Physiology and Pathology in the Perinatal Period PDF
Preview Physiology and Pathology in the Perinatal Period
PHYSIOLOGY AND PATHOLOGY IN THE PERINATAL PERIOD BOERHAA VE SERIES FOR POSTGRADUATE MEDICAL EDUCATION PROCEEDINGS OF THE BOERHAAVE COURSES ORGANIZED BY THE FACULTY OF MEDICINE, UN IVERS I TY OF LE IDEN, THE NETHERLANDS PHYSIOLOGY AND PATHOLOGY IN THE PERINATAL PERIOD EDITED BY R. H. GEVERS, M.D. AND J. H. RUYS, M.D. Leiden University Hospital LEIDEN UNIVERSITY PRESS 1971 SOLE DISTRIBUTOR FOR NORTH AMERICA SPRINGER-VERLAG NEW YORK INC. I NEW YORK ISBN-13: 978-94-010-3150-9 e-ISBN-13978-94-010-3148-6 DOl: 10.1007/978-94-010-3148-6 Library of Congress Catalog Card Number 76-140618 Jacket design: E. Wijnans © 1971 Leiden University Press, Leiden, The Netherlands Softcover reprint of the hardcover 1s t edition 1971 No part of this book may be reproduced by print, photoprint, or any other means without written permission of the publisher. CONTENTS Preface . A. SIKKEL Gas exchange between mother and foetus and placental design . 3 G. S. DAWES Glucose metabolism in the foetus in physiological and pathological circumstances . . . . . . . . . . . .. . . 13 H. J. SHELLEY Intrauterine pressure and the human foetus . 28 T. K. A. B. EsKES Foetal heartmonitoring and biochemical examination of the child during labour. 39 R. H. GEVERS, P. E. R. RHEMREv and J. FAVIER Iatrogenic fetal hypoxia 57 F. KUBU and H. RiiTTGERS The influence of anesthetic drugs on the foetus and newborn. 76 D. T. POPESCU The influence of anesthesia on the acid-base values of mother and child. . . . . . . . . . . . . . . . . . 90 J. SPIERDIJK Treatment of asphyxia of the newborn . 103 J. H. Ruys The incidence and treatment of hypoglycemia in the newborn. . 115 R. DE LEEUW v VI CONTENTS Panel discussion Part I . . . 126 Moderator A. SIKKEL Panel discussion Part II . . . . . . . . . . . 136 Moderator F. KUBLI Comparison of ventilators for newborns and prematures. . . . 145 D. H. G. KEUSKAMP Artificial ventilation of infants . . . . . . . . . . 158 J. J. VAN ZANTEN Pathological findings in ventilated newborns. . . . . . . . 165 J. L. P. GAILLARD Summing-up . . . . . . . . . . . . . . . 169 H. H. VAN GELDEREN Panel discussion . . . . . . . . . . . . . . . . . 177 Moderator J. H. Ruys Index of subjects. . . . . 193 LIST OF CONTRIBUTORS G. S. Dawes, The Nuffield Institute for Medical Research, University of Oxford, U.K. T. K. A. B. Eskes, Department of Obstetrics, st. Lucas Hospital, Amsterdam, Nether lands J. Favier, Department of Obstetrics and Gynecology, University Hospital, Leiden, Netherlands J. L. J. Gaillard, Pathological Laboratory, University of Leiden, Netherlands H. H. van Gelderen, Department of Pediatrics, University Hospital, Leiden, Nether lands R. H. Gevers, Department of Obstetrics and Gynecology, University Hospital, Leiden, Netherlands F. Kubli, Department of Obstetrics, University Hospital, Basel, Switzerland D. H. G. Keuskamp, Department of Anesthesiology, Dijkzigt University Hospital, Rotterdam, Netherlands R. de Leeuw, Department of Physiology and Pathology of the Newborn, Wilhelmina Hospital, University of Amsterdam, Netherlands D. T. Popescu, Department of Anesthesiology, University Hospital, Leiden, Nether lands P. E. R. Rhemrev, Department of Obstetrics and Gynecology, University Hospital, Leiden, Netherlands H. Riittgers, Department of Obstetrics, University Hospital, Basel, Switzerland J. H. Ruys, Neonatal Unit, Department of Obstetrics and gynecology, University Hospital, Leiden, Netherlands H. J. Shelley, The Nuffield Institute for Medical Research, University of Oxford, U.K. A. Sikkel, Department of Obstetrics and Gynecology, University Hospital, Leiden, Netherlands J. Spierdijk, Department of Anesthesiology, University Hospital, Leiden, Netherlands J. J. van Zanten, Intensive Care Unit, University Hospital, Leiden, Netherlands VII PARTICIPANTS IN THE DISCUSSION * J. van Aken, Anesthesist, Drongen, Belgium J. W. Barents, Obstetrician and gynecologist, Arnhem J. H. van Bemmel, Institute of Medical Physics T.N.O., University of Utrecht M. A. Broer, Pediatrician, Assen J. I. de Bruijne, Department of Physiology and Pathology of the Newborn, Wilhel mina Gasthuis, University of Amsterdam A. C. Drogendijk, Department of Obstetrics and Gynecology, Free University, Amsterdam H. D. Hamming, Pediatrician, Groningen J. J. van der Harten, Pathological anatomist, Amstelveen M. J. Koop, Pediatrician, Brunsum J. G. Koppe, Pediatrician, Amsterdam J. Lauweryns, Department of Pathological Anatomy, University Hospital Saint Raphael, Louvain, Belgium H. A. Polman, Pediatrician, Haren (Gr.) J. Reepmaker, Pediatrician, Dordrecht R. L. Rosan, Stanford University, U.S.A. A. A. M. de Steenhuijsen Piters, Pediatrician, Oosterhout (N.