A record-linkage study on risk factors for cause-specific infant mortality

Infant death certificates were linked with birth certificates for infants born to residents of Tohoku, Tokai and Kyushu regions in 1989 (n = 409, 679, or about one-third of all births in Japan), to examine the effects of variables, as reported on birth certificates, on cause-specific infant mortality. "Certain conditions originating in the perinatal period" and "congenital anomalies" accounted for nearly 90 percent of neonatal deaths, while "congenital anomalies", "injuries and poisoning" and "sudden infant death" were responsible for about 65 percent of postneonatal deaths. Mortality rates for almost all causes of infant deaths, except injuries and poisonings, increased as birth weight decreased not only in the neonatal period but also in the postneonatal period. This suggests that low birth weight places some infants at higher risk of death, and conditions that lead to low birth weight independently contribute to the risk of infant death. Cox's proportional hazards linear model was used to assess the effects of variables on infant mortalities by causes of death. An extremely strong birth weight effect was noted for "certain conditions originating in the perinatal period" and "congenital anomalies". Being a male infant and late order of birth in multiparity were other risk factors for deaths from "congenital anomalies", while being a male infant, resident of Tohoku region and maternal stillbirth experience related to deaths from "certain conditions originating in the perinatal period". Elevated risks of sudden infant death syndrome (SIDS), of which mortality rate in Japan was considerably lower than those in most developed Western countries, i.e. 0.23 per 1,000 live births in 1989, were associated with low birth weight, being a male infant, low maternal age, late order of birth in multiparity and illegitimacy. Low maternal age, late order of birth in multiparity and illegitimacy, also, related significantly to increased risk of infant deaths for "injuries and poisoning". These results suggest the independent contributions of socioeconomic factors to infant mortality, especially postneonatal mortality, from SIDS, "injuries and poisonings".     

A meta-analysis of infant outcomes after breech delivery

OBJECTIVE: To estimate the risks of neonatal morbidity and mortality associated with a trial of labor and with elective cesarean for the term breech infant. DATA SOURCES: Using the terms "breech," "malpresentation," and "external cephalic version," we used the MEDLINE and Health Planning and Administration data bases to search the English-language literature from January 1981 to June 1993. The search was supplemented with a review of the reference lists of key articles and text chapters. METHODS OF STUDY SELECTION: We included randomized trials or cohort studies that specified selection criteria for a vaginal delivery, provided detailed outcome data, and allowed for analysis by intended mode of delivery. DATA EXTRACTION AND SYNTHESIS: Nine studies met the inclusion criteria. We pooled the weighted results from these studies to estimate the risks of birth injuries and perinatal death, and the risk differences between trial of labor and no trial of labor groups. The pooled risk for any injury was 1.00% after a trial of labor and 0.09% after elective cesarean. For any injury or death, the risk was 1.23% after a trial of labor and 0.09% after elective cesarean. The risk differences for injury and injury or death were 0.89 and 1.10%, respectively. These are significantly different from zero, suggesting an increased risk of injury and injury or death after a trial of labor. CONCLUSION: When management decisions are made, the potential increased risk of neonatal morbidity after a trial of labor should be considered along with the increased maternal risk from cesarean delivery.     

Vaginal birth after cesarean section in twin gestation

OBJECTIVE: We report a 10-year experience with vaginal birth after cesarean section in women with twins. STUDY DESIGN: Data were gathered from labor and delivery records and maternal and neonatal hospital charts. Women with a vertical uterine scar, a previous uterine rupture, an unrepaired dehiscence, or obstetric contraindications to labor were excluded from a trial of labor. Full-thickness uterine defects requiring intervention were classified as ruptures; all others were classified as dehiscences. RESULTS: Between Jan. 1, 1985, and Dec. 31, 1994, at Los Angeles County/University of Southern California Women's Hospital, 210 women with previous cesarean births were delivered of twins. One hundred eighteen (56%) underwent repeat cesarean delivery without a trial of labor. Ninety-two (44%) undertook a trial of labor with no uterine ruptures and no increase in maternal or perinatal morbidity or mortality. CONCLUSIONS: In women with twins a trial of labor after a previous cesarean section is a safe and effective alternative to routine repeat cesarean delivery.     

