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The literature shows little evidence of much attention given to transverse or oblique presentation of the fetus during the last trimester of pregnancy. We believe that such fetal position, especially if it tends to persist, is of definite clinical importance and should be considered as sufficient reason for carrying out soft-tissue x-ray studies of the uterus, in order to visualize the placenta and determine its location, the necessity for which determination will be demonstrated. The purpose of this paper is to show the principal causes and the significance of transverse or oblique presentation of the fetus in the last ten weeks of pregnancy.

1.1. We have presented the underlying causal mechanisms of persistent breech and transverse presentations of the fetus in single pregnancies at or near term.2.2. We recommend, in applying this knowledge clinically, that the implantation site of the placenta be determined in all cases of breech and transverse presentations of the fetus persisting after 30 to 32 weeks of pregnancy.3.3. The knowledge of where the placenta is implanted is of great aid when one is performing external cephalic version, since this permits the manipulation of the fetal poles without handling that portion of the uterus in which the placenta is implanted, and thus the risk of traumatic placental separation (which is the one dangerous accident that may occur during the performance of external version) may be obviated.4.4. In primigravid women in whom any degree of cephalopelvic disproportion is suspected, the conversion of breech presentation to a cephalic one will permit a test of labor and may obviate the necessity of section.5.5. A general method of external cephalic version is pictured and described, and the performance of this valuable maneuver is recommended in the routine management of persistent transverse presentation because it permits delivery through the birth canal in two-thirds of these cases. It should also be performed on all patients with breech presentation persisting after 32 to 34 weeks of pregnancy so as to obviate the two to three times increased risk to the fetus which is attendant upon breech delivery throughout the country as a whole.6.6. The optimum time for the initial performance of external cephalic version is about 34 weeks of pregnancy, in general, although nulliparous patients had best have their fetuses turned first at about 32 weeks. Engagement of the breech occurs fairly early in primigravid women, and disengagement of the breech becomes increasingly difficult as term approaches. Failure to disengage the breech is the most common cause of failed version.7.7. Unfavorable accidents involving the umbilical cord resulting from external version are very rare. The fetal heart should be carefully ausculted before and just after performance of version, and if, after 30 to 60 seconds, it is not normal the fetus should at once be returned, by reverse maneuver, to its original position.8.8. Anatomic factors which in general make the performance of external cephalic version difficult or impossible are: primigravidity, frank breech with extended legs, deep engagement of the breech, oligohydramnios, “extended attitude” of the fetus, and elongation of the amniotic sac resulting from relatively low implantation of the placenta in the cornual region it principally occupies. When external version cannot readily be accomplished, even though the breech has been successfully disengaged from the pelvic canal, it is probably because the placenta is offering mechanical blockage to the swinging past it of a pole of the fetus. Since the main precaution is to avoid placental separation, one should be willing not to attempt to force such a situation and should abandon the attempt for the time being. About one-fourth of such patients will undergo spontaneous cephalic version within the next week, but if this has not occurred, version should again be attempted, because it may then, surprisingly enough, be successfully performed with ease.9.9. Since external cephalic version is an extremely safe and valuable obstetric maneuver, and one which any physician familiar with obstetric practice can easily teach himself to do, it is hoped that it will enjoy increased and wide-spread usage.

In the 12-year period of this study there has been marked improvement in the clinical picture of cervical carcinoma. An increasing number of carcinoma cases has been detected in the early stages, and, concurrently, the number of cases discovered in the advanced stages has been decreasing. These beneficial changes are principally the result of more widespread use of better detection methods, chiefly that of the routine Papanicolaou vaginal smear. There has also been an improvement in the 5-year survival rates following treatment with irradiation therapy; this has especially been true in the additional group of cases which received full irradiation followed by radical Wertheim hysterectomy with extraperitoneal pelvic lymphadenectomy. The better survival rate is the joint result of earlier detection of the disease and improvements in the treatment methods employed.

Without Abstract:

1.1. A series of 112 infertile women has been divided into three groups, as a study method, on the basis of the abnormality or relative normality of the endometrium on initial pretreatment biopsy.2.2. The normality and abnormality or inadequacy of their initial pretreatment midcycle cervical mucous specimens has been studied for each endometrial group and related to it, and the mucus has also been studied in those women in each group who subsequently became pregnant and in those who did not, and comparisons have been made.3.3. The findings from this study are: (a) it is more important for an infertile woman to have normal endometrium if she is to eventually attain successful pregnancy than to have normal initial cervical mucus, but both factors play an essential role in the process, (b) more infertile women who have normal cervical mucus become pregnant than do those in whom the mucus is deficient, and (c) there is a relationship between the endometrial and cervical mucus factors in infertile women which may be quantitatively expressed for groups having differing degrees of infertility.

1.1. A series of 12 cases of septic abortion with shock due to infection are presented. These occurred in 662 cases of septic abortion seen in Detroit Receiving Hospital in the past 2 years.2.2. The early recognition of these cases and the institution of massive antibiotic therapy is of crucial importance, since such therapy is the mainstay of their treatment.3.3. Since the shock in these women is due to sepsis rather than to actual blood loss, these patients present the potential danger of being overtransfused and thus thrown into cardiac decompensation. This danger is actually greater than might be expected because such sepsis also confers actual instability of the patient's apparatus for maintaining blood pressure.4.4. Dilatation of the cervix and evacuation of the uterus of any pus or retained placental tissue should be done after 24 hours of antibiotic therapy in all cases unless this is contraindicated on some sound basis.

