CORRESPONDENCE
Human placental lactogen measurements
2. On page 841 of our article, it was stated that the perinatal mortality rates in the two groups with normal HPL values were low and not different. The rates in the control and treatment groups were 0.5 and 0.7 per cent, respectively. 3. Two of the fetal deaths in the treated group were stillbirths which occurred before the fetus was judged to be mature enough to be delivered on the basis of the L/S ratio. In the third case the patient had abruptio placentae and presented in labor with a fetal death.
To the Editors:
Drs. Spellacy, Buhi, and Birk’s use of human placental lactogen (HPL) in the antepartum management of high-risk obstetric patients was very interesting (AM. J. OBSTET. GYNECOL. 121: 835, 1975). 1 would request clarification of a few points in their paper. First, in the treated group, how were the patients with HPL values in the fetal-danger (F-D) zone range and lecithin/sphingomyelin ratios less than 2.0 managed? Second, is it safe to assume that there were no antepartum or neonatal deaths among the 1,245 treated and 1,258 untreated patients who had HPL values above the F-D zone range? Finally, what were the circumstances surrounding the three fetal deaths, in the treated group? Specifically, were they unexplained or did they result from unanticipated problems, e.g., sudden rapid deterioration of underlying maternal disease, abruptio placentae, etc.? My congratulations to Dr. Spellacy and his group on a well-planned and meticulously executed study. David Department oJ Ob.rtetrics-Gynecology Southern Calqtirnia Permnnrntr WOO East Rosrcrans .4w. BrllJouw, Cal$wnLa 90706
Medical
A. Sacks,
Department Uniwrsity Gaine.wille,
of Obstetrics and Florida College Florida 32610
qf
M’. N. Sf.vllar~, Gynecology of Medicine
N.D.
Development of the oral contraceptives To the Editors:
An article has appeared on the development of the oral contraceptives,’ but the actual originators of the oral contraceptives, the personnel of the Obstetrical and Gynecological Research Institute and Jefferson Davis Hospital, Houston, Texas, were not mentioned. From a review of the literature, it can be seen that the first “oral contraceptive” was the harmless, nontoxic, safe, and very cheap synthetic estrogen diethrlstilbestrol, or stilbestrol, which is still the best pill m 1975. Dr. Willard M. Allen reported our contribution in the origination of the first “pill” (lnt. J. Gynaecol. Obstet. 8: 613, 1970). Dr. Allen was one of the first users of “ovulation inhibition” in the treatment of endometriosis, sclerocystic ovaries, adenomyosis, and fibroids, after he was informed about this action of stilbestrol by myself and my co-workers. The “ovarian rebound phenomenon” of Karnaky, that ovaries become atrophic during therapy but soon rebound after discontinuation of estrogen, was also reported by Dr. Allen. We carried out exploration of stilbestrol as an “ovulation inhibitor” and as a “menstrual inhibitor” for all types of benign hormonal endometrial bleeding from puberty through the menopause. Stilbestrol does not stop “mechanical” bleeding. Some twenty-seven different medical conditions were found to be best treated with stilbestrol plus a B-complex vitamin ( Livitamin*).2 Millions of operations have been avoided in the past
M.D.
Group
Reply to Dr. Sacks To the Editors:
The answers to Dr. Sacks three questions relating to our recent paper are: 1. A major problem for perinatologists is the management of the distressed and immature fetus. The patients whose HPL values indicated placental dysfunction and, therefore, potential fetal distress (F-D zone values or plasma HPL’S less than 4 Fg per milliliter after 30 weeks of gestation) and whose infants are immature (amniotic fluid L/S ratio < 2.0 fit into this group. The management program which we have published is to attempt to improve the intrauterine environment. In the study reported, the patients were kept at bed-rest, in an attempt to improve uterine blood flow. Newer developments in fetal therapy allow us to use pharmacologic agents to alter uterine blood flow and/or fetal lung maturation.
*Beecham-Massengill Inc. Bristol. Tennessee 771
Pharmaceuticals,
37620.