Perinatal mortality in breech presentation sibships

OBJECTIVE: To compare perinatal mortality in breech presentation delivered vaginally and by cesarean in individual births and in sibships. METHODS: A national, population registry-based study, 1967-1994, was conducted, with maternal record linkage of sibships, comprising the first to the third birth of a mother. The main outcome was perinatal mortality. Odds ratios of perinatal mortality were calculated and adjusted by logistic regression analysis. RESULTS: The overall relative perinatal mortality was 4.3 (95% confidence interval [CI] 4.1, 4.5) in breech compared with nonbreech presentation and 5.4 (95% CI 4.7, 6.2) in vaginal compared with cesarean delivery. The relative perinatal mortality in breech compared with nonbreech presentation was lowest in birth order one compared with birth orders two and three. In breech vaginal delivery compared with cesarean delivery, the opposite effect of birth order was found. The highest perinatal mortality was found in a current breech presentation of a sibship with no previous breech births. In birth subsequent to breech births, perinatal mortality was more or less independent of current presentation, without respect to delivery method. The increased perinatal mortality in breech presentation is explained partly by its association with other risk factors for perinatal death. CONCLUSION: Women with recurring breech presentation represent a lower risk of adverse perinatal outcome. This might be explained by a biologic mechanism or by increased quality of antenatal care. An increased mortality in subsequent nonbreech siblings after a breech presentation was surprising.     

Epidemiologic paradox in multiple births among Asians in Illinois. Correlation between risk factors and outcomes

OBJECTIVE: To determine if the plural birth rate, maternal risk factors and neonatal outcomes among Asian American populations residing in Illinois are homogeneous or heterogeneous with regard to maternal risk factors and neonatal outcomes and to attempt to establish correlations between maternal risk factors and neonatal outcomes. STUDY DESIGN: A total of 1,145,962 computerized birth certificate files were analyzed for 11 Asian subgroups giving birth in Illinois in the years 1989-1994. RESULTS: The multiple birth rates varied between 6 per 1,000 (Vietnamese) to 15 per 1,000 (Cambodian) (heterogeneity among all groups, P < .005). The percent of neonates born at gestational ages 22-33 weeks varied between 0 (Cambodian) to 28 (Thai). Japanese women showed the highest rate of neonates with birth weight less than 2,500 g after adjustment for race: 15.38 per 1,000. Women from Cambodia and Laos had the highest sum of maternal risk factors; those from the Philippines and Thailand had the least. The lowest collective adverse neonatal outcomes were in infants born to women from Cambodia and Laos. CONCLUSION: The 11 subgroups of Asians living in Illinois demonstrate heterogeneity with respect to multiple birth rate, selected maternal risk factors and adverse neonatal outcomes. After considering all maternal risk factors and neonatal outcomes, the two groups (Cambodians and Laotians) with the poorest maternal risk factors had the lowest rate of poor neonatal outcomes. This is the first time that this epidemiologic paradox has been observed in twins of Asian ancestry.     

Biological control of nematode parasites of livestock in Fiji: screening of fresh dung of small ruminants for the presence of nematophagous fungi

OBJECTIVE: To assess risk factors and outcomes associated with nuchal cord at birth. STUDY DESIGN: A population-based, case-control study was conducted using linked birth and hospitalization records. Three thousand newborns were randomly selected from all singleton births with nuchal cord as noted on the birth record (n = 5,426) in King County, Washington, 1992-1993. For comparison, 3,000 controls were randomly selected from the 46,952 unaffected singleton births. RESULTS: An increased risk of nuchal cord was associated with induction of labor (odds ratio [OR] adjusted for maternal age and parity 2.0, 95% confidence interval [CI] 1.7-2.3), African American infant race (OR 1.3, 95% CI 1.0-1.6), primiparity (OR 1.2, 95% CI 1.0-1.5) and male sex (OR 1.2, 95% CI 1.0-1.3). After exclusion of selected obstetric complications, the risk of nuchal cord associated with induction of labor increased (OR 2.4, 95% CI 2.0-3.0). Nuchal cord was associated with increased risks of fetal distress (OR 2.7, 95% CI 2.1-3.4), meconium staining (OR 2.1, 95% CI 1.7-2.6), five-minute Apgar score < 7 (OR 1.6, 95% CI 1.1-2.4) and assisted ventilation < 30 minutes (OR 1.9, 95% CI 1.4-2.6). Although hospital charges for newborns with nuchal cord were slightly greater than for those without (P = .02), hospital lengths of stay did not differ significantly. CONCLUSION: Induction of labor was identified as an independent risk factor for nuchal cord. Certain adverse perinatal outcomes are increased in neonates with nuchal cord. However, neonates with nuchal cord do not have significantly longer neonatal hospital stays, and thus the adverse effects of nuchal cord may be transient.     

