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PubMed1994

A comparison between health centre deliveries and deliveries born before arrival in the Aitape district.

In this survey the obstetric and neonatal data of the admissions to the Obstetric Ward in Raihu Health Centre during 1990, 1991 and the first half of 1992 were analyzed. The emphasis of the survey was on the difference between deliveries born before arrival (BBA) (24%) and health centre (HC) deliveries (76%). The survey shows that there were differences in postnatal complications, postpartum haemorrhage (16% vs 4.3%), retained placenta (21% vs 1.3%) and puerperal sepsis (18% vs 4.3%), and in antenatal attendance (52% vs 90%), average bedstay (6.5 days vs 5.4 days), mean haemoglobin level (7.78 vs 8.77 g/dl) and gonorrhoea (17% vs 8%). For the neonatal data the survey shows differences in stillbirth rate (10.5% vs 2.3%), perinatal death in the first week (4.0% vs 2.5%) and mean birthweight (for male infants 2.75 kg vs 2.88 kg and female infants 2.60 kg vs 2.73 kg).

Birth Weight↗
PubMed1991

Epidemiological aspects of Mendelian syndromes in a Spanish population sample: I. Autosomal dominant malformation syndromes.

Using a sample of 710,815 liveborn infants throughout Spain, monitored from April, 1976, to December, 1988, by the Spanish Collaborative Study of Congenital Malformations (ECEMC), we estimated the prevalence of each recognized autosomal dominant malformation syndrome for a total prevalence figure of 12.1 per 100,000 live births, including all detected autosomal dominant malformations syndromes. We estimated that the mutation rate for those syndromes was 48.5 per 1,000,000 gametes. The geographical distribution of these syndromes was homogeneous in the Spanish Regions.

Abnormalities, Multiple↗
PubMed2000

Associated malformations in cases with oral clefts.

OBJECTIVE: Infants with oral clefts (OCs) often have other associated congenital defects. The reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalence of associated malformations in a geographically defined population. METHOD: The prevalences at birth of associated malformations in infants with OCs were collected between 1979 and 1996 on all infants born in the area covered by the registry of congenital anomalies of Northeastern France in 238,942 consecutive births. RESULTS: Of the 460 cleft infants born during this period, 36.7% had associated malformations. Associated malformations were more frequent in infants who had cleft palate (46.7%) than in infants with cleft lip and palate (36.8%) or infants with isolated cleft lip (13.6%). Malformations in the central nervous system and in the skeletal system were the most common other anomalies, followed by malformations in the urogenital and cardiovascular systems. Weight, length, and head circumference of children with OCs and multiple associated malformations were lower than in controls, as was the weight of the placenta. Prenatal diagnosis was rarely done by fetal ultrasonographic examination in isolated clefts. However, even in multiple associated malformations, prenatal diagnosis by fetal ultrasonographic examination had a low sensitivity, 31.6%. CONCLUSION: The overall prevalence of malformations, which was one in more than three infants, emphasizes the need for a thorough investigation of infants with clefts. A routine screening for other malformations especially skeletal, central nervous system, and cardiac defects may need to be considered in infants with clefts, and genetic counseling seems warranted in most of these complicated cases.

Abnormalities, Multiple↗
PubMed1977

Perinatal aspects of omphalocele and gastroschisis.

Forty-one infants treated for abdominal wall defects were studied retrospectively. Using established anatomic criteria the infants were identified as having either an omphalocele or gastroschisis. They were compared for maternal and infant characteristics to determine if distinct perinatal characteristics exist between the two groups. Gastroschisis patients had lower mean maternal age, were more likely to be first born, and to be of lower birth weight. Major malformations apart from those associated with the gastrointestinal tract and the anterior abdominal wall occurred 12 times more often in omphalocele patients. Ventral defects warrant a careful anatomical and clinical differentiation, and in the case of omphalocele, a thorough search for other anomalies.

Abnormalities, Multiple↗
PubMed1993

Congenital diaphragmatic hernia: influence of associated malformations on survival.

