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PubMed1994

Low birth weight deliveries at the Nyanza General Hospital Kisumu, Kenya.

The results of a four month descriptive study on low Birth weight (LBW) deliveries in Nyanza Provincial General Hospital, Kisumu from 15th March to 30th July 1987 are presented. The incidence of LBW was 15.0%. Premature labour accounted for 55.3% while term small for gestational age contributes 44.7% of all LBW babies. 4.8% of the mothers of LBW babies were teenagers. The mean gravidity of the mother's was 2.5 with 46.8% being primigravidae. Of the multiparae who delivered LBW babies: 26.6%, 25%, 12.9% and 12.1% gave history of previous abortion, premature delivery, neonatal death and stillbirth respectively. The most common antenatal complications associated with LBW delivery were pyrexia (20.2%), premature rupture of membranes before term (16.7%) and multiple pregnancy (14.6%). 82.4% of LBW deliveries were spontaneous vertex delivery, 12.5% vaginal breech delivery and 2.9% caesarean section. The worst perinatal outcome was associated with caesarean section while spontaneous vertex delivery had the best outcome. Other factors associated with good perinatal outcome were increasing birth weight; first stage of labour lasting less than 18 hours and small for gestational age babies.

Abortion, Spontaneous↗
PubMed2002

An evaluation by focus group and survey of a course for Midwifery Ventouse Practitioners.

OBJECTIVE: to evaluate the Midwifery Ventouse Practitioners' (MVPs) Course and the MVPs' perception of its effect on their practice. DESIGN: qualitative and quantitative. PARTICIPANTS: 18 midwives who had completed the MVP course at Bournemouth University 1998-2000. DATA COLLECTION: focus group (n=8) and postal questionnaire (n=18). FINDINGS: important issues were identified by the focus group and informed the development of the questionnaire which achieved a 100% response rate. The mean length of full-time experience as a midwife was 18.6 years (SD 6.8; range 9-33); 11 midwives were based in community maternity units and seven in consultant units. Seventeen of the MVPs had been called to assist 505 women in this capacity; 366 (72%) had an MVP ventouse-assisted birth, 129 (26%) a normal birth and 10 women (2%) needed obstetric assistance. In this regard, there were considerable differences between individual MVPs. The midwives gave high priority to woman-centred values and to the very judicious use of intervention. They felt that the course had increased their confidence in relation to their midwifery practice, in general, and their ability to define fetal position and station, in particular. They reported a high level of confidence when undertaking their first ventouse birth after completing the course. KEY CONCLUSIONS AND IMPLICATIONS: midwives who have undertaken this course do not appear to expand their role to the detriment of normal midwifery, as had been feared. Even highly experienced midwives value increasing their confidence in relation to vaginal and abdominal examination. Ambulance transfer in the second stage of labour was prevented for at least 109 women. A long-term clinical evaluation of the births to which an MVP has been called is needed.

Adult↗
PubMed2005

Maternal malaria and gravidity interact to modify infant susceptibility to malaria.

BACKGROUND: In endemic areas, placental malaria due to Plasmodium falciparum is most frequent and severe in first-time mothers, and increases the risk of infant mortality in their offspring. Placental malaria may increase the susceptibility of infants to malaria parasitemia, but evidence for this effect is inconclusive. METHODS AND FINDINGS: During 2002-2004, we monitored parasitemia in 453 infants, including 69 who were born to mothers with placental malaria, in a region of northeastern Tanzania where malaria transmission is intense. We used a Cox proportional hazards model to evaluate the time from birth to first parasitemia, and a generalized estimating equations logistic regression model to evaluate risk of any parasitemia throughout the first year of life. Compared with infants whose mothers did not have placental malaria at delivery ("PM-negative"), offspring of mothers with placental malaria at delivery ("PM-positive") were 41% more likely to experience their first parasitemia at a younger age (adjusted hazard ratio [AHR] = 1.41, 95% confidence interval [CI] 1.01-1.99). The odds of parasitemia throughout infancy were strongly modified by the interaction between placental malaria and gravidity (p for interaction = 0.008, Type 3 likelihood ratio test). Offspring of PM-negative primigravidae had lower odds of parasitemia during infancy (adjusted odds ratio [AOR] = 0.67, 95% CI 0.50-0.91) than offspring of PM-negative multigravidae, and offspring of PM-positive primigravidae had the lowest odds (AOR = 0.21, 95% CI 0.09-0.47). In contrast, offspring of PM-positive multigravidae had significantly higher odds of parasitemia (AOR = 1.59, 95% CI 1.16-2.17). CONCLUSION: Although parasitemia is more frequent in primigravid than multigravid women, the converse is true in their offspring, especially in offspring of PM-positive women. While placental malaria is known to increase mortality risk for first-born infants, it surprisingly reduced their risk of parasitemia in this study. Placental malaria of multigravidae, on the other hand, is a strong risk factor for parasitemia during infancy, and therefore preventive antimalarial chemotherapy administered to multigravid women close to term may reduce the frequency of parasitemia in their offspring.