Asphyxia of the newborn in east, central and southern Africa

Very scanty information is available in East, Central and Southern Africa on the incidence and risk factors associated with asphyxia of the newborn. A multicentre prospective study involving 4267 deliveries in eight countries was undertaken over a three month period, in maternity units of the central hospitals to determine the incidence; maternal, service and logistic risk factors for asphyxia of the newborn as determined by an abnormally low apgar score. 30% of births were by primigravida mothers, of whom 67% were teenagers. A birth by a teenager had a higher risk for low birth weight. Overall incidence of low birth weight was 13.9%. The overall incidence of asphyxia of the newborn was 22.9% while that associated with low birth weight (i.e. babies weighing less than 2500 grams) was 29.3% compared with 21.5% among the normal birth weight babies. Low birth weight contributed a large proportion of the high neonatal mortality of 15.9% compared to 1.8% for normal birth weight babies by 24 hours after birth. The mean mortality by 24 hours post delivery was 3.8%. Obstetrical complications are important risk factors for asphyxia of the newborn. Among the important risk factors are those associated with prolonged labour and intra partum accidents. The incidence of risk for asphyxia broadly was 21.3%, which is very close to the actual incidence of asphyxia of 22%. Lack of referral contributed to increased risk of asphyxia. In a significant proportion of infants, resuscitation measures taken were inappropriate. The stillbirth rate was 3.0% while the incidence of externally evident congenital malformations was 1.2%. There is urgent need to institute appropriate measures to prevent and manage asphyxia of the newborn in the region. These should include identification of the at risk mother, proper referral and management while adhering to correct established procedures. There is also need to develop appropriate and relevant technologies for perinatal and neonatal care through research undertaken in the region. It is also concluded that the co-operation and joint effort between the obstetricians, paediatricians and the nursing staff who all contributed to the collection of this data is a cost effective approach to research in perinatal health and consequently in instituting interventions.     

Changes in brain memory functions as affected by a constant magnetic field]

OBJECTIVE: The preferred route of delivery for breech presentation has been controversial. We compared the birth weight-specific neonatal mortality of vaginal births to cesarean births in singleton births with breech presentation. METHODS: A total of 371,692 singleton live births with breech presentation were selected for the study from the United States birth cohorts for the years 1989-1991. Differences in birth weight specific mortality were compared using a z-statistic for differences in proportions and by logistic regression. RESULTS: Compared to primary vaginal births, primary cesarean births had significantly lower neonatal mortality for all birth weight groups, despite increased prevalence of fetal malformations in the cesarean as compared with vaginally delivered group. This mortality difference was greatest in the first hour of life. Difference in overall neonatal (less than 28 days) mortality rate ranged from a low of 1.6-fold in the 500-749 g group (726.6 per 1000 vaginal births compared with 456.3 per 1000 cesarean births, P < .001) to as high as about three-fold in the 1250-1499 g group (232.9 per 1000 vaginal births compared to 72.5 per 1000 cesarean births, P < .001). In the group with birth weights over 2500 g, neonatal mortality in the primary vaginal births was 5.3 per 1000 and in the primary cesarean births, 3.2 per 1000 (P < .001). Similarly, repeat cesarean births had significantly lower birth weight-specific neonatal mortality, compared with vaginal births after previous cesarean. CONCLUSION: Singleton live births with breech presentation delivered by cesarean had lower birth weight-specific neonatal mortality as compared with vaginal births.     

Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators

OBJECTIVES: To examine the relationship between birth weight and mode of delivery among women with untreated borderline gestational diabetes mellitus (GDM), treated overt GDM, and normoglycemia. DESIGN: Prospective cohort study. SETTING: Three Toronto, Ontario teaching hospitals. PATIENTS: A total of 3778 volunteers aged 24 years or older. INTERVENTIONS: Subjects underwent a 3-hour long, 100-g oral glucose tolerance test at 28 weeks' gestation, regardless of screening test results. Usual care was provided to 143 women who met the National Diabetes Data Group criteria for GDM. Physicians were blinded to glucose tolerance test results for all others, including 115 untreated women with borderline GDM by the broader criteria of Carpenter and Coustan. MAIN OUTCOME MEASURES: Crude and adjusted rates of cesarean delivery and neonatal macrosomia (birth weight >4000 g). RESULTS: Compared with normoglycemic controls, the untreated borderline GDM group had increased rates of macrosomia (28.7% vs 13.7%, P<.001) and cesarean delivery (29.6% vs 20.2%, P=.02). Cesarean delivery in this subgroup was associated with macrosomia (45.5% vs 23.5%, P=.03). Usual care of known GDM normalized birth weights, but the cesarean delivery rate was about 33% whether macrosomia was present or absent. A clearly increased risk of cesarean delivery among treated patients compared with normoglycemic controls persisted after adjustment for multiple maternal risk factors (adjusted odds ratio, 2.1; 95% confidence interval, 1.3 to 3.6). CONCLUSIONS: Infant macrosomia was a mediating factor in high cesarean delivery rates for women with untreated borderline GDM. While detection and treatment of GDM normalized birth weights, rates of cesarean delivery remained inexplicably high. Recognition of GDM may lead to a lower threshold for surgical delivery that mitigates the potential benefits of treatment.     

The alpha-isoform of glycogen synthase kinase-3 from rabbit skeletal muscle is inactivated by p70 S6 kinase or MAP kinase-activated protein kinase-1 in vitro

OBJECTIVES: A major component of the increasing trend in cesarean sections in Western Australia is the rise in emergency cesarean sections in primiparous women. The aim of this study was to identify independent risk factors (particularly those known early in pregnancy) associated with operative delivery in low-risk primiparous women. METHODS: Retrospective multivariate logistic regression analyses of antenatal and perinatal data were conducted for all low-risk primiparous women entering labor spontaneously and giving birth in Western Australia in 1987 (n = 3641). RESULTS: Of the subjects, 58% had a spontaneous vaginal delivery, 8% had an emergency cesarean section, and 34% had an operative vaginal delivery. The significant independent risk factors for emergency cesarean section were older maternal age, shorter maternal height, heavier infant birthweight, and long labor. The risk factors for operative vaginal delivery were older maternal age, shorter maternal height, heavier infant birthweight, epidural anesthesia, labor/delivery complications, male infant, private patient status, and being married. CONCLUSIONS: This multivariate analysis confirms known risk factors for operative delivery in low-risk primiparous women and suggests that it may be possible to predict the likelihood of operative delivery for an individual woman by using knowledge of maternal age and height and assessment of infant birthweight.     

Factors that influence route of delivery--active versus traditional labor management

OBJECTIVE: Our purpose was to compare maternal and fetal factors that influence the route of delivery with active management of labor and a traditional labor management protocol. STUDY DESIGN: Data were collected prospectively on 346 consecutive patients receiving active management of labor and 354 patients who were managed traditionally. Within each group demographic and labor characteristics of patients undergoing cesarean section were compared with those of patients having vaginal deliveries by means of the Student t test, chi 2 analysis, and stepwise logistic regression. RESULTS: With both active management of labor and traditional labor management success in achieving vaginal delivery was related to the station of the fetal vertex at admission, the need for oxytocin augmentation of labor, the uterine response to oxytocin, the use of epidural anesthesia, and the development of chorioamnionitis. By means of multiple logistic regression analysis maternal age, height, payor status, and birth weight were also identified as risk factors for cesarean section with traditional labor management but not with active management of labor. CONCLUSIONS: Differences were identified in risk factors for cesarean section between active management and traditional labor management. Active management of labor may diminish or eliminate some patient characteristics as risk factors for cesarean birth.     

Molecular characterization of low-molecular-weight component protein, Flp, in Actinobacillus actinomycetemcomitans fimbriae

OBJECTIVE: To demonstrate the use of aggregated, locally collected birth notification data to examine trends in birth-weight specific survival for singleton and multiple births. DESIGN: Retrospective analysis of 171,527 notified births and subsequent infant survival data derived from computerised community child health records. Validation of data completeness and quality was undertaken by comparison with birth and death registration records for the same period. SETTING: Notifications of births in 1989-1991 to residents of the North Thames (East) Region (formerly North East Thames Regional Health Authority). OUTCOME MEASURES: Birthweight specific stillbirth, neonatal, and postneonatal death rates. RESULTS: There was close correspondence between the notification and registration data. For 96% of the registered deaths a birth notification record was identified and for the majority of these the death was already known to the Community Child Health Computer. Completeness of birth-weight data, particularly at the lower end of the range, was substantially better in birth notification data. Comparison with the most recent published national data relating to birthweight specific survival of very low birthweight singleton and multiple births suggests that the downward trend of mortality is continuing, at least in this Region. CONCLUSIONS: The use of routinely collected aggregated birth notification data provides a valuable adjunct to existing sources of information about perinatal and infant survival, as well as other information regarding process and outcome of maternity services. Such data are required for comparative audit and may be more complete than that obtained from registration or hospital generated data.     

