Reply to Dr. Nelson

Reply to Dr. Nelson

CORRESPONDENCE and sphingomyelin were not done to my knowledge. Again, one can only speculate as to how many of these cases of RDS would have been id...

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and sphingomyelin were not done to my knowledge. Again, one can only speculate as to how many of these cases of RDS would have been identified as being at risk had a quantitative lecithin measurement been carried out.

The male midwife, back in 1779 To the Editors:

The following

is from Nurse y World,

Just as the government wives,

a reader


29, 1976:

has decided to train men for mid-

has sent us somewhat




an advertisement in the Kent& Gazette, dated December 18, 1779: “I, John Hall, surgeon and man-midwife, having opened a shop in the market place, Dover, proposes practising in the different branches of his profession and hopes for the favours of the public, which he will endeavor to merit by the utmost attention to his business. “He intends delivering poor women gratis, residing in the town of Dover, for the space of three months from the date hereof.” Sheerness-December 20, 1779 From

Department of Obstetrics and Medical College of Georgia Augusta, Georgia 30902



Reply to Dr. Nelson We too were surprised at the unexpectedly high incidence of RDS in diabetic mothers with L/S ratios >2.0. We do not do total lecithin and sphingomyelin measurements in the amniotic fluid and therefore cannot comment on this. Studies by Gluck and associates’ have shown that the sphingomyelin level has remained relatively constant throughout gestation; therefore, the rise in the L/S ratio indicates an actual increase in lecithin. Gebhardt and Beintema2 showed that the L/S ratio was more accurate than other phospholipid values in predicting respiratory distress. Also, the use of a concentration rather than a ratio is subject to great error in conditions with associated hydramnios such as diabetes mellitus. Therefore, we feel that what we term “respiratory distress” may be a pool of clinical conditions with different causes and that better criteria for defining the clinical entity will help us differentiate these groups and find their etiology. It would then be very interesting to see if the quantitative lecithin determination has any fewer false positive values in a large series of patients with diabetes mellitus complicating pregnancy.

Dates. G. H. Bishop 6AN,


To the Editors:

In England, midwifery became a science about the period of the institution of the College of Physicians to Henry VII, 1518. Dr. Harvey engaged in the practice of it about 1603 according to Haydn’s Dictionary of

40 Marine Parade Hythe, Kent. CT21




Respiratory distress syndrome with mature lecithinlsphingomyelin ratios: Diabetes mellitus and low Apgar scores To the Editors:

I read with great interest the report by Cruz and associates (AM. J. OBSTET.GYNECOL.126: 78, 1976) concerning the incidence of respiratory distress syndrome (RDS) after “mature” lecithin/sphingomyelin (L/S) ratios. The over-all incidence of RDS was 6.0 per cent, and in cases of insulin-dependent diabetes it was 28.5 per cent. This is considerably higher than that in our institution where a quantitative lecithin measurement is used. While the authors mentioned some possible reasons for the occurrence of RDS with “mature” L/S ratios, they did not comment upon what seems to me to be the most logical reason for these false “mature” values. I strongly suspect that the high L/S ratios obtained in the RDS cases were due to unusually low sphingomyelin concentrations which falsely elevated the L/S ratios. This is obviously speculation on my part since quantitative measurements of lecithin


C. Cruz,


of Obstetrics and Gynecology University of Florida College of Medicine







1. Gluck, L., and Kulovich, M. V., Lecithin/sphingomyelin ratios in amniotic fluid in normal and abnormal pregnancy, AM. J. OBSTET. GYNECOL. 115: 539, 1973. 2. Gebhardt, D. 0. E., and Beintema, A.: A comparison between the lecithin/sphingomyelin ratio of Cluck and other phospholipid values of amniotic fluid, AM. J. OBSTET. GYNECOL. 122: 734, 1975. 231