Effect of mithramycin on calcium and hydroxyproline metabolism in patients with malignant disease.

MEDICAL JOUIRNAL more often by spasm of the umbilical cord vessels due to mani- pulation and cooling (Rhodes, 1956).Various authors have commented on the adverse effect of a long detection-delivery interval on the perinatal mortality, and it has been shown that after one hour there is a rapid rise in mortality (Fenton and D'Esopo, 1951 ; Ball et al., 1961 ; Winch and Claman, 1961; Nelson and Bums, 1963 ; Widholm and Nieminen, 1963 ; Sinnathuray, 1964).In a small series of 15 cases Campbell (1962) quotes an average detection-delivery interval of 8 minutes 20 seconds for vaginal delivery and 28 minutes for caesarean section.To reduce the foetal loss in pro- lapsed cord it is necessary to have adequate facilities, so that caesarean section or any other treatment can be initiated imme- diately the diagnosis is made.Routine vaginal examination as soon as the membranes rupture, irrespective of the presenting part and irrespective of its level, will favour early diagnosis and reduce the all-important time lag between the occurrence of cord prolapse and initiation of the appropriate treatment.The late prognosis for the survivors of cord prolapse was assessed by Cushner (1961), and 95% of those located were normal.It seems that, provided the infant is delivered alive and survives the neonatal period, no harm is done by the possible period of anoxia before delivery associated with cord prolapse. SummaryFifty cases of cord prolapse occurring in the last two years are analysed and compared with the results obtained 12 years ago in the same unit.Caesarean section is superior to all other forms of treatment; in the series surveyed it resulted in a very low perinatal mortality.It is unlikely that cord prolapse will ever be eliminated as a cause of perinatal mortality.I thank Mr. J.J. Foley, Mr. F. A. Murray, and Mr. C. W.