The medical records of 116 consecutive cases of congenital diaphragmatic hernia (CHD) among 368,772 live births at the three maternity hospitals in Dublin were examined and the incidence of associated malformations and their impact on survival analysed. The patients were divided into two groups: group I included 64 (55%) patients who died during resuscitation and stabilisation before surgery at a mean age of 11.2 hours and group II included 52 (45%) patients who were operated upon. All patients in group I underwent detailed postmortem examination as did the 45% patients who died in group II. The mean (SD) gestational age for group I patients (36.1 (4.5) weeks) was significantly lower than the mean gestational age of group II patients (39.0 (2.4) weeks). Similarly, the mean birth weight of group I patients (2415 (906) g) was significantly lower than that of group II patients (3140 (563) g). Of the newborns who died before surgery, 40 (62.5%) patients had 79 associated malformations. The major associated anomalies were: cardiac (n = 16), neural tube defects (n = 15), skeletal (n = 8), chromosomal (n = 5), urinary tract (n = 6), gastrointestinal (n = 3), omphalocele (n = 4), craniofacial (n = 5), pulmonary (n = 2), and syndromes (n = 2). Sixteen (40%) of these patients were found to have multiple anomalies. Of the 52 patients who were operated upon, only four (7.7%) had associated malformations. Our data shows that associated malformations in neonates with CDH is a major factor influencing outcome in this congenital malformation.

Abnormalities, Multiple↗
PubMed2026

Exploring birth options after three or four cesarean sections in Poland: maternal and neonatal outcomes following vaginal vs repeat surgical deliveries.

OBJECTIVES: The study aimed to analyze maternal and neonatal outcomes of women with a history of three or four caesarean sections (CS) and to evaluate the feasibility and safety of vaginal birth after multiple caesarean sections (VBAC ≥ 3) in Polish clinical practice. MATERIAL AND METHODS: A retrospective analysis was conducted on medical records of 186 women with three or four prior CS who delivered at St. Sophia Specialist Hospital in Warsaw between 2017 and 2024. Data on delivery mode, obstetric management, complications, and neonatal outcomes were assessed. Multivariate logistic regression was applied to identify factors associated with successful VBAC. RESULTS: Of the study group, 62 women attempted trial of labour after caesarean (TOLAC), resulting in 32 successful vaginal births (success rate 53.2%). 124 women chose Elective CS. Logistic regression showed that prior vaginal birth (OR = 20.34; p = 0.008) and the use of epidural anaesthesia (OR = 22.88; p = 0.006) significantly increased the likelihood of successful VBAC. Spontaneous onset of labour showed a positive but non-significant trend (OR = 2.52; p = 0.230). The model demonstrated a classification accuracy of 77.4% and a good overall fit (Nagelkerke R² = 0.456). Uterine rupture occurred in three cases (4.8%), while no maternal or neonatal deaths were reported. CONCLUSIONS: Vaginal birth after three or more CS may be a viable option for carefully selected women, provided it is offered in tertiary centers with immediate surgical readiness. Key predictors of success include prior vaginal birth and epidural anaesthesia. Further large-scale studies are needed to refine guidelines and inform clinical practice in this high-risk group.

Humans↗
PubMed2006

Comparison of accuracy of transabdominal ultrasonography, progesterone and pregnancy-associated glycoproteins tests for discrimination between single and multiple pregnancy in sheep.

The aim of the present study was to evaluate and, compare the accuracy of transabdominal ultrasonographic (US) and the progesterone (P4-RIA) and ovine pregnancy-associated glycoprotein (ovPAG-RIA) tests for the discrimination between single and multiple pregnancy in sheep. One hundred pregnant AwassixMerino ewes were scanned by transabdominal ultrasonography (3.5 MHz linear-array transducer) at Days 43-56 and 81 of these ewes were scanned at Days 76-87 of gestation. The ewes were scanned in dorsal recumbency at the bare area of the inguinal regions (without pre-scanning shaving of the ventral abdominal wall). After each scan, blood samples were withdrawn from the jugular vein to estimate the levels of P4 and ovPAG by radioimmunoassay. At lambing, 61 ewes gave birth to single lambs and 39 ewes gave birth to multiples. The sensitivity of the transabdominal US, the P4-RIA and the ovPAG-RIA tests for determining ewes carrying multiples was 54, 64.1 and 64.1% at Days 43-56. At Days 76-87 of gestation these accuracies were 60.0, 66.7 and 76.6% for the US, P4-RIA and PAG-RIA tests, respectively. The specificity of the transabdominal US, the P4-RIA and the ovPAG-RIA tests for determining ewes carrying singles, was 78.6, 60.7 and 62.3% at Days 43-56 and 78.4, 64.7 and 70.6% at Days 76-87 of gestation, respectively. It is concluded that the accuracy of transabdominal ultrasonographic (without pre-scanning shaving of the ventral abdominal wall), the P4- and the ovPAG-RIA tests for determination of the fetal numbers in AwassixMerino crossbred ewes is too low to be used in the field.