Impaired growth and risk of fetal death: is the tenth percentile the appropriate standard?

OBJECTIVE: Our purpose was to determine whether the 10th percentile of birth weight for gestational age is appropriate to identify fetuses at risk of death associated with impaired growth. STUDY DESIGN: All live births recorded in Virginia from Jan. 1, 1991, through Dec. 31, 1993, were examined. Percentile growth curves were constructed, and fetal, neonatal, and perinatal mortality rates were calculated for births within various percentile intervals. RESULTS: Significantly elevated fetal mortality was found for birth weights through the 15th percentile. The odds ratio for fetal mortality relative to the baseline for births < or = 5th percentile was 5.6, for the 5th through the 10th percentile 2.8, and for the 10th through the 15th percentile 1.9. These were all significant. CONCLUSION: Fetuses with birth weights between the 10th and 15th percentiles are at a significantly increased risk for fetal death. Therefore the use of the 15th percentile as a diagnostic threshold for the identification of the fetus at increased risk associated with impaired growth is recommended.     

Maternal risk factors for preterm birth and low birthweight in Cape Verde

BACKGROUND: Fifteen years after the implementation of an antenatal risk screening program in Cape Verde, the first assessment of an association between maternal obstetric characteristics and preterm birth or low birthweight (LBW) infants was undertaken. METHODS: A cohort of 353 systematically selected antenatal clinic attenders in the county of Praia, Cape Verde, was studied prospectively during the period October 1991 through December 1992. The cohort was followed past the perinatal period and information was obtained according to a pretested structured questionnaire. In the analysis of preterm birth and LBW, multiple logistic regression was listed to estimate the relative risks of ll background variables. RESULTS: The prevalence of preterm birth (<37 gestational weeks) was 12%, and the prevalence of LBW infants was 8%. Low birthweight (<2500 grams) was significantly associated with low maternal age (< or = 19 years, RR=3.7); nulliparity (RR=5.2) and obstetric history of previous LBW infant (RR-6.5). The risk of preterm birth was significantly increased if the woman had an obstetric history of hypertension or convulsions (RR=2.6). CONCLUSIONS: In the setting studied, teenage women and women with previous pregnancy hypertension should be given selective attention in antenatal care to achieve improved pregnancy outcome. Primary prevention is needed to lower the prevalence of teenage pregnancies.     

Comparison of ketoconazole and fluconazole as cytochrome P450 inhibitors. Use of steady-state infusion approach to achieve plasma concentration-response relationships

OBJECTIVE: To define factors causing prolonged labor in nulliparous women undergoing active management of labor. METHODS: We included all nulliparas delivered during 1990-1994 with spontaneous onset of labor lasting more than 12 hours, singleton gestation, cephalic presentation, and labor at greater than 37 weeks. Each patient was matched with the next nulliparous woman who delivered with a labor lasting less than 12 hours and who fulfilled the same inclusion criteria. Subjects were managed according to the previously described active management of labor protocol from The National Maternity Hospital, Dublin. RESULTS: In the 5-year period, 9018 nulliparas met inclusion criteria, with 147 (1.6%) having prolonged labor. Prolonged labor was due to inefficient uterine action in 65%, persistent occipitoposterior position in 24%, and cephalopelvic disproportion in 11% of cases. Univariate analysis showed statistically significant (P < .05) differences in maternal body mass index, cervical dilation on admission, oxytocin use, epidural use, placement of epidural at less than 2 cm of dilation, and birth weight between these study groups. On multivariate conditional logistic regression analysis, the following were significant independent predictors for having a prolonged labor (odds ratios with 95% confidence intervals presented): 3.1 (1.3-7.3) for cervical dilation less than 2 cm on admission, 42.7 (7.5-242.0) for early epidural placement, 5.1 (1.9-13.7) for epidural placement at greater than or equal to 2 cm, and 10.2 (3.6-29.4) for birth weight greater than 4000 g. CONCLUSION: Less-advanced cervical dilation on admission and epidural use, especially when placed early, are strongly associated with prolonged labor.     