Div.
of Beecham.
Human placental lactogen measurements
2. On page 841 of our article, it was stated that the perinatal mortality rates in the two groups with normal HPL values were low and not different. The rates in the control and treatment groups were 0.5 and 0.7 per cent, respectively. 3. Two of the fetal deaths in the treated group were stillbirths which occurred before the fetus was judged to be mature enough to be delivered on the basis of the L/S ratio. In the third case the patient had abruptio placentae and presented in labor with a fetal death.
To the Editors:
Drs. Spellacy, Buhi, and Birk’s use of human placental lactogen (HPL) in the antepartum management of high-risk obstetric patients was very interesting (AM. J. OBSTET. GYNECOL. 121: 835, 1975). 1 would request clarification of a few points in their paper. First, in the treated group, how were the patients with HPL values in the fetal-danger (F-D) zone range and lecithin/sphingomyelin ratios less than 2.0 managed? Second, is it safe to assume that there were no antepartum or neonatal deaths among the 1,245 treated and 1,258 untreated patients who had HPL values above the F-D zone range? Finally, what were the circumstances surrounding the three fetal deaths, in the treated group? Specifically, were they unexplained or did they result from unanticipated problems, e.g., sudden rapid deterioration of underlying maternal disease, abruptio placentae, etc.? My congratulations to Dr. Spellacy and his group on a well-planned and meticulously executed study. David Department oJ Ob.rtetrics-Gynecology Southern Calqtirnia Permnnrntr WOO East Rosrcrans .4w. BrllJouw, Cal$wnLa 90706
Medical
A. Sacks,
Department Uniwrsity Gaine.wille,
of Obstetrics and Florida College Florida 32610
qf
M’. N. Sf.vllar~, Gynecology of Medicine
N.D.
Development of the oral contraceptives To the Editors:
An article has appeared on the development of the oral contraceptives,’ but the actual originators of the oral contraceptives, the personnel of the Obstetrical and Gynecological Research Institute and Jefferson Davis Hospital, Houston, Texas, were not mentioned. From a review of the literature, it can be seen that the first “oral contraceptive” was the harmless, nontoxic, safe, and very cheap synthetic estrogen diethrlstilbestrol, or stilbestrol, which is still the best pill m 1975. Dr. Willard M. Allen reported our contribution in the origination of the first “pill” (lnt. J. Gynaecol. Obstet. 8: 613, 1970). Dr. Allen was one of the first users of “ovulation inhibition” in the treatment of endometriosis, sclerocystic ovaries, adenomyosis, and fibroids, after he was informed about this action of stilbestrol by myself and my co-workers. The “ovarian rebound phenomenon” of Karnaky, that ovaries become atrophic during therapy but soon rebound after discontinuation of estrogen, was also reported by Dr. Allen. We carried out exploration of stilbestrol as an “ovulation inhibitor” and as a “menstrual inhibitor” for all types of benign hormonal endometrial bleeding from puberty through the menopause. Stilbestrol does not stop “mechanical” bleeding. Some twenty-seven different medical conditions were found to be best treated with stilbestrol plus a B-complex vitamin ( Livitamin*).2 Millions of operations have been avoided in the past
M.D.
Group
Reply to Dr. Sacks To the Editors:
The answers to Dr. Sacks three questions relating to our recent paper are: 1. A major problem for perinatologists is the management of the distressed and immature fetus. The patients whose HPL values indicated placental dysfunction and, therefore, potential fetal distress (F-D zone values or plasma HPL’S less than 4 Fg per milliliter after 30 weeks of gestation) and whose infants are immature (amniotic fluid L/S ratio < 2.0 fit into this group. The management program which we have published is to attempt to improve the intrauterine environment. In the study reported, the patients were kept at bed-rest, in an attempt to improve uterine blood flow. Newer developments in fetal therapy allow us to use pharmacologic agents to alter uterine blood flow and/or fetal lung maturation.
*Beecham-Massengill Inc. Bristol. Tennessee 771
Pharmaceuticals,
37620.
Div.
of Beecham.
