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Fifteen endometrial cancers were discovered in 587 office endometrial biopsies between 1956 and 1966, an incidence of 2.5 per cent. All of these patients have been followed for 5 or more years, and the survival rates, method of treatment, and pathologic findings were recorded. Endometrial tissue obtained by our method is adequate for pathologic section diagnosis. The over-all survival rate of the cancer patients was 93.3 per cent.

1. 1. In a review of 16,057 deliveries at the Kings County Hospital 165 cases of fetal death prior to the onset of labor were found, an incidence of 1.03 per cent. 2. 2. There was no difference between the patient's history and the physical examination with regard to dating the time of fetal death. 3. 3. The patients in the study group had an older age distribution than the clinic population though there was no difference in parity. 4. 4. Seven per cent of the fetuses were retained for 22 or more days; the longest period of retention was 120 days. 5. 5. There was no difference in incidence of postpartum hemorrhage between the study group and the clinic at large. 6. 6. Premature separation of the placenta was associated with 32 per cent of the fetal deaths, toxemia was implicated in 21 per cent, and diabetes in 11.5 per cent; a true knot of the umbilical cord was encountered in 3 instances. In none of these cases was syphilis the cause of death. 7. 7. Thirty-six per cent of the fetal deaths were thought to be preventable; the responsibility was equally divided between patient and physician. 8. 8. There was one maternal death (0.6 per cent) following spontaneous rupture of the uterus prior to labor. 9. 9. The data in this study support the concept of conservative management and abstinence from interference in cases of prolonged retention (more than 21 days) of a dead fetus.

1. 1. A study of 3,816 cesarean sections, 2,219 primary and 1,597 repeat, has been presented. 2. 2. The gross perinatal mortality in the primary group was 9.0 per cent, and 2.9 per cent in the repeat group. Eliminating deaths prior to labor, these figures are corrected to 6.3 and 2.5 per cent, respectively. The perinatal mortality in mature infants, corrected by eliminating deaths prior to labor, was 2.5 per cent in the primary and 0.9 per cent in the repeat cesarean sections. 3. 3. The type of anesthesia is not an important factor in the cause of perinatal mortality. 4. 4. In the uncomplicated elective repeat cesarean section, the perinatal loss was not affected by performance of the section prior to rather than at the onset of labor.

T H E early history of cesarean section in twin pregnancy suffers from the same lack of clarity which beclouds the whole history of the operation. Scholars still argur whether references in the Talmud to delivery by yoze dofan mean that women in that era were delivered by cesarean section. The Talmud, the transcription of the Jewish oral law (Mishnah) which had grown up in the thousand years after the Bible and the commentary upon it (Gemara) , was written during the second to sixth centuries, A.D. According to Hebraic scholars, the two words yore dofan should be translated by the phrase “a cut in the loin.” The two most important Talmudic references to this mode of delivery are concerned with the laws of purification and primogeniture. The Rabbis questioned whether purification, the taking of the ritual bath 40 days after the birth of a male and 80 days after the birth of a female, was to be carried out when delivrry was accomplished through yozt’ dofan. Obviously the woman must have been alive when the “cut in the loin” was made and she also must have survived the procedure. otherwise there would be no concern about puerperal purification. The second reference to yoze Rabbis dofan is germane to our topic. The argued whether the first of malt

The results of a survey of 1,456 breech presentations from seven institutions have been presented. It is evident that breech presentation is accompanied by an increased perinatal mortality. One of the greatest hazards to the fetus is prematurity which is two and one-half times as common in breech presentation as in the clinic as a whole. Any decrease in prematurity would lower the perinatal loss markedly. Although there is an increased perinatal loss in mature infants delivered as breeches, this loss can be kept at a relatively low level if certain principles of management are kept in mind and if the obstetrician has had sufficient experience in the handling of these cases. This means that in many cases consultation should be obtained and this communion of the minds should not be limited to ward patients. Cesarean section has the lowest perinatal mortality of the various methods of delivery but this should not imply that cesarean section should be used in all breech deliveries. There are complications of breech presentation, however, that are best handled by cesarean section and delay in its employment may be disastrous. Breech presentation including delivery is one of the greatest tests of an obstetrician's skill and the art of obstetrics finds full flower in the proper handling of this problem.

1. 1. Two analgesic substances were compared in 990 women during labor by means of a double-blind method. 2. 2. The effects on the breathing and crying time of the infants were noted. 3. 3. An attempt was made to compare their analgesic effects by the observation of their obstetricians and by questioning the patients. 4. 4. Oxymorphone was found to produce better analgesia but somewhat more fetal depression.

