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The use of Pergonal at a fixed dosage was evaluated in 200 women. The primary monitoring mode was vaginal ultrasonography. The overall pregnancy rate was 59% (118/200). The rates of multiple birth, hyperstimulation, spontaneous abortion and ectopic pregnancy were evaluated, also. The use of this regimen in private practice appears to be safe and effective.
OBJECTIVE: To determine the incidence of venous thromboembolism in pregnancy and the puerperium and to identify risk factors for pregnancy-related venous thromboembolism. DESIGN: Cohort study and case-control study. SETTING: London, UK. POPULATION: 395,335 women with live births or pregnancies of 24 or more weeks of gestation between 1988 and 1997. METHODS: Data extraction from the St Mary's Maternity Information System database. Random sample of 5% for case-control study. MAIN OUTCOME MEASURES: Incidence of venous thromboembolism; odds ratios for variables associated with venous thromboembolism. RESULTS: The incidence of venous thromboembolism was 85/100,000 maternities. There were approximately twice as many postpartum as antepartum events. Blood group A, multiple pregnancy, caesarean section, cardiac disease, delivery at gestational age of < 36 weeks, a body mass index of > or = 25, or more and maternal age of 35 or over were all found to increase incidence of venous thromboembolism. CONCLUSIONS: Although venous thromboembolism is the leading cause of maternal deaths in the UK, it is still a rare event. Most of these events are deep vein thromboses occurring in the postpartum period. Antenatally multiple birth is an important risk factor. Postnatally women who have had a caesarean section, premature delivery or history of cardiac disease should be assessed carefully for venous thromboembolism.
Delivery records of public hospitals and local health centers were analyzed to investigate the secular trend of multiple births from 1955 to 1990 in Taiwan. Twinning rates decreased gradually from the late 1950s to 1973, slightly increased and remained stable from 1974 to 1980, and then increased strikingly from 1981 to 1990. During the study period, MZ rates were consistently higher than DZ rates except in 1986 when a higher DZ rate was observed. The highest MZ rate of 7.7 per 1,000 deliveries was observed in 1985, while the highest DZ rate of 4.6 per 1,000 deliveries was observed in 1986. The triplet incidence rate also declined from the early 1960s to 1973 and then increased markedly from 1974 to 1990. A case-control study including 482 MZ and 252 DZ twin pairs and 1,496 singletons was carried out in four teaching hospitals in Taipei City between October 1985 and June 1989 to examine factors related to twinning. The zygosity of twin pairs was determined by sex, placentation and red blood cell antigens. Multiple logistic regression analysis showed that the higher the maternal age, the lower the MZ and DZ rates, while the higher the parity, the higher the rates. There was no association of paternal age or of maternal educational level with twinning rates.
In this phenomenological study women's experiences regarding their decisions to undergo or forgo multifetal reduction of their higher-order multiple pregnancies were explored. Seven women who had conceived higher-order multiple pregnancies as the result of in vitro fertilization were interviewed. Four participants accepted reduction, whereas three participants declined. Three themes were discerned: (a) the presence of infertility as a barrier to contemplating hyperfertility; (b) multiple-birth pregnancy as yet another form of loss for infertile women; and (c) the lasting effects of having made the decision.
During a 10-year period (1971-1980) 16 sets of conjoined twins were delivered in the author's hospital. The incidence of those twins was 1 in 4242 deliveries, 1 in 69 multiple births, and 1 in 139 congenitally malformed babies. All diagnoses were made during labour or at operation and all babies were lost. There were no maternal deaths.
OBJECTIVES: This report presents 2002 period infant mortality statistics from the linked birth/infant death data file by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. METHODS: Descriptive tabulations of data are presented and interpreted. RESULTS: The U.S. infant mortality rate increased from 6.8 infant deaths per 1000 live births in 2001 to 7.0 in 2002. The rate for infants of non-Hispanic white mothers was 5.7 in 2001 compared with 5.8 in 2002. The rate for infants of non-Hispanic black mothers was 13.5 in 2001 compared with 13.9 in 2002. Neither of the changes for non-Hispanic white nor non-Hispanic black was significant. Between 2001 and 2002, overall cause-specific rates increased 5 percent for low birthweight and 14 percent for maternal complications. The rate rose significantly for infants of mothers who smoked, 10.5 to 11.1. It also increased significantly from 10.7 to 11.5 for infants of mothers aged 15-17 years. The rate dropped significantly for triplet births, 71.4 to 60.1. Infant mortality rates ranged from 3.0 per 1000 live births for Chinese mothers to 13.9 for non-Hispanic black mothers. Among Hispanics, rates ranged from 3.7 for Cuban mothers to 8.2 for Puerto Rican mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 States and the District of Columbia, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. The three leading causes of infant death-Congenital malformations, low birthweight, and Sudden infant death syndrome (SIDS)-taken together accounted for 45 percent of all infant deaths. For infants of non-Hispanic black mothers, the cause-specific infant mortality rate for low birthweight was nearly four times that for infants of non-Hispanic white mothers. For infants of non-Hispanic black and American Indian mothers, the SIDS rates were at least double the rate for non-Hispanic white mothers. A more intensive analysis of the rise in the infant mortality rate utilizing information on maternal and infant health risk factors available in the linked birth/infant death and fetal death data files is forthcoming.