Animals↗
PubMed2003

Central hypoventilation and diaphragmatic eventration: diagnosis and management.

Congenital central alveolar hypoventilation syndrome (CCAHS) is a disorder of ventilatory control that occurs without neuromuscular blockade or pulmonary disease. It is characterized by a lack of response to habitual respiratory stimulants, especially hypercapnia. In this article, the management of this syndrome by diaphragmatic pacing is discussed. Paralysis of the phrenic nerve in small children usually results from injury during birth or during a cardiothoracic operation and results in eventration of the hemidiaphragm. Alternatively, eventration of the diaphragm may be a congenital condition. In both cases it may lead to respiratory distress in the newborn. In this article, we review the diagnosis of these conditions and their management, focusing on the surgical indications. We also discuss outcome.

Abnormalities, Multiple↗
PubMed1998

Causes of mortality in twins in a rural region of The Gambia, West Africa.

Little is known about birth or mortality rates of twins in The Gambia. There are no reports of the causes of death among twins in sub-Saharan Africa. We identified twin births and deaths from a community-based study which had been carried out in a large rural region of The Gambia over a 5-year period from 1989 to 1993. The overall twinning rate excluding stillbirths was 14.3 (95% CI 12.9, 15.8) per 1000 live deliveries. This was significantly lower among the Mandinka ethnic group (8.8 per 1000) than among the Serahulis (15.1 per 1000) or Fulas (18.3 per 1000). The early-neonatal, late-neonatal and post-neonatal twin mortality rates were 114.0, 45.9 and 64.2 per 1000 live twin births, respectively. In comparison, the early-neonatal, late-neonatal and post-neonatal mortality rates of singletons were 18.6, 16.0 and 41.1 per 1000, respectively. In the post-neonatal period, malnutrition was more frequently a cause of death among twins than among singletons (7.8 per 1000 twin births vs 2.0 per 1000 singleton births; p = 0.0008). Appropriate strategies for preventing malnutrition are required for this high-risk group.

Birth Rate↗
PubMed2003

Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer.

OBJECTIVE: To determine whether the amount and timing of female and male alcohol use during IVF and GIFT affect reproductive endpoints. DESIGN: Multicenter prospective study. SETTING: Clinics in southern California. PATIENT(S): Two hundred twenty-one couples with female infertility. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Egg retrieval, transfer, fertilization, pregnancy, miscarriage, live birth, and multiple gestations. RESULT(S): Female alcohol consumption was associated with: (1) a 13% decrease in the number of eggs aspirated (adjusted 95% confidence interval [CI]: -2% to -23%, for one additional drink per day, 1 year before the IVF or GIFT attempt); (2) an increase in risk of not achieving pregnancy by 2.86 times (0.99-8.24, 1 month prior); and (3) an increase in risk of miscarriage by 2.21 times (1.09-4.49, 1 week before the procedure). For men, one additional drink per day increased the risk of not achieving a live birth by 2.28 (1.08-4.80) to 8.32 (1.82-37.97) times, depending on the time period; beer also affected live births (ORs = 5.49-45.64). This outcome may be due partially to increased risk of miscarriage by 2.70 to 38.04 times for men who drank <or=1 month before and during IVF and GIFT. CONCLUSION(S): This is the first study to report an association between alcohol use and reproductive endpoints of IVF and GIFT. Because alcohol use is ubiquitous, modifying drinking habits may increase assisted reproductive technology success rates.

Abortion, Spontaneous↗
PubMed1977

Partial trisomy 6p due to familial translocation t(6;20)(p21;p13). A new syndrome?

Cytogenetic findings in a case of partial trisomy 6p due to a translocation t(6;20)(p21;p13) and eleven balanced translocation heterozygotes are described. The clinical data of the proposita are compared with those of five other published cases. A partial trisomy 6p syndrome is postulated, characterized by: low birth weight, psychomotor retardation, craniofacial abnormalities (such as high prominent forehead, large fontanel, wide sagittal suture, blepharoptosis, low-set and/or malformed ears), congenital heart malformation, small kidneys, and proteinuria. Linkage studies have shown that the breakpoint in chromosome 6 involved in this translocation is close to the HLA gene cluster.

