Summary: The range of total urinary hydroxyproline was determined by 71 assays on 36 women with normal pregnancies. In addition, 103 assays were performed on 58 women with complicated pregnancies. There was a gradual increase in values up to 36 weeks in normal pregnancy, with a fall towards term. In patients with placental insufficiency due to such conditions as marked hypertension and diabetes, high values were obtained in those with a successful outcome of the pregnancy, which seemed to be indicative of compensatory increased vascularity of the placenta. A lack of this rise was seen in those in whom intrauterine death occurred. It is suggested that total urinary hydroxyproline assay may be useful as an additional parameter for assessing placental function.
Endotoxic shock is a syndrome resulting from sepsis due to gram-negative bacteria. The most common organisms involved are Escherichia coli, Aerobacter aerogenes, Proteus mirabilk or vulgaris and Pseudomonas aeruginosa. Endotoxic shock in the young patient is relatively rare. When it does occur it is usually in association with pregnancy. The most common cause is septic abortion, but it is also seen with chorioamnionitis and pyelonephritis. In 1956, Studdiford and Douglas first drew attention to "acute circulatory collapse" in association with septic abortion. The incidence of endotoxic shock with septic abortion vanes from 2.5% to 6.4% (Douglas and Beckman, 1966;Weil et al., 1964).Although few cases of endotoxic shock are seen by the average obstetrician-gynaecologist, the problem is of vital importance for 2 reasons ( 1 ) there is a high mortality (2) there is a difference of opinion on management.The mortality in endotoxic shock vanes from 1 1 % to 82% (Coleman, 1964;Shubin and Weil, 1963). The mortality statistics will, of course, depend upon the type of patient, the method of treatment, and how early the diagnosis is made.Endotoxic shock with septic abortion should be associated with a relatively good prognosis in so much as (a) the patients are young and have a firm grasp of life, (b) they have a removable septic focus, and (c) they respond well to treatmant. Despite these facts, the death toll of patients with septic abortion and endotoxic shock remains high, the reported incidence being from 22% to 70% (Studdiford and Douglas, 1956;Douglas and Beckman, 1966).
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