OBJECTIVES: To review the medical records of neonates found to have birth-associated trauma of the head and neck region. To describe the anomalies, physical findings, and possible sequelae of these injuries and to bring attention to the cause of mechanical birth injury as a potential cause of anomalies in the infant. DESIGN: Case-controlled retrospective chart review of a cohort of patients identified with birth-associated trauma to the head and neck from January 1, 1991, to March 1, 1997. SETTING: Academic tertiary care medical center. PATIENTS: Medical records from infants born or transferred with the diagnosis of birth trauma were reviewed. Medical records from a control group of 148 uninjured full-term infants born during the same period were reviewed for comparison. Neonatal charts, including labor and delivery records, were analyzed. MAIN OUTCOME MEASURES: Each patient record was reviewed for diagnosis, associated injuries, maternal statistics, gestational age, birth weight and size, Apgar scores, type of delivery, length of labor, complications of labor, and length of hospital stay. RESULTS: One hundred sixty-four infants (incidence, 0.82%; prevalence, 9.5 per 1000 live-births) were identified with 175 birth-associated injuries to the head and neck. The most common finding was cephalhematoma (56.6%). Other findings included scalp and/or facial lacerations (12%) and hematomas (2.3%), facial nerve paresis (8.6%), brachial plexus injuries (5.1%), clavicular (9.1%) and skull fracture (2.9%), nasal septal dislocation (0.6%), and phrenic (1.7%) and laryngeal nerve injuries (0.6%). Risk factors included birth weight (P = .001) , vaginal delivery (P = .001), primiparity (P = .02), forceps delivery (P = .005), vacuum delivery (P = .001), infants categorized as large for gestational age (P = .02), and male infant sex (P = .03). Apgar scores were also noted to be lower in our study population (P = .001). Risk factors for specific types of injuries varied. However, facial nerve paralysis was associated with multiple birth injuries (P = .001), and 2 of 3 phrenic nerve injuries co-occurred with brachial plexus injuries. Correlation coefficients for factors such as maternal age, gravidity, and race were low. CONCLUSION: Birth-associated head and neck trauma is rare. However, mechanical birth-associated trauma must be considered when assessing anomalies, injuries, respiratory difficulty, or feeding difficulties in the neonate or infant. A comprehensive approach is required to diagnose and manage these patients.
Postneonatal deaths in Western Australia from 1970-78 were studied using a linked file of birth and death registrations. Postneonatal mortality fell during the period under study. The fall occurred in both male and female rates and the former were higher than the latter in all years. The infants at high risk during the postneonatal period were those born to unmarried teenage mothers residing in rural areas, especially if the infants were of low birthweight (less than 2500g). Multiple births and those infants born to mothers whose previous issues were over 4 were also at high risk. Infants born to Aboriginal mothers experienced a significantly higher rate of postneonatal mortality than those born to non-Aboriginal mothers. However, a significant improvement in the Aboriginal rate occurred between 1976 and 1977. The major causes of postneonatal death were sudden infant death syndrome, infections and congenital abnormalities.
A population-based case-control study of the determinants of stillbirths was conducted in Greece from 1989 to 1991. All reported stillbirths after 28 weeks of pregnancy (N = 2,006) during the three year study period comprised the case group. The control group derived from random sampling of 10% of all livebirths in Greece, during the same period (N = 30,705). The data were analysed by modelling through multiple logistic regression. The adjusted relative risk of stillbirth was significantly higher for males compared to females. A statistically significant monotonic increase in relative risk was observed with shorter gestational age, low maternal education, and older maternal age. Birthweight and parity showed a statistically significant U-shaped association with stillbirth risk, with a higher risk being observed among both low and high birthweight deliveries, as well as among primiparous or multiparous (4+) mothers. Positive associations of stillbirth with multiple births, out-of-wedlock marriage and non-Greek-orthodox maternal religion were noted in crude analyses, but these associations almost disappeared in logistic regression model. Maternal urban or rural residence showed no relation to risk. Overall, the prospective risk of stillbirth after the 24th week of gestation in Greece has been estimated to be higher than that in Japan (a more developed country) with more than 40% of stillbirths occurring after the 36th week of pregnancy.