Abnormalities, Multiple↗
PubMed1991

Comparison of infant mortality among twins and singletons: United States 1960 and 1983.

Infant mortality among US black and white twins and singletons was compared for 1960 and 1983 using the Linked Birth/Infant Death Data Sets from the National Center for Health Statistics. Both twin and singleton infant mortality rates showed impressive declines since 1960 but almost all of the improvement in survival for both twins and singletons was related to increased birth weight-specific survival rather than improved birth weight distribution. One-half of white twins and two-thirds of black twins weighed less than 2,500 g at birth, and 9% of white twin births and 16% of black twin births were in the very low (less than 1,500g) birth weight category. In 1983, twin infant mortality rates were still four to five times that of singletons. However, twins had a survival advantage in the 1,250-3,000 g range, which persisted after adjustment for gestational age. Cause-specific mortality among twins was considerably higher for every major cause of death: twin mortality risks due to newborn respiratory disease, maternal causes, neonatal hemorrhage, and short gestation/low birth weight were six to 15 times that of singletons. The lowest twin-to-singleton mortality ratios observed were for congenital anomalies and sudden infant death syndrome with relative risks twice that of singletons. The data underscore the need to develop effective strategies to decrease infant mortality among twins.

Birth Weight↗
PubMed2000

Smoking during pregnancy increases the risk of preterm births among parous women.

BACKGROUND: We wanted to study a possible association between smoking during pregnancy and preterm birth. METHODS: A population based prospective study was performed among 7,236 consecutive pregnancies over seven years delivered at one birth clinic. Smoking habits were obtained at a routine ultrasound examination around 18 gestational weeks, and preterm birth was defined as delivery of a child between 24 and 37 gestational weeks. We estimated relative risk (odds ratio) between smoking, possible confounding variables and preterm birth using multiple logistic regression analysis. RESULTS: Overall, 1,769 (25%) women said that they smoked every day during their pregnancy. The smoking women had an increased risk of preterm delivery compared with non-smokers (odds ratio 1.53, 95% confidence interval 1.24, 1.89). However, this association was only demonstrated among the multiparous women (odds ratio 1.88, 95% confidence interval 1.39, 2.54). The association was statistically significant after adjusting for maternal age, diabetes, cervical conization, preeclampsia, placental abruption and placenta previa in a multivariate analysis, and we observed a dose-response effect of maternal smoking on preterm birth among multiparous women. CONCLUSION: For multiparous women smoking during pregnancy increases the risk of preterm delivery, and there seems to be a dose-response effect of smoking.

Adolescent↗
PubMed2003

[Clinical features of 3798 perinatals suffering from syndromic neural tube defects].

OBJECTIVE: To investigate the patterns and associated malformations in neural tube defects (NTDs) cases. METHODS: From 1987 to 1995, hospital-based cluster sampling method was adopted for collecting data. During that period all live or still births with 28 weeks of gestation or more were assessed within 7 days after delivery. RESULTS: Three thousand seven hundred and ninety eight syndromic NTDs were identified, among which anencephaly, spina bifida and encephalocele were 997, 2394 and 407 respectively. 51.3% associated abnormalities of NTDs appeared in muscle and skeletal system, 19.6% in face, ear and neck, and 9.3% in urinary-genital system. Congenital talipes equinovarus, cleft lip with cleft palate, gastroschisis, talipes valgus, undescended testicle were frequently combined with NTDs. The most frequent association in schisis type of NTDs was NTDs accompanied by cleft lip with or without cleft palate (67.5%), followed by anencephaly with cleft palate (8.3%) and anencephaly with omphalocele (6.6%). Of all syndromic NTDs, the rate of low birth weight was 36.9%, of perinatal mortality was 71.2% and the ratio 33.1% patients were diagnosed prenatally. CONCLUSIONS: Approximately one third of NTDs may be associated with other system's malformation. Syndromic NTDs has a high perinatal mortality rate and a poor prognosis.

Abnormalities, Multiple↗
PubMedDate not supplied

[Nation-wide registration of limb deficiencies in Germany].

