OBSTETRICS AND GYNÆCOLOGY

s from t1J)ellical Literature. OBSTETRICS AND GYNLECOLOGY. Sterility and ABO Incompatibility. S. J. BEHRMAN et alii (Amer. J. Obstet. Gynec., May, 1960) have studied 200 infertile couples who had been trying to conceive for at least five years, and in whom no reason for their infertility problem could be determined by exhaustive gyneecological and urological investigation. The authors investigated the possibility of serologically incompatible mating in the ABO system. The presence of naturally occurring ant.ibodies of the ABO system has been detected in almost all the body secretions, including the cervical secretion. These antibodies are most significant in the Type 0 wife because she may have both the anti-A and anti-B present. Sperms can carry the antigen and these sperms can be agglutinated by ordinary anti-A or anti-B serum. The authors postulate that infertility resulted from ineompatibility of an ABO blood group mating at the cervical level, involving most frequently a Type 0 wife and a Type A or Type AB husband. Of 102 such infertile couples carefully evaluated, 87% were found to have incompatible matings as compared to 38% of 171 fertile couples. In seven additional subfertile couples with incompatible matings who eventually conceived after 10 years of infertility, all the offspring were of Type O. This indicated that the Type A or Type B fathers were heterozygous and the children were born of homospecific pregnancies. Urinary Deviation in Gynsecologfcal Surgery. R. SHACKlIIAN (J. Obstet, Gynrec. Brit. Emp., August, 1959) discusses urinary deviation in gynrecological surgery under the broad classification of fortuitous and planned deviation. Fortuitous deviation may be recognized at operation or may reveal itself subsequently by the develop. ment of a fistula-vesico-vaginal, ureterovaginal, utero-vesical or vesico-colie. Planned deviation may be brought about by the operations of ureterostomy, pyelostomy, nephrostomy, uretero-colic transplantation and uretero-ileostomy (" ileal bladder "). Bladder injuries noted during gynrecological operations are sutured at once and an indwelling Foley catheter is inserted for seven days. When the ureter is divided in the region of the uterine vessels the author recommends reimplantation of the ureter into the bladder by a mucosa-to-mucosa single. layer silk stitch using the Coffey tunnel technique through the bladder wall. When the ureter is divided at a more proximal level, or when a length of ureter has been inadvertently resected, reo implantation into the bladder is not possible and the three alternatives are: (i) the use of a closed loop of ileum, anastomosed to the end of the severed ureter proximally and implanted into the bladder distally; (ii) direct ureteral anastomosis if adequate mobilization is possible; (iii) cutaneous ureterostomy as a last resort. The author briefly discusses the not uncommon complications of vesico-vaginal fistula and uretero-vaginal fistula, as well as the rare utero-vesical and vesico-colic fistulee. Planned deviation of urine in gynrecological surgery is usually performed as part of the surgical treatment of extensive malignant disease of the pelvic organs. Other indications include the relief of ureteric obstruction. Case reports quoted include those of patients treated by temporary nephrostomy for obstructed ureters, one of permanent nephrostomy in a patient with only one kidney, one of transplantation of the ureters into the colon, and one of transplantation of the ureters into an isolated segment of ileum. The author emphasizes certain principles of technique in the operation of uretero-colic transplantation. In cases of complete exenteration, urotero-colio transplantation is considered to afford more comfort to the patient than uretero-ileostomy, Routine Cytology Smears in Pregnancy. H. E. SCHl\UTZ et alii (Amer. J. Obstet, Gynec., May, 1960) report their findings in routine vaginal smears taken routinely from 10,369 ante-natal patients. In all, 105 patients (I %) gave positive or suspicious smears. Patients with positive or questionable smears were investigated further by biopsy until the presence or absence of disease was established. Invasive carcinoma was found in 12 cases and carcinoma-in-situ in 13; this total of 25 cases of malignant change in the cervix during pregnancy represents about one in every 400 obstetric patients. The majority of these lesions were early and curable. Nineteen patients showed basal-cell hyperplasia with positive smears; these were all followed up, and in three cases a cone biopsy of the cervix, taken three months after delivery, revealed carcinoma-in-situ. In two cases there was definite progression from basal-cell hyper. plasia to early invasive carcinoma, one in a period of one year and one over a period of three years. Cases in this group should be followed indefinitely. The authors conclude that there seems to be enough carcinoma of the cervix in younger women, especially those bearing children, to warrant the routine examination of vaginal smears in pregnancy. Bioflavinoid Compounds in Rh-Immunized Women. W. M. JACOBS (Burg. Gynec. Obstet.. January, 1960) reports his further experience with the administration of bioflavinoid compounds to Rh-immunized women. The author refers to a preliminary report on the subject published in 1956. He states that much has been written on the effect of bioflavinoid compounds in the prevention of capillary fragility, and that the mechanism of Rh immunization depends on the entry of foetal Rh-positive cells into the maternal circulation through breaks in the placental capillary system. Such breaks may occur in normal pregnancy, and the use of bioflavinoid compounds is an attempt to eliminate or reduce the transfer of Rh-positive cells into the circulation of Rh-negative mothers. The author has conducted a trial in which 32 Rh-negative pregnant patients with evidence of previous Rh immunization were given bioflavinoid compounds in doses of 400 to 600 mg. daily. The outcome of their pregnancies was compared with that of 71 pregnant women with similar evidence of previous Rh immunization who were not given bioflavinoid capsules. The patients were divided into three groups according to the severity of the effect of Rh immunization in previous pregnancies, and in each group it was found that those receiving bioflavinoid capsules fared better than the controls. In the whole series, the 71 patients who did not receive bioflavinoid compounds produced 22 surviving infants (a 31 % success rate) and the 32 who did receive bioflavinoids produced 24 surviving infants (a 75% success rate). The author concludes by stating that though the results seem striking, the number of treated patients is small, and that further studies are in