Selective effects in potential fertility: a simulation study

"The effect of various factors on selection for family planning status and for natural fecundability is studied in a Monte Carlo simulation that incorporates heterogeneity of natural fecundability and of risks of foetal loss. Selection depends crucially on the duration of marriage at which contraceptive status is recorded, and on desired family size....The contraceptive status of sterile women is also revealed in the simulation, including users who do not know that they have become sterile. Formulae are developed to allow the estimation of births averted and potential fertility among the users, and results checked by further simulation." The results indicate "that selection for foetal loss is much less important than selection for natural fecundability in its effect on numbers of averted births and potential fertility." (summary in FRE)

Singapore in international comparisons of birthweight and perinatal mortality

The position of Singapore as regards birthweight distribution and perinatal mortality has been compared with six countries in the 1973 WHO study namely, Austria, Cuba, Hungary, Japan, New Zealand and Sweden. Birthweight distribution and perinatal mortality reflect both the social and health conditions of a population and the standards of obstetric and paediatric care, and seeing where a country ranks in the international comparison of them may play a role in the formulation of health policy for that country. Singapore was well placed for the proportion of very low birthweight babies (less than 1,500 grams), ranking 2nd for both live births (0.5%) and total births (0.7%). It was however not so well placed for proportion of low birthweight babies (less than 2,500 grams), ranking 5th for both live births (8.8%) and total births (9.2%). With regard to perinatal mortality Singapore at 20.0 per 1,000 total births ranked 4th and this improved to 3rd after standardizing for birthweight and in fact was little different from Hungary (1st) and Sweden (2nd). Given that standardization for birthweight largely removes the effect of "socioeconomic and demographic factors" so that remaining differences to a large extent reflect medical care, this indicates a relatively high standard of perinatal care in Singapore. The problems of interpretation, the implications of the findings and suggestions for improving birth statistics in Singapore are discussed.

Dermal ridge patterns and fertility in a Polish rural sample

The relationship between ridge counts and pattern intensities on fingers, palms and soles, and number of pregnancies, number of surviving children, maternal age at birth of first child, and miscarriages was investigated in a rural Polish sample of 273 females. All subjects had completed their reproduction by the time of investigation and the use of contraceptives was negligible. Results show that females with a history of miscarriage have lower mean ridge counts on all fingers and lower pattern intensity on all fingers except V, with statistically significant differences for fingers III and IV. The results also suggest a relationship between the intensity of patterns on fingers II and V and in thenar areas, with the number of pregnancies and/or surviving offspring. The limitations of the present data and a need for more specific investigations are discussed.

The "grand multipara"--is it a problem? A review of 5785 cases

The Grand Multipara (GM) has almost disappeared in the Western countries due to the advancement of family planning. Having a heterogeneous population, the problem of Grand Multiparity still exists in our country. This study is based on 5785 cases of GM which were treated in our Obstetrical Department during a period of 16 years (1960-1975). We have compared this group to the general obstetrical population in terms of pregnancy and delivery complications. Face and breech presentations as well as transverse lie were twice, brow presentations were three times as frequent in the GM group. Postpartum hemorrhage (P.P.H.) was four times and premature separation of the placenta twice as frequent. Rupture of the uterus was about 20 times more frequent. Forceps delivery and Cesarean section rate were twice, while the vacuum extraction 5-fold more frequent. Though there was no material mortality and perinatal mortality was not higher than in the general population. Even though the percentage of GM in our population has been decreased in the last 10 years, our results suggest that Grand Multiparity is still a high risk obstetrical problem.

The impact of abortion policy on prematurity in Hungary

In our country both the high frequency of prematurity and abortion and the possible correlation between them have been in the focus of professional interest during the last three decades. The harmful effect of abortion is undeniable. However, it is not possible to label it as the only or leading factor responsible for the high frequency of prematurity.

Are there adverse effects of periconceptional spermicide use?

Recent studies have suggested that spermicide exposure around conception may cause congenital malformations, reduced birth weight, or spontaneous abortion. This large, prospective study examined the risk for multiple malformation, patterns of malformations, low birth weight, preterm delivery, and spontaneous abortion in infants whose mothers used spermicides only before or after their last menstrual period, compared with a control group using other contraceptive methods. The multiple malformation rates in women using spermicides only before or after their last menstrual period were 3.8 and 4.8 per thousand, respectively. For the control groups, the corresponding rates were 5.4 and 6.4 (not significant). No pattern of malformations was found in spermicide-exposed infants. The risk of preterm delivery, the risk for producing a low-birth-weight (less than 2500 gm) infant, and the risk of spontaneous abortion were no higher in women exposed to spermicides than in women using other methods of contraception. This study finds no evidence that spermicide exposure around the time of conception is dangerous to the fetus.

[Perinatal mortality in Austria: an analysis of social risk factors]

Social factors related to perinatal mortality are analyzed using log-linear models and data for a sample of 215 perinatal deaths that occurred in hospitals in Vienna, Austria, during 1978. A sample of 210 surviving children is used as a control group. "The findings indicate that perinatal mortality decreases with higher education of mothers. Furthermore, the risk of perinatal mortality is considerably higher for those who have mothers above age 35.... For illegitimate births, the risk of death is twice that of legitimate births even when accounting for differential medical control during pregnancy." (summary in ENG)

Births averted under family planning programme: a mathematical approach

"In this paper a probability model is proposed to describe the distribution of births to couples in first T years of marriage, when T is large and/or when couples use various methods of family planning. This model is derived on the assumption that conditional instantaneous risk of a conception, the incidence of foetal loss and the chance of attaining [sterility] following a child birth are functions of parity....The application of the model in evaluation of family planning programme changes in the child bearing pattern is illustrated."

Perinatal and maternal mortality in a religious group avoiding obstetric care

We investigated perinatal and maternal deaths occurring among women who were members of a religious group in Indiana; these women received no prenatal care and gave birth at home without trained attendants. Members of the religious group had a perinatal mortality rate three times higher and a maternal mortality rate about 100 times higher than the statewide rates. These findings suggest that, even in the United States, women who avoid obstetric care have a greatly increased risk of perinatal and maternal death.