AIM: A detailed registration of the frequency and the aetiology of limb deficiencies has been established for the first time in Germany. METHOD: According to the ESPED model (Documentation of rare paediatric diseases in Germany) we send out at an interval of three months a questionnaire for registration of live births, still births and their limb deficiencies to 1 073 gynaecological hospitals. In case of a positive response for a limb deficiency a second questionnaire is sent for details about pregnancy, birth and family. The limb defects are registered according to the ICD-10 classification and statistically analysed. RESULTS: Current acquisition period: 48 months (April 2000-April 2004). Total number of registered births: 1 070 541. Number of live births with limb deficiencies: 1 534 (0.14 %). Number of still births with limb deficiencies: 55 (1.7 %). Minor limb deficiencies such as polydactyly (22.4 %) are more frequent than major deficiencies of the tibia (1.0 %) or of the fibula (1.6 %). A familiar disposition is found in 9.7 %. A correlation to the profession of parents or their age (mother: 29, father: 33), or nicotine abuse could not be detected. The numbers of special features during pregnancy (amniocentesis in 3.3 %, oligohydramnion in 0.5 %, polyhydramnion in 0.3 %, etc.) and during delivery (relation between normal delivery and caesarean section = 59.5 %/29 %, etc.) were similar to the frequencies in the normal population. CONCLUSIONS: Our register represents the largest study world-wide in respect to the birth rate and the most accurate record of limb deficiencies. In the current acquisition period no correlation of the registered limb deficiencies to environmental effects, individual misbehaviour, exposed professional group and peculiarities during pregnancy and parturition could be found. The continuation of our register is essential for further detection of the incidence and aetiology of limb defects.

Abnormalities, Multiple↗
PubMed2005

Definitive surgical management of antenatally diagnosed exomphalos.

BACKGROUND/PURPOSE: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without problems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our institution using a policy of aggressive abdominal wall closure. METHODS: This is a retrospective review of all infants with exomphalos treated from January 1995 to September 2002. RESULTS: There were 35 infants, all of whom underwent surgery. These were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos major) underwent primary closure (n = 13), and group C (exomphalos major) underwent staged closure involving a silo (n = 11). Infants in group C had a lower birth weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P < .001), a longer hospital stay (P = .001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97%) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failure) early after the creation of a silo. CONCLUSIONS: An aggressive surgical approach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly greater resources than other options.

Abdominal Wall↗
PubMed1984

Perinatal intensive care: where and how to draw the line.

With the rapid advances in perinatal intensive care and resultant changes in neonatal prognosis, it is often difficult for the medical personnel involved to know where application of such care is justified, whether major intervention for fetal reasons is warranted, or what information to give parents as to probable outcome. To aid in developing guidelines for these areas of concerns, 730 consecutive live births that occurred in a perinatal unit between 23 and 32 weeks' gestation were analyzed for mortality and long-term morbidity by gestational age at birth. Probability of a normal outcome varies considerably according to which method of analyzing outcome is used. With a greater than 50% probability of intact survival from 25 weeks' gestation and above, intervention for fetal reasons seems to be justified if indicated on purely medical grounds, although prolonged use of restricted resources at or below 25 weeks remains a concern.

Abnormalities, Multiple↗
PubMed1999

Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications.

PURPOSE: The aim of this study was to determine the influence of various prognostic factors on the outcome of esophageal atresia patients. METHODS: The authors reviewed 240 charts of patients admitted with esophageal atresia or tracheoesophageal fistula (EA-TEF) in a single institution. A logistic regression model was used with survival as the dependent variable and era of repair, birth weight, and cardiac anomaly as independent variables. RESULTS: Era was statistically significant (P = .011); 87% (117 of 134) of patients survived in the era from 1980 through 1997 compared with 78% (83 of 106) from 1960 through 1979. Cardiac anomaly (CHD) was a significant risk factor (P = .001); 88% (176 of 199) survived without cardiac anomaly, whereas only 59% (24 of 41) survived with cardiac disease. Eighty-four percent (185 of 219) of infants with a birth weight (BW) of more than 1,500 g survived, compared with 71% (15 of 21) of infants with a birth weight of less than 1,500 g. This was not statistically significant (P = .59). Early hospital deaths were primarily cardiac and chromosomal (61%). Late deaths were primarily respiratory (59%; two-tailed Fisher's Exact test, P = .004). CONCLUSIONS: (1) Survival of patients with esophageal atresia has significantly improved in the recent years. (2) Low birth weight (<1,500 g) does not seem to affect survival. (3) Associated cardiac and chromosomal anomalies are significant causes of death, particularly for early demise. (4) Late death from respiratory disease (tracheomalacia, reactive airway disease, reflux, and aspiration) warrants attention, and a close follow-up of postoperative patients is suggested.

Abnormalities, Multiple↗