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Title: The dystocia-dystrophia syndrome in the early primigravidae
Author: Chalmers, James A.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1944
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The elderly primigravida has long been a source of interest and anxiety to the obstetrician and in view of the increasing numbers of the group, she is becoming ever more important at the present day. Throughout the literature, many writers from Mauriceau to the present day have noted especial risks of pregnancy, labour and the puerperium in the upper age groups. On the other hand we find such statements as "Most accoucheurs have been agreeably surprised by the ease and rapidity with which elderly primigravidae have delivered" (Herring,) Again, Schulze observes that, "Practical experience has shown that although a certain proportion of these women do have serious difficulty, even a woman near menopausal age may have her first baby with surprising ease and rapidity." She further points out that the dangers of labour in the elderly primigravida have been somewhat exaggerated, and that about twenty per cent of the women have strikingly rapid and easy labours. It is obvious, however, when statistics are studied which enable comparison to be made between the upper age -groups and the average for all ages, that the incidence of many complications at all stages of the reproductive life is increased. In consequence of the apparent disparity between this fact and the views quoted above, the question arises as to whether the special risks are evenly spread over the whole group of elderly primigravidae or whether they are incurred by a sub -group. Several writers have attempted to describe special types in whom either easy, or difficult labour is to be anticipated ( Meyer , Jaroschka ) but none has clearly defined these groups. A study of the characters of the dystocic types as described by these authors has led to a recognition of the fact that a marked similarity exists between the groups of elderly primigravidae in whom difficult labour is to be anticipated and the women showing the dystocia- dystrophia syndrome as described by De Lee , Bryan Williams , and others. On examination of a small series of twenty -five personal cases of elderly primigravidae this appeared to be borne out, and a more extensive investigation has been undertaken at the Liverpool Maternity Hospital, where all cases of women of thirty -five years of age and over delivered there during the five-year period 1939 - 43 have been analysed. This Liverpool series numbered four hundred and sixteen cases. In this paper, I propose to record results of my investigation as follows: - 1. Evidence that the elderly primigravida incurs a higher risk, and conclusions drawn from this evidence. 2. Evidence that the features of the dystocia- dystrophia syndrome are in many instances identical with the complications encountered amongst elderly primigravidae. 3. Evidence that the groups of elderly primigravidae included a considerable proportion of cases corresponding to the dystocia -dystrophia syndrome, and that these cases incur the majority of the increased risks attributed to the higher age -group. 4. Factors of importance in the prognosis of dystocia and their relationship to the dystocia- dystrophia syndrome. 5. The practical application of these findings in relation to prognosis and treatment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available