Temporal trends in reported malformation incidence--comments from Tasmania.
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Biomedical subjects
Publications and source records attributed to J F Correy.
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Three infants, born of two mothers with inflammatory bowel disease who received treatment with sulphasalazine throughout pregnancy, were found to have major congenital anomalies. In the singleton pregnancy, the mother had ulcerative colitis, and the infant, a male, had coarctation of the aorta and a ventricular septal defect. In the twin pregnancy, the mother had Crohn's disease. The first twin, a female, had a left Potter-type IIa polycystic kidney and a rudimentary left uterine cornu. The second twin, a male, had some features of Potter's facies, hypoplastic lungs, absent kidneys and ureters, and talipes equinovarus. Despite reports to the contrary, it is suggested that sulphasalazine may be teratogenic.
Smoking and alcohol ingestion were analysed in 5100 women confined in Tasmania in 1981. This represented 70% of the total number of confinements. The incidence of smoking throughout pregnancy was 33.6%, and 2.7% of the women studied smoked at some time during pregnancy. Alcohol consumption in pregnancy was recorded for 55.9% of patients. However, 99% were only occasional drinkers. There was a statistically higher incidence in smoking habits in the age group 20 years and under, the unmarried and the lower socio-economic classes, whereas the reverse was true for alcohol consumption. The analysis provides a basis for the groups toward which programmes should be directed.
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The outcome of pregnancy was studied in all women conceiving after ovulation induction with clomiphene at the gynaecological endocrine clinics operating in 2 Tasmanian cities. In 156 pregnancies where details were available, the main findings were: abortion rate 10.3%; multiple pregnancy rate 4.1%; congenital abnormality rate 3.6%; and perinatal mortality rate 3.5%. The results are compared with other reported series.
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A Tasmanian survey from 1975 to 1978 inclusive is presented of 742 vaginal breech deliveries and 26,424 cephalic deliveries of infants weighing 1,000 g or more. There was a significantly higher intrapartum and neonatal death rate associated with the preterm breech delivery; Caesarean section is advocated for this group.
Over the 10-year period 1968-1977, 131 patients with ectopic pregnancy were treated at the Royal Hobart Hospital. The clinical features of these patients are discussed. Using data on the number of ectopic pregnancies confirmed in Southern Tasmania in the period 1973-1977, it was shown that in terms of the ratio of ectopic pregnancies to total births, the incidence of ectopic gestation in the essentially stable population has risen from 1:130 to 1:72; possible reasons for this increase are discussed. The difficulty in diagnosis of the condition is emphasised.
A simple and safe protocol is described for the conduct of a controlled comparison of the relative predictive values of the antenatal cardiotocograph in the absence and in the presence of artificial stress (oxytocin challenge) to the fetus. Each patient serves as her own control, the tests are performed on the same day, and labour also commences on the same day, so that fetal performance in labour and status at birth are closely related in time to both tests and provide a reasonable assessment of the relative value of the tests. A pilot study of 83 patients has been carried out and the results are presented.
A phenotypic female, karyotype XY presented with virilisation and amenorrhoea. The gonads showed evidence of oestrogen and testosterone production and, in view of the risk of malignancy, a laparotomy was performed. A streak gonad was present on one side with a streak gonad containing discrete tumours on the other. The uterus and Fallopian tubes were present. Removal of the gonads and uterus and subsequent oestrogen replacement therapy have produced a satisfactory clinical result.
The genesis and implementation of a continuing obstetric audit in Tasmania is described. The survey includes all public and private deliveries in Tasmania. Some of the early difficulties and their resolution are discussed. Because of its simplicity, the suggestion has been made that such a system would be suitable for a national audit.
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