Adult↗
PubMed1987

Variation in early neonatal mortality for different types of fetal growth retardation.

Birth and first-48-hr death records were analyzed for 10,024 liveborn infants in Mexico City and 12,786 liveborn infants in Santa Cruz, Bolivia. The objective of the analysis was to characterize the early postnatal mortality rates for different types of fetal growth retardation and prematurity. Infants who were delivered prior to 37 weeks of gestation had 23-100 times the mortality risk of infants born at full term and normal weight. Light-for-gestational-age infants (birth weight less than 2,900 g) were further divided into proportionately growth-retarded with normal Rohrer's index (weight/height) and disproportionately growth-retarded with low Rohrer's index. The proportionately growth-retarded infant had nearly twice the mortality of the full-term, appropriate-weight infants, whereas the disproportionately growth-retarded infants had 2.9-5.7 times the mortality rate of the full-term, appropriate-weight infants. There were some differences between samples in mortality rates and prevalence of the different classes of small infants, but the pattern of mortality within samples was consistent between samples.

Bolivia↗
PubMed1995

Screening for neuroblastoma: a 9-year birth cohort-based study in Niigata, Japan.

Between April 1985 and March 1994 (9 years), 229,346 babies were born in Niigata prefecture, and 201,888 (88.0%) underwent mass screening (MS) for neuroblastoma at 6 months of age. To date, 29 infants have been screen-detected as having neuroblastoma (1:7908). All screen-detected patients survived after removal of the primary tumor. In the same birth cohort, 17 additional children were clinically diagnosed as having neuroblastoma. The cumulative incidence rate of neuroblastoma at 5 years of age was 10.5 per 100,000 live births in the 5-year birth cohort before MS was introduced, and 18.6 per 100,000 in the first 5-year birth cohort after MS was introduced. These values were not statistically different. The birth cohort incidence rate increased significantly to 22.2 per 100,000 (p < 5% compared with before MS) after the method of MS was changed to high-power liquid chromatography (HPLC), even though this latest birth cohort has not been followed for 5 years. The population-based mortality rate from neuroblastoma was 5.9 per 100,000 in the 5-year birth cohort before MS, and 4.5 per 100,000 after MS in the first 5-year birth cohort, using the vanillymandelic acid (VMA) spot test. These values were not statistically significant. In contrast, no death was observed in the next 4-year birth cohort after MS using HPLC; however, this birth cohort has not yet been followed for 5 years.

Chi-Square Distribution↗
PubMedDate not supplied

Becoming a father. First-time fathers' experience of labor and delivery.

In this study, ethnographic interviews were used to identify first-time fathers' experiences of the birth of their first child. Fourteen fathers were interviewed, and prenatal expectations of the experience are compared with the fathers' perceptions after the birth. Although the fathers expected to be treated as part of a laboring couple, they found that they were relegated to a supporting role. Initially the fathers were confident of their ability to support their wives, but they found that labor was more work than they had anticipated. They became fearful of the outcome, but hid these fears from their partners. Later, they found that their focus moved from their wives to their babies at the time of birth. The men all completed the experience with an enhanced respect for their wives. Fathers should be included in labor management plans and need support for their role as coach, particularly when their wives experience pain. They also need to be encouraged to eat and take a break from their wives' labor when appropriate.

