280
Correspondence
Finally, the retraining maneuver does not, as Dr. Seski has erroneously inferred, involve the patient in a violent constriction of the “urethral sphincter mechanism” every time there is a surge of activity on the part of the hyperactive detrusor. Rather, it consists of a continuing, conscious effort on the part of the patient to prolong the intervals between spontaneous voidings in order to break the urgency-frequency habit pattern, reaccomodating the bladder to the comfortable holding of larger urine volumes and, hopefully, thereby diminishing detrusor hyperirritability and helping the patient regain more voluntary control of the detrusor reflex. Thomas 8 Hawthorne Cha.rles River Boston,
H. Green,
Jr.,
the susceptible woman.3 Continued, systematic efforts to isolate wild mumps virus in fetal tissues, spontaneously aborted following infection of the susceptible woman, should demonstrate conclusively transplacental infection in the human subject. However, one must be aware of the fact that we could not recover virus from the simian fetus beyond one week following experimental maternal infection.’ Indeed, our earlier studies of gestational mumps virus infection and childhood cardiomyopathy had suggested that split immunologic recognition may be very simply due to the abbreviated replication of viral antigen in an immunologically hyporesponsive host, the fetus.”
M.D.
Joseph W. St. Gems, Jr., M.D. LLoyd F. Vau Pelt, D.V.M. Terr?; Yamaurhi, M.D.
Place Park
Massachusett.c
02114
Transplacental mumps virus infection To the Edit0r.r:
The recent correspondence by Drs. Chiba, Ogra, and Nakao (AM. J. OBSTET. GYNECOL. 122: 904, 1975) has been brought to our attention. These authors commented about the previously published paper of Dr. Monif (AM. J. OBSTET. GYNECOL. 119: 549, 1974) concerning the biological and immunologic impact upon the progeny of women who developed mumps virus infection during pregnancy. They also reported their own unsuccessful effort to isolate virus or detect viral antigen in the conceptual tissues of a woman who underwent a therapeutic abortion two weeks after an early second-trimester natural mumps infection. Furthermore, they suggested that these limited observations do not support the notion of transplacental mumps virus infection. During the past 12 years, we have analyzed prospectively nine cases of first-trimester maternal parotitis and three cases of second-trimester infection. Five of the nine infants whose mothers incurred parotitis during the first trimester demonstrated split immunologic recognition of prior fetal mumps virus infection, i.e., cellular immunity (cutaneous delayed hypersensitivity) without humoral immunity (neutralizing antibody). The same response was observed in one of the three infants born after second-trimester maternal infection. One infant with cellular immunity to mumps virus developed an anamnestic antibody response following a skin test, substantiating prior fetal exposure to viral antigens. The same immunologic events have been witnessed in the subhuman primate,’ where carefully controlled experimental infection has delineated very clearly that mumps virus crosses the mammalian placenta, and in Eskimo children2 examined 10 years after an extensive epidemic of mumps. Recently, we have shown that attenuated mumps virus may be recovered from the placenta of
Department of Pediatrics and A,nimal Care Facility Harbor General Hospital University of‘ California Lo.s Angeles School of Medicitte 1000 West Car.ron Street Torrance, Cnlijornia 90509 George
R. Nwen,
M.D.
Department Hennepin
oj Pediatric.\ County General Hospital Minneapoli,r, Minne.sota 55415 REFERENCES
St. Ceme, J. M., Jr., Peralta, H., and Van Pelt, L. F.: Intrauterine infection of the rhesus monkey with mumps virus, J. Infect. Dis. 126: 249, 1972. Aase, J. M., Noren, G. R., Reddy, D. V., and St. Geme, J. W., Jr.: Mumps-virus infection in pregnant women and the immunologic response of their offspring, N. Engl. J. Med. 286: 1379, 1972. Yamauchi, T., Wilson, C., and St. Geme, J. W., Jr.: Transmission of live, attenuated mumps virus to the human placenta, N. Engl. J. Med. 290: 710, 1974. St. &me, J. W., Jr., Noren, G. R., and Adams, P.. Jr.: Proposed embryopathic relation between mumps virus and primary endocardial fibroelastosis, N. Engl. J. Med. 275: 339, 1966.
Complications in selection of sex of children To the Editors..