AIMS: To identify perinatal risk factors for developmental dysplasia of the hip (DDH) and define the risk for each factor. METHODS: In this case control study, using logistic regression analysis, all 1127 cases of isolated DDH live born in South Australia in 1986-93 and notified to the South Australian Birth Defects Register were included; controls comprised 150130 live births in South Australia during the same period without any notified congenital abnormalities. RESULTS: Breech presentation, oligohydramnios, female sex and primiparity were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (as well as an increased risk for emergency section over elective section), high birthweight (> or = 4000 g), postmaturity and older maternal age; multiple births and preterm births had a reduced risk. There was no increased risk for caesarean section in the absence of breech presentation. For breech presentation, the risk of DDH was estimated to be at least 2.7% for girls and 0.8% for boys; a combination of factors increased the risk. CONCLUSIONS: It is suggested that the risk factors identified be used as indications for repeat screening at 6 weeks of age and whenever possible in infancy. Other indications are family history and associated abnormalities.
OBJECTIVES: This report presents 2003 period infant mortality statistics from the linked birth/infant death data file by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. METHODS: Descriptive tabulations of data are presented and interpreted. Excluding rates by cause of death, the infant mortality rate is now published with two decimal places. RESULTS: The U.S. infant mortality rate was 6.84 infant deaths per 1,000 live births in 2003, a return to the rate in 2001, compared with 6.95 in 2002. Infant mortality rates ranged from 4.83 per 1,000 live births for Asian or Pacific Islander mothers to 13.60 for non-Hispanic black mothers. Among Hispanics, rates ranged from 4.57 for Cuban mothers to 8.18 for Puerto Rican mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 States and the District of Columbia, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. Infants born at the lowest birthweights and gestational ages have a large impact on overall U.S. infant mortality. Nearly one-half (49 percent) of all infant deaths in the U.S. in 2003 occurred to the 0.8 percent of infants whose birthweight was less than 1,000 grams. The three leading causes of infant death--Congenital malformations, low birthweight, and SIDS--taken together accounted for 45 percent of all infant deaths. For infants of non-Hispanic black mothers, the cause-specific infant mortality rate for low birthweight was nearly four times that for infants of non-Hispanic white mothers. For infants of non-Hispanic black and American Indian mothers, the SIDS rates were more than double the rate for non-Hispanic white mothers.
Smith-Lemli-Opitz syndrome (SLOS) is a common autosomal recessive disorder. Children with SLOS present with specific facial dysmorphism and have multiple congenital anomalies including cleft palate, congenital heart disease, genitourinary anomalies, and limb abnormalities. They also manifest severe failure to thrive and mental retardation. A metabolic defect at the final step in the cholesterol biosynthetic pathway has been described in SLOS patients. This defect results in markedly reduced cholesterol levels and abnormal accumulation of cholesterol precursors, particularly 7-dehydrocholesterol. This newly described metabolic defect in humans is one of only a few metabolic errors known to cause multiple birth defects. The biochemical profile of reduced plasma cholesterol levels in association with markedly elevated levels of the cholesterol precursor 7-dehydrocholesterol is now used to confirm the diagnosis of SLOS, which was formerly made on purely clinical grounds. This biochemical abnormality has been confirmed in dozens of patients with SLOS in both the United States and Europe. The severe cholesterol deficiency seen in these patients has multiple effects on health and early childhood development, because cholesterol is an essential component of many cell functions, which explains many of the clinical findings seen in SLOS.
STUDY OBJECTIVE: To examine social inequalities and trends in low birth weight in England and Wales. DESIGN: Analysis of routine birth data, comparing (a) couple and sole registered births, and (b) manual and non-manual occupational groups. SETTING: England and Wales, 1993-2000. MAIN RESULTS: Social inequalities in low birth weight were evident throughout 1993-2000: relative to the non-manual group, there is an increased risk for the manual group (range in RR 1.22-1.35) and sole registrations (RR 1.51-1.67). An estimated 6.5% (2979 births) of low birth weight in 2000 could have been avoided if risks associated with the manual group were absent, and 2.8% (1290 births) avoided if risks associated with sole registration were absent. Between 1993 and 2000, the low birthweight rate increased significantly with an estimated overall increase of 11%. Increases were evident in all social groups (15% in manual, 11% in sole registrations and 9% in non-manual); however relative to non-manual the increase in RRs were not statistically significant for manual or sole registrations. When multiple births are excluded, the rate of low birth weight is reduced but there is still a significant increase over time and social differentials are undiminished. CONCLUSIONS: There are social inequalities in low birth weight in England and Wales that have not narrowed over an eight year period, 1993-2000. These inequalities are likely to affect childhood and adult health inequalities in the future, hence strategies will need to address differences in low birth weight and further monitoring of trends is therefore desirable.