Forty-four cases of fatal puerperal sepsis in women delivered vaginally in the second half of pregnancy are presented in this 17 year study in Michigan; its importance is underscored by the fact that in 5 of the last 6 years sepsis has been the number one cause of death in that state. Premature rupture of the membranes occurred in 75 per cent of the cases; sepsis became clinically evident before delivery in 66 per cent and following it in the remainder. There were equal numbers of ante- and postpartum infections in the first 10 years of the study, while there were 3 times as many antepartum as postpartum infections in the last 7 years. The reason for this is believed to be the advent of “new,” or more pathogenic strains of common vaginal bacteria in April, 1960, because starting in that month there was a doubling of the annual number of deaths from puerperal sepsis over previous figures.

1.1. In a series of 195 cases of carcinoma of the cervix, 143 were treated with irradiation alone and 52, or 27 per cent, were treated with full irradiation therapy followed by the radical Wertheim-Bonney operation.2.2. The operative mortality in the 52 cases was zero. There was one post-operative ureterovaginal fistula, an incidence of 2 per cent, and 4 vesicovaginal fistulas, an incidence of 8 per cent.3.3. Five of the 52 patients died, one from primary adenocarcinoma of the liver after first surviving for 5 years and 5 months, one from intracranial hemorrhage and hypertensive cardiovascular disease 3 years following operation, and 3 from recurrence of their pelvic cancer.4.4. Residual carcinoma was present in the surgical specimens in 18 cases, or 34.6 per cent of the 52 cases; the cervix contained viable cancer in 12 cases, the uterus in 2, the cardinal ligaments in 2, and the pelvic lymph nodes in 6.

1.1. Maternal mortality rates are now so low that, for conservation of life, the fetus rather than the mother has become the primary concern of the obstetrician.2.2. More deaths occur in the first month of life than during all other periods in the pediatric age group up to 15 years.3.3. Of 150,000 fetal deaths each year, one-half are still births and one-half are neonatal deaths.4.4. Ninety per cent of this fetal loss is attributed to prenatal and natal causes.5.5. Pediatricians have requested and have been assigned the responsibility for the care of the newborn but they can function only as salvage officers whose results are limited by conditions already in effect.6.6. Infants under 1,500 grams comprise only 1.4 per cent of deliveries, but 36.9 per cent of fetal and neonatal deaths are in this group. Over half of these infants die within 24 hours of delivery. Since the combined mortality rate in this weight group is 78 per cent, the only prospective method for reduction of fetal loss is the prevention of prematurity.7.7. The infants who weigh between 1,500 and 2,500 grams comprise only 6.8 per cent of deliveries, but account for 29 per cent of the deaths. The combined stillbirth and neonatal mortality rate in this weight group has been reduced to 15 per cent and can probably be lowered further.8.8. Ninety-three per cent of deliveries are at term but they account for only 33.6 per cent of fetal deaths.9.9. Forty-seven per cent of stillbirths result from anoxia associated with premature separation of the placenta, placenta previa, or cord complications. An additional 10.4 per cent result from trauma. In 17.5 per cent stillbirth results from the fetal factors of congenital anomaly or erythroblastosis. In 16.8 per cent, the cause, other than prematurity alone, remains unknown.10.10. In contrast to stillbirths, only 10.5 per cent of neonatal deaths are directly due to anoxia. About 19.1 per cent are due to trauma, chiefly intracranial hemorrhage discovered at autopsy. The remainder of neonatal deaths are explainable by congenital anomalies (20.4 per cent), infection (5.9 per cent), erythroblastosis or maternal diabetes (10.5 per cent), hyaline atelectasis (14.5 per cent), and prematurity or unknown (19.1 per cent).11.11. In infants over 2,000 grams delivered by cesarean section the mortality rate is eight times that for those delivered by the vaginal route, and we are convinced that cesarean section should rarely be done in the primary interest of the fetus.12.12. Toxemia of pregnancy is related to fetal and neonatal mortality only to the degree that it increases the absolute number of premature deliveries.

1.1. Eighteen cases of tuberculous cervicitis are reported, one of which is the sole tuberculous focus of infection in the genital tract, and the only active one in the patient.2.2. Tuberculous cervicitis is of chief interest because it clinically resembles cervical carcinoma and announces the presence of genital tuberculosis.3.3. The cervix is involved in from 5 to 8 per cent of the cases of genital tract tuberculosis and thus appears to have a relative immunity to this infection. About 90 per cent of the cases of cervical tuberculosis are secondary to upper genital tract infection. A true primary cervical tuberculosis is extremely rare.4.4. The two chief symptoms are a persistent offensive watery leucorrhea, and bleeding following coitus or douching.5.5. Physically the cervix shows symmetrical hypertrophy and superficial friability and the portio may show abnormalities ranging from erosion and eversion to ulceration or papillary granulations.6.6. The treatment should be surgical when possible and as radical as necessary and as the condition of the patient will allow.7.7. The microscopic pathology is treated in detail and is chiefly characterized by large tubercles lying snugly up against lymphatic channels deep in the body of the cervix and Langhans' giant cells and tubercles scattered through hyperplastic canal mucosa.8.8. The term “primary tuberculous cervicitis” demands that it be the only tuberculous lesion in the patient.

The article looks at U.S. Federal government spendings as of October 15, 1948 with special attention paid to public money spent for bureaucracy. Investigations carried out in Federal agencies like the State and the Agriculture Department reveal the number of employees engaged in the administration, the effectiveness of their work, and the government payroll. The expenditures of U.S. Veterans' Administration and Federal groups operating in the field of public health are also commented on.