Midweek Eponym

Apt-Downey Test


Other Known Aliases – alkali denaturation test

DefinitionLab test where the blood sample is hemolyzed using sterile water and centrifuged to produce a hemoglobin supernatent.  This is then mixed with 1% NaOH.  Fetal hemoglobin will stay pink, while maternal hemoglobin will turn yellow/brown.


Clinical SignificanceHelps differentiate maternal from fetal blood in cases of vaginal bleeding or neonatal hematemesis/hematochezia.

History – Given to Dr. Leonard Apt and Dr. William Downey, Jr., who were physicians at Harvard Medical School and Children’s Medical Center in Boston, MA in the mid-1900’s.


  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com
  3. Apt L, Downey WS. Melena neonatorum: the swallowed blood syndrome; a simple test for the differentiation of adult and fetal hemoglobin in bloody stools. The Journal of Pediatrics. 47(1):6-12. 1955. [pubmed]


  1. Women should be screened for gestational diabetes at 24-28 gestation.
  2. There are 2 different recommended testing strategies:
    1. Two-Step (most common)
      1. 50g glucose challenge
        1. Given regardless of when last meal was.
        2. Serum glucose measured at 1-hour
          1. ≥130-140 mg/dL is positive test
            1. The lower the threshold the higher sensitivity, but increased false positives
            2. The higher the threshold the higher the specificity, but with decreased sensitivity
      2. If 1st step positive, a 100g glucose challenge given
        1. Overnight fast and measured at:
          1. Fasting –> (+) if ≥ 95 mg/dL
          2. 1 hour –> (+) if ≥ 180 mg/dL
          3. 2 hour –> (+) if ≥ 155 mg/dL
          4. 3 hour –> (+) if ≥ 140 mg/dL
    2. One-Step
      1. 75 glucose challenge
        1. Given after overnight fast and measured at:
          1. Fasting –> (+) if ≥ 92 mg/dL
          2. 1 hour –> (+) if ≥ 180 mg/dL
          3. 2 hour –> (+) if ≥ 153 mg/dL


  1. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstetrics and Gynecology. 2013;122(2 Pt 1):406-16. [pubmed]
  2. Hod M, Kapur A, Sacks DA. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. International journal of gynaecology and obstetrics. 2015;131 Suppl 3:S173-211. [pubmed]
  3. Moyer VA, . Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Annals of internal medicine. 204;160(6):414-20. [pubmed]

Midweek Eponym

Ferguson’s Reflex


Other Known AliasesFetus Ejection Reflex

DefinitionStimulation of the cervix leading to contraction of the uterus through oxytocin release.

Clinical SignificanceDemonstrates positive feedback during labor and delivery to increase uterine contractions as cervical dilation progresses. Long standing belief that epidural anesthesia before cervical dilation increased risk of cesarean section (this was debunked in 2005).

History – Given to Dr. James Ferguson, a Canadian obstetrician, in 1940 after he showed this physiologic effect in rabbits and postulated it to be true in humans.


  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Wong CA, Scavone BM, Peaceman AM. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. The New England journal of medicine. 2005;352(7):655-65. [pubmed]
  3. Newton N.  The fetus ejection reflex revisited.  Birth.  1987;14(2):106-108.



For this week’s PAINE PANCE pearl, we will highlight gestational diabetes.  Please:

  1. Describe the two tests
  2. How they are administered
  3. How long the tests need
  4. Laboratory cut-off for diagnosis or further tests
Wrinkled Parchment Paper

#27 – Abnormal Uterine Bleeding – Definitions and Classifications


History of FIGO

Because of confusing terminology and difficulty in translating to other languages, the International Federation of Obstetrics and Gynecology (FIGO) created a special task force in 2005 charged with clarifying the terminology and classifying the different causes.  This way clinicians, patients, and researchers throughout the world could be talking the same language.  Dysfunctional uterine bleeding (DUB) was replaced by abnormal uterine bleeding (AUB).. They also introduced a classification system to help sub-divide the causes of AUB.


But in order to define something as “abnormal”, they needed to define normality, which can obviously be very difficult when incorporating the world’s population. The consensus definitions were then agreed upon in 2015 to include the 5th to 95th percentiles form the available data.


The FIGO definition of AUB is any symptomatic variation from normal menstruation, with regards to frequency, regularity, duration, or volume.


Classifications of Abnormal Uterine Bleeding

In 2011, FIGO created a classification system for the main causes of AUB.  It is broken down into 2 main categories based on whether or not the pathology can be seen on imaging or histopathology.  This also allows for subclassifications due to multiple etiologies.

  • Structural (PALM)
    • Polyps (AUB-P)
    • Adenomyosis (AUB-A)
    • Leiomyomas (AUB-L)
      • Hierarchy of classification
        • Primary
          • Presence or absence
        • Secondary
          • Submucosal
            • Abuts the endometrium or distorts the endometrial cavity
          • Other
            • Subserosal
          • Tertiary
            • 0-8 numbering system based on endometrial or serosal involvement
            • Hybrid (2-5)
              • Submucosal and subserosal
    • Malignancy and hyperplasia (AUB-M)
  • Non-structural (COEIN)
    • Coagulopathy (AUB-C)
      • Most commonly is von Willebrand disease
    • Ovulatory dysfunction (AUB-O)
      • At least one cycle that varies by more than 7 days in 12 months
    • Endometrial (AUB-E)
      • Category of exclusion
    • Iatrogenic (AUB-I)
      • Medications
        • Anticoagulants
        • Hormone therapies
      • IUDs
    • Not otherwise classified (AUB-N)



Very similar to the documentation for an OB patient (TPAL score), the documentation uses the PALM-COEIN scoring system for “simplicity”.  Example:

  • Patient with adenomyosis would be:
    • P0A1L0M0-C0O0E0I0N0
  • Patient with endometrial hyperplasia and a subserosal leiomyoma < 50% intramural would be:
    • P0A0L6M1-C0O0E1I0N0


  1. Fraser IS, Critchley HO, Munro MG, Broder M, . A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertility and Sterility. 2007; 87(3):466-76. [pubmed]
  2. Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. Fertility and Sterility. 2008;90(6):2269-80. [pubmed]
  3. Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Human reproduction (Oxford, England). 2007;22(3):635-43. [pubmed]
  4. Harlow SD, Lin X, Ho MJ. Analysis of menstrual diary data across the reproductive life span applicability of the bipartite model approach and the importance of within-woman variance. Journal of clinical epidemiology. 2000;53(7):722-33. [pubmed]
  5. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Seminars in reproductive medicine. 2011;29(5):383-90. [pubmed]
  6. Munro MG, Critchley HO, Broder MS, Fraser IS, . FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2011;113(1):3-13. [pubmed]

Midweek Eponym

Chadwick Sign


DefinitionBlue discoloration of the cervix and vaginal mucosa seen in early pregnancy.

Clinical SignificanceDue to increased blood flow to support a newly implanted embryo and can be seen 6-8 weeks after conception.

History – Given to James R. Chadwick, an American gynecologist of the late 19th century, after he read a paper before the American Gynecologic Society in 1886, but 1st described by Etienne Jacquemin in 1836.  Dr. Chadwick did give appropriate recognition to Dr. Jacquemin during this presentation.


  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Gleichert JE. Etienne Joseph Jacquemin, discoverer of ‘Chadwick’s sign’. Journal of the history of medicine and allied sciences. 1971;26(1):75-80. [pubmed]