from 2 to 4.1 g percent. Side effects were minimal. At follow-up no patient had a haemoglobin level below 11 g percent. It is suggested that unless blood replacement is an immediate necessity because of shock or severly low haemoglobin levels, infusion of iron dextran is a reliable procedure in the management of post-operative anaemia. (Summary)

Umbilical endometriosis

Pelvic or other forms of endometriosis is very uncommon in Jamaica, yet 3 cases of umbilical endometriosis were seen in a short space of time. There was no associated pelvic endometriosis. One developed 4 months after a total hysterectomy. It is suggested that endometrial cells reach the umbilicus by lymphatic migration where they give rise to the characteristic lesion by proliferation or metaplastic change. (AU)

The metabolism of iron-dextran given as a total-dose infusion to iron deficient Jamaican subjects

The movements of iron-dextran, following a total dose infusion of up to 2550 mg. iron in six severely iron deficient patients, have been studied using a Fe tagged complex. The preparation is removed from the plasma in 8-10 days. Fifty per cent of the iron was incorporated into haemoglobin in 3-4 weeks and the iron stores replenished rapidly. Using organ scanning, the liver was confirmed as the site of primary plasma clearance, but accumulations of iron were detected in the spleen and bone marrow. Only minute quantities of radioactivity appeared in the urine. No untoward effects on iron metabolism have been detected, but reduction of the serum iron and total binding capacity to low levels 6 weeks post infusion is of interest. An attempt has been made to interpret the findings to elucidate the ferrokinetics of this method of treatment.(Summary)

The obese patient in obstetrics

Obesity has traditionally been blamed for a number of abnormalities in obstetrics and has thus come to be looked upon as a special hazard. Little statistical information has been advanced to raise this clinical impression to the exalted status of a scientific fact. We selected 100 consecutive obese patients (weighing over 175 lbs. and less than 16 weeks pregnant at their first visit to the Antenatal Clinic) and studied their antenatal, intranatal and postnatal careers. These were compared with a control series matched for age and parity (AU)

Bacteriuria of pregnancy: results of treatment

A screening programme involving approximately 6,000 pregnant negro females has revealed the incidence of bacteriuria to be three per cent in Jamaica. Asymptomatic bacteriuria was shown to be associated with a higher incidence of pyelonephritis, prematurity, pre-eclamptic toxaemia and other hypertensive disorders of pregnancy (Stuart et al, 1965, Brit. Med. J., 1, 554). Present study was undertaken, in order to eradicate bacteriuria and study the results of this. One hundred and fifty bacteriurics were treated with nitro-furantoin (100 mg. twice daily) and a matching placebo on a double blind basis. In distinction to long-term therapy (Kincaid-Smith, P., 1965, International symposium on Progress in Pyelonephritis, Ed. by E. H. Kass, p. 11, Davis, Philadelphia a short three-week course was found sufficient to keep approximately 80 per cent patients bacteria-free for the rest of the pregnancy. All relapses except one cleared on a repeat course. Approximately 60 per cent of subjects on placebo therapy remained positive to delivery. Clinical pyelonephritis occurred in 30 per cent of untreated or unsuccessfully treated bacteriurics. Early foetal loss, prematurity and relatively small size of babies were twice as common in persistent bacteriurics as compared with successfully treated group. The offspring of the treated and persistent bacteriurics were studied for rates of growth in the first four months of life. No clearcut difference has emerged as yet. Twenty treated and untreated patients have been subjected to renal function tests. The tests include urinalysis, blood urea, electrolytes, dehydrated osmolaity, water concentration test, creatinine clearance test and intravenous pyelogram by the infusion technique. No gross abnormality has been demonstrated although the results in successfully treated groups seem to be superior to those in untreated groups (AU)