-B.) J. G. Stolk, Gynecologist, Arnhem * When country is not indicated, address in the Netherlands. VIII PREFACE The course of history is never one of smooth progression. Periods of relative quietness are interrupted by periods of wars and revolution. This pattern resembles that of a river which, before flowing into the delta, has to pass countless rapids. The same holds for the development of the science of medicine. In obstetrics some of these 'revolutions' or 'rapids' consist of the introduction of conservative obstetrical treatment by Lucas Johann Boer at the beginning of the nineteenth century, the discovery of the cause of puerperal sepsis by Oliver Wendell Holmes and Semmelweiss between 1843 and 1847, the introduction of the principle of asepsis by Pasteur in 1874, the introduction of prenatal care at the end of the nine teenth and the beginning of the twentieth century (Mijnlieff, Treub, De Snoo), the improvement of surgical techniques, the possibility to treat shock by bloodtransfusion, and, finally, the acquisition of new means for the effective therapy of infection. All these developments have led to a sharp reduction of maternal and perinatal mortality. In this connection it must be pointed out that such a reduction could never have been accomplished without the favourable social changes as a result of which medical and prenatal care could be made universally available. In recent years there has been another revolutionary develop ment in obstetrics. Two factors have been responsible for this: the ap plication of basic sciences in obstetrics, and the dissolution of the isolation with respect to other clinical disciplines. Our knowledge and views have been increased since the physiological processes during pregnancy and labour have been studied in collaboration with physiologists and bio chemists. For indeed, how can we know where pathology starts if we are ignorant of the physiology? Between these two regions lies a 'no-man's land', whose area is now steadily diminishing. Modem obstetrics must concentrate on perinatal morbidity. The im mense difficulties involved in this subject can be judged from the fact that we have not yet been able to define, even in adults, just what illness is. 1 2 PREFACE There is no doubt that the historia morbi is of great importance for arriving at the correct diagnosis in a patient and that the historia morbi of the newborn belongs mainly to the period of intra-uterine life. Until recently, we obstetricians had a far too simple conception of this ex ceedingly important period in human life. For us too, it holds that 'l'inter pretation simpliste des causes a toujours fausse l'histoire' (Gustave Ie Bon). It is clear to all of us that the responsibility accepted by every scientist, namely the search for truth, cannot be the responsibility of the obstetrician alone. Close collaboration with physiologists, biochemists, paediatricians, anaesthesists and pathologists is imperative. This is the view that has governed the composition of the present program, both the subjects and the speakers. We are happy that so many of you were able to accept our invitation to participate, whether as speakers or as listeners. Today we are mainly concerned with 'the intra-uterine patient'. As Le Bon put it: 'Dans la genese des phenomenes historiques les causes s'addi tionnent en progression arithmetiqueet leurs effects en progression geo metrique', and this certainly does not differ for the treatment of perinatal pathology. The smallest disturbances occurring during intra-uterine life can at a given moment have great and serious consequences. This is why it is of paramount importance to detect the possible causes of perinatal morbidity as early and as thoroughly as possible, which will give therapy its greatest chance of success. A. SIKKEL M.D. University Hospital, Leiden
The list of books you might like
