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GYNAECOLOGY Professor W THEr BRTTTSR 714 APRIL 22, 19331 UTERINE ACTION AND ITS ABNORMALITIES [MEDICAL JOURNAL i natal period, and thus help to annihilate the dread CONGRESS OF OBSTETRICS AND of labour. GYNAECOLOGY Professor W. BLAIR-BELL, Dr. M. M. DATNOW, and Dr. T. K. JEFFCOATE presented a paper on the mechanism of uterine action and its disorders. In vivo and The ninth British Congress of Obstetrics and Gynaeco- in vitro experiments on animals were described and graphs of logy was h3ld at the University of Birmingham on April 5th, 6th, and 7th, under the presidency of Professor uterine contractions shown. In woman the anterior pituitary hormone was in excess in the early months, BECKWITH WHITEHOUSE. The foreign visitors were Pro- fessor Oskar Fraenkl of Vienna, Professor Van Rooy of but diminished as pregnancy continued, and by the fourth month the influence of the corpus luteum was on Amsterdam, and Professor Birger Lundqvist of Gothen- the burg. wane. The function of the corpus luteum varied quanti- tatively and qualitatively in different animals. Neither UTERINE ACTION AND ITS ABNORMALITIES oestrin nor " antuitrin S " had any effect on the isolated At the morning session on April 5th, with Professor uterus ; oestrin sensitized the uterus to respond to infun- Whitehouse in the chair, Mr. ALECK BOURNE read the open- dibulin, and it assisted in bringing about hypertrophy ing paper, " The Uterine Action and its Abnormalities." and increased vascularity of the uterine musculature He said that feeble contractions were the cause of many during pregnancy. The hormone of the corpus luteum of the disasters of labour. For the child the long labour inhibited uterine activity ; but after the first two months was a considerable risk. He had searched the clinical it was not essential for the maintenance of pregnancy in histories of over 4,500 consecutive deliveries at Queen the human subject. The view was put forward that the Charlotte's Hospital, and had classified as " long hormones of the anterior lobe of the pituitary assisted, labours " all cases in which the first stage had lasted and might even replace, the corpus luteum in causing for more than forty-eight hours. There were forty-nine inhibition. Primary uterine inertia was due to lack of cL ses of genuine primary uterine inertia ; thirty-six sensitization of the uterus by oestrin, and to insufficiency occurred at full term, and it would appear that inertia of the pressor substances in the maternal blood. The onset was not influenced by maturity. The condition was five of labour and the occurrence of many cases of abortion times more common in primigravidae. Malpresentation were associated with an excess of oestrin in the circula- was not a predisposing factor. In this series there was tion. Uterine inertia was not due to muscle fatigue. In an unduly high number of cases of albuminuria. The abortion oestrin was found in large quantities in the membranes ruptured prematurely in thirty out of the urine, with a disappearance of prolan B. Abortion in its forty-nine cases. Manual removal of the placenta was early stages had been averted by the injection of corpus performed eight times. In less than half the cases luteum and " antuitrin S." Premature labour was delivery was spontaneous. There was no relation between usually due to powerful emotions through sympathetic the weight of the child and the occurrence of inertia. stimulation, as well as to foetal influences. An increased Sedatives had been employed in over half the cases, and amiount of pressor substances was present in the blood in a combination of pituitrin and sedatives in eleven. In tonic contraction, and magnesium sulphate had an only two cases had manual dilatation of the cervix been immediate effect. performed. The maternal mortality was 10 per cent., Dr. J. M. RoBSON dealt with some of the recent and morbidity 40 per cent., three of the maternal deaths hormonic advances underlying uterine activity. He had being due to sepsis. He demonstrated a graph which experimented with strips of human uterus removed at the recorded the intrauterine pressure at the thirty-sixth week time of a Caesarean section. When these were exposed of pregnancy. After an injection of two units of pitocin to the action of oxytocin there was no effect in the early contractions resembling first-stage labour pains were months of pregnancy; but, on the other hand, vaso- registered ; they were not felt by the patient, nor did pressin caused contractions. Strips removed late in preg- the cervix dilate. Normal labour depended on fundal nancy required only a very small amount of oxytocin contraction and cervical -dilatation. -The speaker said to induce a contraction, and those removed durinog labour that FitzGibbon had emphasized the importance of the required a still smaller dose.