If dexamethasone can lower the incidence of RDS in the premature infant from approximately 30 to 9 per cent, it will be a significant advance in the prevention of RDS. However, it is my opinion that the etiology of RDS is composed of multiple factors, and research into the importance of the aspiration aspect must not be neglected. Charles Newborn Nurseries Hotel Dieu and Cornwall General Cornwall, Ontario, Canada
1. Caspi, I:., Schreyer, P., Weinraub, Z., Bukovsky, I. and Tamir, 1.: AM. J. OBSTET. GYNECOL. 122: 327, 1975. 2. L&gins, G. C., and Howie, R. N.: Pediatrics 50: 515, 1972. 3. Kaplan, S. D.: Lancet 1: 834, 1973. 4. p,ak:, C. B.: Resuscitation 2: 157, 1973.
Reply to Dr. Pewter To the Editors:
In response to Dr. Pender’s letter, we would like to point out that our study was concerned only with the changes of the amniotic fluid lecithin/sphingomyelin (L/S) ratio following maternal administration of dexamethasone and not with the incidence of the respiratory distress syndrome (RDS) in these small series of premature infants. We never stated that the development of RDS is solely dependent on a certain level of surfactant expressed by a mature value of the L/S ratio. We agree that RDS is a result of a multitude of factors, of which surfactant is certainly an important one. It happens that the 9 per cent incidence (calculated by Dr. Pender) of RDS in our small series is very similar to that found by Liggins and Howiei after betamethasone administration. In a recent study to be published,’ we found an incidence of 8.3 per cent of RDS in a dexamethasonetreated group compared to 35.2 per cent in a control group. It seems that pharmacologic doses of glucocorti,zoids reduced the incidence of RDS from approximately 30 to 9 per cent. This reduction is probably concomitant with an increase of the L/S ratio. That dexamethasone induces an increase of the L/S ratio is supported by the observation of Kling and Kotas3 made in the pregnant baboon, injected intra-amniotically with dexamethasone. This was followed by a significant rise in the amniotic L/S ratio. Eliahu Department of Obstetrics Asaf Harojh Government
1. Liggins, C. C., and Howie, R. H.: Pediatrics 50: 515, 1972. 2. Caspi, E., Schreyer, P., Weinraub, Z., Reif, R., Levi, I., and Mundel. G.: J. Obstet. Gynaecol. Br. Commonw. In press.
3. Kling, 0. R., and Kotas, R. V.: AM. J. OBSTET. GYNECOL. 121: 664, 1975.
Unforeseen fetal death in a monitored labor To the Editors:
This concerns a “Communication in brief” entitled “Unforeseen sudden intrapartum fetal death in a monitored labor,” by Drs. R. H. Hayashi and M. E. Fox, published in the July 15, 1975, issue of theJouRNAL, on p. 786. The case reported by these authors is an interesting one and may be an exceptional one too. I want to express some criticism about some conclusions drawn from the monitoring charts represented. First, about half of the adequate “fetal” heart rate (FHR) registration is lacking following the onset of the sudden drop of the FHR from 150 to 86 beats per minute. Moreover, it is also important to remember the technical limits of the fetal monitoring procedure used. Most of the monitoring apparatuses indeed are not provided with a continuous visual, e.g., oscilloscope, or graphic control of the fetal scalp electrode input signal. Furthermore, the electronic brain of the monitor only “accepts” standardized FHR patterns, triggers “automatically” but with some delay on the amplitude of the input signal and eliminates “noise.” In this way, irregular and weak or slow-but still existing-fetal heart activity cannot be registered with this type of cardiotocograph. Therefore, what exactly happened to this fetus before death cannot be ascertained from the registration chart; it may well be different from what is suggested by the monitor. Dr. Department of Gynecolog?r St. Maria Kliniek 1500 Halle, Belgium
Routine pregnancy test on admission to hospital To the Editors:
I was disappointed when I finished reading “Routine pregnancy test on admission to hospital, by Drs. Laubach and Wilchins (AM. J. OBSTET. GYNECOL. 123: 69 1, 1975) because the authors did not demonstrate in their paper that by doing a pregnancy test their patient’s embryos were going to be protected and they did not demonstrate why the 97 per cent of other hospitals should start doing routine pregnancy testing. Although most hospitals with which I am familiar require routine pregnancy tests for gynecologic admissions, this is not always enforced practice for all women of reproductive age. My personal experience, and that of many of my colleagues in this area, is that with the present availability of abortions at low cost in the city of and with newspaper advertisements, we Chicago, rarely see a woman trying to con us into performing an abortion. However, I agree that there is still a large group of women who have so-called “luteal pregnan-