1. 1. The purposes and methodology of the Hartford Community Obstetrical Study are presented and discussed. 2. 2. The maternal mortality rate was 2.5 per 10,000 live births, 1.5 per 10,000 for the white patients and 15.4 per 10,000 for the nonwhite. Four postmortem cesarean sections were performed and 4 living children were obtained. 3. 3. Cesarean section was performed at a frequency of 8.2 per cent which varied in the individual institutions from 1.9 per cent to 9.4 per cent. About one half, 50.5 per cent, were primary sections. The indications for primary sections are discussed. 4. 4. The perinatal mortality experience was found to be favorable. This was considered to be related to the low incidence of premature births. 5. 5. Congenital malformations were presented as “incompatible, consequential, or inconsequential.” The total frequencies were similar for the races, but quite different as far as the breakdowns were concerned. The nonwhite had fewer “consequential” malformations. 6. 6. The results of a superficial analysis of stimulation of labor with oxytocin suggest a possible adverse effect upon the infants. A more definitive analysis in this area has been recommended. 7. 7. Elective induction of labor has been subjected to a special statistical analysis and some results were presented. This special analysis indicated no undue risk to mothers and/or infants.

1. Our 5,480 newborn infants were divided into two groups. In 2,212 babies sterile distilled water was instilled into the eyes immediately after birth and in 3,268 cases no treatment was instituted. 2. Purulent conjunctival discharge was present in only 76 cases (1.4 per cent) and heavy watery discharge in 243 instances (4.4 per cent). 3. All cultures were negative for gonococci and in only one case were the smears suspicious of gonococcal ophthalmia neonatorum. 4. In cases exhibiting conjunctival discharge and in which cultures were taken, negative bacteriological findings were present in 45.2 per cent. The cultures were negative in 35 per cent of cases with purulent discharge. 5. It is suggested that virus infection or maternal irritants might be incriminating factors in some cases of conjunctivitis with negative cultures. 6. It is believed that chemical conjunctivitis occurs in a significant number of cases when silver nitrate is used and to a lesser extent with oxytetracycline. 7. The routine instillation of silver nitrate or antibiotics into the eyes of the newborn should be reconsidered.

1. In a double blind study, 1,022 patients in labor were given meperidine and oxymorphone with and without simultaneous administration of a respiratory antagonist. 2. No statistical difference was found in infant breathing and crying time or perinatal survival regardless of analgesic employed, with or without the addition of the respiratory antagonist. 3. Oxymorphone compares well with meperidine as an obstetric analgesic.

Chown 3, 4 has presented evidence of fetal hemorrhage into the maternal circulation. The work to be reported is an attempt to assess the relative frequency of such hemorrhage. Though such an occurrence had been postulated by others, 18 proof was first obtained by Chown.

This case has been presented to point out the complications during pregnancy which may arise as the result of the decidual reaction in the nongravid companion uterus of uterus didelphys. There is striking similarity between the patient's first and third pregnancies and the differences in management and outcome furnish much material for speculation. Since abortion of the decidual cast of the companion nongravid uterus in uterus didelphys has been shown to be an accomplished fact, it becomes necessary therfore in the management of bleeding in uterus didelphys to determine (1) with uterus contains the pregnancy and (2) which uterus is doing the bleeding. This can be accomplished only by adequate abdominal and pelvic examination of the uteri supplemented by speculum examination of the cervices. Only in this manner can rational therapy for the bleeding be instituted and a prognosis for outcome of the pregnancy be determined.

Since March 1967, 3,687 first insertions of the Majzlin spring were performed at the State University of New York Downstate Medical Center Family Planning Clinic. Seven different forms of this device, with different degrees of flexibility, made of wire gauges varying from 0.010 to 0.020 inches in diameter, were used. The 14T device made of a metal core measuring 0.014 inches in diameter with a tail string tied to one limb of the spring was found to be the most efficient. The accidental pregnancy rate was 2.0; spontaneous expulsion rate, 3.8; and the need for medical removal, 7.5 per 100 woman-months of use. At the end of the study period, nearly 86 per cent of the women were still active users. The nurse-midwife training program of the Family Planning Clinic at the Downstate Medical Center has had an important positive effect on the success of the Majzlin spring program as well as other aspects of family planning at this medical center.

1.1. An undiagnosed case of hydatidiform mole with a 4½ months' fetus has been presented. 2.2. Certain diagnostic points have been emphasized. 3.3. One of the inherent dangers of the Acosta-Sison diagnostic procedure has been demonstrated.