AIMS: The ponderal index describes body proportionality at birth thus distinguishing symmetric from asymmetric growth restriction. We aimed to develop ponderal index percentiles for preterm and term neonates born in a European population. METHODS: Auxologic data were obtained from neonates born from January 1990 to December 1998 from the datasets reported to the perinatal quality assurance system of the Federal State of Hesse, Germany. We excluded data from neonates with lethal malformations, with chromosomal aberrations, from multiple births, from neonates with uncertain gestational age, and from neonates of a gestational age of less than 30 completed weeks. We calculated the weekly 5th, 10th, 25th, 50th, 75th, 90th, and 95th ponderal index percentile values. RESULTS: A total of 480,841 neonates (233,662 females and 247,179 males) were included. Charts and tables of ponderal index values show percentiles for males, females, and for the total group. There were no significant differences between boys and girls. CONCLUSION: Our data offer the ability to refer a neonate's body proportionality to updated percentiles. The percentiles allow the discrimination between symmetric and asymmetric growth restriction in preterm and term infants.
BACKGROUND: It is unclear how the implementation of elective single embryo transfer in clinical practice would affect clinical pregnancy and delivery rates and multiple birth rates. METHODS: This retrospective study analysed 1871 IVF/ICSI cycles carried out from 1997 to 2001 in the IVF programme of a single university infertility clinic. RESULTS: The number of elective single embryo transfers increased from 11 to 56%. At the same time the clinical pregnancy rate was relatively stable; mean 34.0% (range 28-42). The number of embryos per embryo transfer decreased from 1.8 to 1.3. The multiple pregnancy and delivery rates dropped markedly from 25 to 7.5% and from 25 to 5% respectively. CONCLUSIONS: An elective single embryo transfer programme can be adopted in daily practice that decreases the twinning rate to <10% and does not affect the overall pregnancy rate.
OBJECTIVE: To describe the differences in childbearing, in prenatal and obstetrical practices, and in perinatal health outcome in Finland and Estonia. DESIGN: Registry study using the data from the Finnish and Estonian medical birth registries for years 1992 to 1996 (in total 324,021 and 74,297 newborns, respectively). RESULTS: In 1992 the birth rates were 51 per 1,000 women aged 15 to 49 in Finland and 48 per 1,000 in Estonia. The birth rate declined in the study period in both countries, but the decline was more rapid in Estonia (-26%) than in Finland (-6%). In the same period the rates of induced abortion declined in both countries (-34% and -6%, respectively), but the rate in 1996 was still much higher in Estonia (46/1,000) than in Finland (8/1,000). Compared with Finnish mothers, Estonian mothers were younger, had fewer multiple births, less prenatal care and fewer interventions during pregnancy and delivery. The intervention rates increased in both countries during the study period, but this increase was more rapid in Estonia. The infant outcomes were poorer in Estonia, but the differences between Estonia and Finland decreased during the 1990's. CONCLUSIONS: The differences in prenatal and maternal care and in induced abortion rates have decreased between Estonia and Finland. Changes in maternal backgrounds, improved referral system for complicated pregnancies, improvements in prenatal care and in availability of appropriate equipment and technology may have caused improved maternal and infant health in Estonia, but this should be further investigated.
A prospective study was devised to investigate how risk factors at delivery contribute to outcome at birth as measured by the type of resuscitation required ('skilled' or 'not skilled') and the Apgar score. In addition the number of unexpected 'crash calls' was recorded. In a 3-month sample, neonatologists attended 494 (38.6%) of 1279 deliveries. Of those attended, 188 (37.2%) required skilled resuscitation including 5 of 20 crash calls. Four risk factors at delivery were associated with skilled resuscitation: meconium, emergency caesarean section, prematurity and multiple births. Following the implementation of a revised resuscitation policy, a subsequent 3-month sample showed that 299 (24.8%) of 1206 deliveries were attended. A total of 175 (58.5%) required skilled resuscitation including 8 of 16 crash calls. The revised resuscitation policy, in our unit, proved to be safe and led to a reduction of attendance by neonatologists at deliveries.
High risk pregnancies continue to be associated with high perinatal mortality and morbidity in developing countries. Korle Bu Teaching Hospital is no exception with a perinatal mortality rate of 98.7/1000 births. Multiple factors resulting in this include the high risk nature of the pregnancies resulting in increased incidence of premature deliveries and asphyxiated babies, the delay in transfer of the sick neonate as well as the inadequate mode of transfer. The type of delivery other than the spontaneous vaginal route also affects the outcome, though the relationship was not statistically significant. Logistic regression analysis showed that maturity, birthweight and time from birth to admission to NICU were the most significant factors associated with the survival of the neonate. Proper foetal surveillance both in the antenatal period and during labour cannot be over emphasized and the mere presence of a paediatrician at these high risk deliveries may make a difference. Also, increased vigilance in the special care offered will help reduce mortality.