No abstract

Abstract. The clinical and roentgenological picture of symphysiolysis is very well known. In contrast, the rarer syndrome of the rupture of the symphysis pubis during spontaneous delivery is less well known.

During a five-year period, from 1970 through 1974, 26.776 deliveries occurred in our department, of which 55 (0.6%) were in elderly primiparae (EP). This group was compared with two control groups. The first comprised 97 women aged 30--34 years, and the second one, 250 women between 20 and 29 years of age. The parameters investigated were: The gynecologic past history, the course of the present pregnancy, labor, delivery and fetal outcome. In most of the cases, no significant differences were found between the EP group and the control groups. A striking difference was observed in the rate of cesarean sections, which was 49.1% in the EP group, as against only 2.3% in the age group 20--29 years. It may be concluded that by more liberal use of cesarean sections, available means of antenatal care, and prompt intervention in cases of postmaturity and prolonged labor, one can reduce the maternal and fetal morbidity and mortality, and that the EP, although a group at risk, has nowadays a better outlook for both mother and fetus.

A study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44-80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram-positive bacteria which, together with the Gram-negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child-bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the memopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogen, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.