Adult↗
PubMed1998

Obstetric complications, treatment response and brain morphology in adult-onset and early-onset males with schizophrenia.

BACKGROUND: Substantial variability in age at onset of illness and course of illness exists between patients with schizophrenia. Recent studies suggest that age at illness onset may be useful in defining biologically and clinically distinct subgroups of patients. METHODS: Two hundred and ten males with schizophrenia were classified as early-onset or adult-onset according to their age at first hospitalization. Birth history, clinical functioning and treatment response was assessed in a subgroup of patients. Brain anatomy was assessed from CT scans in all patients and in 32 non-psychiatric control subjects. RESULTS: Patients with an early-onset were likely to have a history of obstetric complications, a poor response to neuroleptic treatment, and showed no relationship between ventricle size and duration of illness. Adult-onset patients were less likely to have obstetric complications, more likely to respond to treatment in the first years of illness, and showed an association between brain structure and duration of illness. CONCLUSIONS: The distinction between early- and adult-onset patients may have important aetiological and treatment implications.

Adolescent↗
PubMed1990

Role of beta-adrenoceptor-adenylate cyclase system in the developmental decrease in sensitivity to isoprenaline in foetal and neonatal rat heart.

1. The inotropic and chronotropic sensitivity to noradrenaline and isoprenaline (Iso) of foetal and neonatal rat heart decreases as the heart becomes sympathetically innervated. In the present study, we have examined adenylate cyclase (AC) activation and beta-adrenoceptor binding to determine whether a developmental decrease in sensitivity was demonstrable in the beta-receptor-AC system of atrial and ventricular membranes from the 15 day foetus and 1 day and 7 day neonates. 2. While the maximum activation of AC by Iso increased with age, the sensitivity expressed in terms of pD2 values decreased from the 15th foetal day to the first day after birth in the atria, and from the first day to the 7th day after birth in the ventricle. 3. In contrast, activation of AC by forskolin was almost identical at all ages both in atria and ventricle. 4. The maximum equilibrium binding of [3H]-dihydroalprenolol decreased with age, the dissociation constant being about the same at all ages in both the atria and ventricle. 5. In conclusion, we have demonstrated a developmental decrease in the sensitivity of AC to Iso in myocardial membrane fractions consistent with the developmental decrease in chronotropic and inotropic sensitivity to beta-adrenoceptor agonists. Although a reduction in beta-adrenoceptor number partly accounts for the decrease in sensitivity, some other factors such as decreased coupling to AC may largely be responsible.

Adenylyl Cyclases↗
PubMed1978

Interpregnancy interval. Association with birth weight, stillbirth, and neonatal death.

Pairs of first and second births and pairs of second and third births to the same Norwegian mothers were studied to determine the association between interpregnancy interval and birth weight, stillbirth, and neonatal death. Use of the pair approach provides one birth which could possibly have been affected by the length of the interval and one birth which could not. The association of interval and birth weight for births which precede an interval is found to be equivalent to that for births which follow an interval. The data on stillbirth are compatible with higher rates at long intervals while the data on neonatal death are consistent with higher rates at short intervals. However, we conclude that manipulation of the interval between pregnancies is unlikely to have any marked, direct, beneficial effect on outcome of pregnancy.

Birth Order↗
PubMed1989

[The interrelations of ophthalmologic and neurologic changes in newborns with birth injuries].

Examination of 127 newborns in the first day after birth has revealed changes in the eye fundus in 89 of them (70.1%): dilatation of retinal veins, edema of the retina and the optic disc, hemorrhages. The severity of ophthalmological changes in newborns correlates with disturbances in the nervous system in them. It is recommended to subject newborns to early ophthalmological examination for assessment of their state and diagnosis of birth injury of the central nervous system.

Birth Injuries↗