Neonatal infection by Streptococcus agalactiae. Multicenter study in the area of Barcelona, Spain

BACKGROUND: Streptococcus agalactiae or streptococcus group B (SGB) is the main etiologic agent of early neonatal sepsis. A multicenter study was performed with the aim of determining the incidence and characteristics of this disease in our medium and contribute the design of an adequate prevention protocol. METHODS: Ten hospitals and two primary health care centers were implicated in the study; 103 microbiology confirmed episodes of SGB neonatal sepsis (blood and/or LCR positive) were reported from 1994 to 1996. RESULTS: The incidence of early SGB neonatal sepsis was 1.48/1,000 live births with a mortality of 8.7%. The cultures, for detecting the state of the SGB carrier were performed in only 26 (25%) of the patients. At least one of the factors described for risk of perinatal SGB infection was observed in 46% of the mothers, with the most frequent being prolonged amniorrhea (26%), intrapartum fever (17%), and early delivery (14%). At the time of delivery only 10.7% of the mothers received endovenous antibiotherapy. CONCLUSIONS: From these results the following recommendations have been made: a) detection of SGB carriers by the systematic practice of blood cultures in the last weeks of gestation and b) the administration of intrapartum antibiotic prophylaxis in both early births (< 37 weeks) and in all the SGB carriers should be undertaken. With these measures we aim to decrease the neonatal infections by streptococcus group B.     

Obstetric and perinatal outcome of pregnancies following intracytoplasmic sperm injection

The aim of this study was to describe the obstetric and perinatal outcome for births following intracytoplasmic sperm injection (ICSI). Of 210 infants born, 140 were singletons and 70 were twins. There were no triplets or higher births. The multiple birth frequency was 20%. Overall, 17% of deliveries were preterm, although for singleton pregnancies the incidence was reduced to 9%. The median birth weight of all live born infants was 3168 g and singletons 3470 g. Of all infants, 17% had a low birth weight (<2500 g) and 2% had a very low birth weight (<1500 g). Two major malformations occurred in two singleton children and four minor malformations occurred in four children. This was within the range of expected values in Sweden. Karyotyping was performed in 58 pregnancies. All of them were normal. The perinatal mortality was 0.5%. In conclusion, in this observational study from Sweden of the first infants born after ICSI in our programme, the incidence of multiple births, preterm births, low birth weight babies and congenital malformations was low compared with other series of in-vitro fertilization pregnancies not associated with ICSI.     

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.     

Drug use and physical trauma: risk factors for preterm delivery

OBJECTIVE: The present investigation was undertaken to determine the incidence of alcohol, cocaine, and marijuana use among pregnant patients who suffered any type of physical trauma and to determine if the combination of substance use and physical trauma in pregnancy has extended perinatal implications. METHODS: In this single institution, prospective patient series undertaken over 18 months, all pregnant patients who suffered any type of physical trauma were considered for study. RESULTS: Among 6828 live births over an 18-month period, there were 157 (2.3%) patients who reported physical trauma (insignificant = 153, minor = 2, severe = 2). Consent to screen for the presence of alcohol, marijuana, and cocaine was obtained from 85 (54%) patients with refusal by the remainder. Screening was positive in 11% for one or more substances. The perinatal morbidity and mortality for the 153 patients with insignificant trauma was 50:1000 and 20:1000, respectively, all associated with preterm labor and delivery which occurred in 21% of the patients. None of the four patients with minor or severe trauma either had a positive drug/alcohol screen or any perinatal morbidity or mortality. No maternal mortality occurred. CONCLUSION: An 11% incidence of positive drug screens was encountered in consenting pregnant trauma victims and a 21% incidence of preterm birth was encountered even in this patient population with so-called insignificant trauma.     

Perinatal complications in births to low socioeconomic status schizophrenic and depressed women.

Pregnancy and birth complications in births to 57 schizophrenic, 28 depressed, and 31 well women were studied. The sample was of low socioeconomic status (SES) and predominantly African-American. The study extended earlier work on the perinatal status of infants born to schizophrenic women by including measures of severity of maternal disturbance; mother's age, IQ, and premorbid social competence; and family composition. The results show that maternal competence and the mother's diagnosis of schizophrenia were significant variables in determining the likelihood of less adequate prenatal care and more complicated births. The results indicate the importance of an assessment not only of a disturbed woman's diagnosis but also of her personal background and social competence in determining the likelihood of obstetrical complications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)