- Response to either oxytocin engaging head and its pressure upon the cervix as the or vasopressin was absent in menstruation. In pregnant cause of the onset of labour. He was convinced that rahbits a strip of uterine muscle removed during the external stimuli influenced uterine action by way of the puerperium required one hundred times as much nervous system. Non-engagement of the head was often oxytocin to produce the same amount of contraction associated with inertia. He had attempted to induce as that occurring during pregnancy. After injection of labour by injection of tri-hydroxy oestrin in castor oil, oestrin the uterus showed a marked reactivity to the but without success ; the injection did not affect the milk action of oxytocin; corpus luteum had a reverse effect. secretion. He was uncertain of the part played by Mr. WENTWORTH TAYLOR, in a paper on the anomalies oestrin in labour. In an estimation of the oestrin content of uterine action, said that dilatation of the cervix was of the urine in two cases of uterine inertia, the amount not solely a mechanical process, and he described the lower of this hormone had not been found to be definitely uterine segment as the middle segment of the " birth diminished. Pituitary extract did not induce premature sleeve." The walls of the uterus before labour were of labour. By means of hysterograms he demonstrated equal thickness throughout. Incoordinate contraction that adrenaline inhibited fundal contraction during labour might be due to several causes: psychic, hormonic, in the human being. Microscopical slides were shown of mechanical, ante-partum infection of the liquor amnii, portions of the cervix removed at the time of delivery and the administration of oxytocic drugs. Sympathy of from two cases of rigid cervix, which terminated in action between the various parts of the uterus determined circumferential tears. An excess of fibrous tissue was normal labour. A well-fitting dilator caused sympathetic seen. Fear, Mr. Bourne said, played a very great part action between the body of the uterus and the cervix. in causing weak contractions: a contented and care-free Spasm of the uterus was due to obstetrical intervention woman had a spontaneous labour. In the more civilized for this condition he advocated early trial of sedatives. grades of society emotion and anxiety were most impor- in the presence of foetal distress, tenseness of the uterus, tant factors in modifying the course of normal labour. and little or no cervical dilatation Caesarean section was It was essential for the medical attendant to obtain the the method of treatment. In the dystrophic individual confidence of the mother, particularly during the ante- who could not be cured by a course of hormonic extracts, APRIL 22, AND GYNAECOLOGY THE BRITISH 1933] CONGRESS OF OBSTETRI'CS IMEDICAL JOURNAL 715 in occipito-posterior positions, and with a large child in and abnormal phenomena ; the latter were absent in whom flexibility was below normal, anomalies in uterine animals. The importance of the emotional factor in the action were to be expected. human being must never be overlooked. In reply to Mr. Bourne, he said that oestrin in a purely crystalline form increased the reactivity of the uterus to pituitrin AFTERNOON SESSION and was a sensitizing agent. He thought that further At the afternoon session, with Dr. J. P. Hedley in the investigation into the source of the lutein cells was neces- chair, Mrs. BERTRAM LLOYD and Mr. P. J. GANNER sary. If the corpus luteum developed from follicular cells, a case rupture of the uterus in a described of fundal why had it such a different secretion? He was certain premature labour at the thirty- 2-para aged 26, during that polarity of the uterus was a definite entity, and he sixth week. The first labour was normal. Professor thought that during involution of the uterus polarity on a somewhat similar FRAENKL (Vienna) remarked might be replaced by a peristaltic action. He realized case. that calcium was an important prophylactic agent in Mr. W. GILLIATT, in a paper on contraction ring of the uterine inertia. It was essential for uterine tone. uterus in labour, described fourteen cases he had seen. Premature rupture of the membranes and intervention predisposed to it, but uterine inertia was not a definite MISCELLANEOUS PAPERS contributing factor. Sedative treatment was disappoint- On April 6th, when Dr. James Young presided at the ing, but amyl nitrite in a dose of three minims relieved morning session, Professor OSKAR FRAENKL (Vienna) the contraction in one case. He advised Caesarean section described the isthmus uteri. He concluded that the when the cervix was undilated and when there was little isthmus was a well-characterized part of the uterus which risk of sepsis. The maternal death rate was 14.2 per cent. " grossly " belonged to the cervix, but with regard to its and the foetal 20 per cent. Mr. L. C. RIVETT thought mucous membrane it resembled the body, and might be that differences in the thickness of the uterine wall was recognized and limited nearly always by naked eye, and the cause of irregular uterine action, and the endocrine always microscopically.
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