Within the next decade, obstetricians and gynecologists are likely to experience a sharp increase in requests for aid in choosing the sex of children. However, widespread use of sex choice technology is likely to have profound, and unanticipated, social consequences. Research on sex preference is unanimous in confirming the over-all preference for male children in general and for male firstborn children in particular; an astonishing 80 per cent of respondents would opt for a male firstborn and female secondborn family. Unfor-
Correspondence
Finally, the retraining maneuver does not, as Dr. Seski has erroneously inferred, involve the patient in a violent constriction of the “urethral sphincter mechanism” every time there is a surge of activity on the part of the hyperactive detrusor. Rather, it consists of a continuing, conscious effort on the part of the patient to prolong the intervals between spontaneous voidings in order to break the urgency-frequency habit pattern, reaccomodating the bladder to the comfortable holding of larger urine volumes and, hopefully, thereby diminishing detrusor hyperirritability and helping the patient regain more voluntary control of the detrusor reflex. Thomas 8 Hawthorne Cha.rles River Boston,
H. Green,
Jr.,
the susceptible woman.3 Continued, systematic efforts to isolate wild mumps virus in fetal tissues, spontaneously aborted following infection of the susceptible woman, should demonstrate conclusively transplacental infection in the human subject. However, one must be aware of the fact that we could not recover virus from the simian fetus beyond one week following experimental maternal infection.’ Indeed, our earlier studies of gestational mumps virus infection and childhood cardiomyopathy had suggested that split immunologic recognition may be very simply due to the abbreviated replication of viral antigen in an immunologically hyporesponsive host, the fetus.”
M.D.
Joseph W. St. Gems, Jr., M.D. LLoyd F. Vau Pelt, D.V.M. Terr?; Yamaurhi, M.D.
Place Park
Massachusett.c
02114
Transplacental mumps virus infection To the Edit0r.r:
The recent correspondence by Drs. Chiba, Ogra, and Nakao (AM. J. OBSTET. GYNECOL. 122: 904, 1975) has been brought to our attention. These authors commented about the previously published paper of Dr. Monif (AM. J. OBSTET. GYNECOL. 119: 549, 1974) concerning the biological and immunologic impact upon the progeny of women who developed mumps virus infection during pregnancy. They also reported their own unsuccessful effort to isolate virus or detect viral antigen in the conceptual tissues of a woman who underwent a therapeutic abortion two weeks after an early second-trimester natural mumps infection. Furthermore, they suggested that these limited observations do not support the notion of transplacental mumps virus infection. During the past 12 years, we have analyzed prospectively nine cases of first-trimester maternal parotitis and three cases of second-trimester infection. Five of the nine infants whose mothers incurred parotitis during the first trimester demonstrated split immunologic recognition of prior fetal mumps virus infection, i.e., cellular immunity (cutaneous delayed hypersensitivity) without humoral immunity (neutralizing antibody). The same response was observed in one of the three infants born after second-trimester maternal infection. One infant with cellular immunity to mumps virus developed an anamnestic antibody response following a skin test, substantiating prior fetal exposure to viral antigens. The same immunologic events have been witnessed in the subhuman primate,’ where carefully controlled experimental infection has delineated very clearly that mumps virus crosses the mammalian placenta, and in Eskimo children2 examined 10 years after an extensive epidemic of mumps. Recently, we have shown that attenuated mumps virus may be recovered from the placenta of
Department of Pediatrics and A,nimal Care Facility Harbor General Hospital University of‘ California Lo.s Angeles School of Medicitte 1000 West Car.ron Street Torrance, Cnlijornia 90509 George
R. Nwen,
M.D.
Department Hennepin
oj Pediatric.\ County General Hospital Minneapoli,r, Minne.sota 55415 REFERENCES
St. Ceme, J. M., Jr., Peralta, H., and Van Pelt, L. F.: Intrauterine infection of the rhesus monkey with mumps virus, J. Infect. Dis. 126: 249, 1972. Aase, J. M., Noren, G. R., Reddy, D. V., and St. Geme, J. W., Jr.: Mumps-virus infection in pregnant women and the immunologic response of their offspring, N. Engl. J. Med. 286: 1379, 1972. Yamauchi, T., Wilson, C., and St. Geme, J. W., Jr.: Transmission of live, attenuated mumps virus to the human placenta, N. Engl. J. Med. 290: 710, 1974. St. &me, J. W., Jr., Noren, G. R., and Adams, P.. Jr.: Proposed embryopathic relation between mumps virus and primary endocardial fibroelastosis, N. Engl. J. Med. 275: 339, 1966.
Complications in selection of sex of children To the Editors..
Within the next decade, obstetricians and gynecologists are likely to experience a sharp increase in requests for aid in choosing the sex of children. However, widespread use of sex choice technology is likely to have profound, and unanticipated, social consequences. Research on sex preference is unanimous in confirming the over-all preference for male children in general and for male firstborn children in particular; an astonishing 80 per cent of respondents would opt for a male firstborn and female secondborn family. Unfor-
