Thrombophlebitis in the Foot

Abstract

no further bleeding. The following day the prothrom¬ bin level was 90 per cent and there were no symptoms.One baby showed vaginal bleeding and jaundice on the third day, with a prothrombin of 35 per cent. One had coffee ground vomitus on the third day, with a pro¬ thrombin of 36 per cent. One baby on the fourth day showed a large fluctuant bluish mass on the right cheek, numerous petechial hemorrhages on the palate, a small bluish area on the left cheek and a prothrombin of 10 per cent. A diagnosis of hemorrhagic dis¬ ease of the newborn was made by the department of pediatrics. One baby showed evidence of intracranial damage on the fifth day, with a prothrombin of 21 per cent. Another showed palatal bleeding on the fifth day (trauma?) and a prothrombin of 10 per cent. One showed coffee ground vomitus on the fifth day, with a prothrombin of 15 per cent. All showed a marked increase in the prothrombin and cessation of bleeding promptly after the administration of vitamin K intramuscularly.It is interesting to note that in none of the 641 babies whose mothers had vitamin K during labor was there any evidence of neonatal hemorrhage. SUMMARY Evidence is presented from a large series of cases to show that :1. The administration of vitamin K, either the original alfalfa extract or the synthetic product, to a mother in labor increases the percentage of prothrom¬ bin of both mother and child. The vitamin may be given orally or parenterally.2. Such medication also prevents the drop in the porthrombin level of the baby which normally occurs from the second to the fifth day.3. The administration of sodium pentobarbital or sodium amyl bromoallyl barbiturate as an analgesic definitely decreases the prothrombin level in mother and child.4. The decrease can be prevented by the administra¬ tion of vitamin K to the mother during labor. 5. It is apparent that even small doses of barbiturates effect the prothrombin level. CONCLUSIONS 1. It seems reasonable to assume that hemorrhage is more likely to occur in the presence of a low prothrom¬ bin level.2. There is a normal depression of the prothrombin level of the newborn from the second to the fifth day. This depression is much greater when certain anal¬ gesics are administered to the mother during labor.3. This depression can be prevented by the admin¬ istration of nontoxic vitamin K to the mother while she is in labor. 4. Such medication should prove effective in lower¬ ing the incidence of hemorrhage of the newborn. 5. It seems particularly desirable that vitamin K should be administered when barbiturate analgesics are used.Thrombosis of the veins in the foot were found with great frequency by Neumann 1 in his recent anatomic study. In fully 71 per cent of his patients with positive manifestations in the veins of the lower extremities (100 out of 165 unselected cases coming to surgery) there was also evidence of involvement of the venous channels in the foot, either alone or in combination with a similar process in more proximal regions. These anatomic figures are striking, espec...