Changes in maternal and child mortality rates in three isolated Gambian villages over ten years

As an adjunct to the general nutrition research programme, the MRC Dunn Nutrition Unit has provided for the past 10 years a continuous medical service to three adjacent rural Gambian villages. There have been substantial reductions in annual childhood mortality rates. Perinatal mortality fell from 109.6 to 45.5 per 1000 births, infant mortality from 148.5 to 24.5 per 1000 live births, and mortality in children aged 1-4 years from 109.1 to 13.3 per 1000. There have been no pregnancy-related maternal deaths in the community for 8 years; 16 could have been expected given current estimates of maternal mortality elsewhere in rural Gambia. Of all the health and nutritional interventions introduced the single most important factor has apparently been the on-the-spot, 24 h availability of a physician or qualified midwife.

Birth interval, mortality and growth of children in a rural area in Kenya

This paper analyses the impact of the length of birth intervals on mortality and growth of young children. An attempt has been made to improve the methodology of birth interval studies and the results of an analysis of longitudinal data from a rural area in Kenya with a relatively favourable level of health are presented. It is shown that children with short retrospective or short prospective birth intervals do not run a higher risk of mortality or growth retardation than children with longer intervals, neither during the perinatal period nor during the first 2 years of life. This suggests that the socioeconomic setting, in which a birth interval study is carried out, is of ultimate importance.

Previous experience of induced abortion as a risk factor for fetal death and preterm delivery

As part of a community-based study in Korea to evaluate the effects of previous induced abortion on length of gestation and pregnancy outcome of subsequent pregnancies, we analyzed data obtained from January 1979 to December 1981 on pregnancies reported to family health workers in Kang Hwa Island, Korea. The preterm, live-birth rates were not significantly associated with previous induced abortion. Overall, the life table-estimated fetal death rate for women enrolled at the eighth or earlier weeks of gestation was 13.7%, 10.2% for women with no previous induced abortion and 28.9% for women with previous induced abortion. The relative risk for fetal death for women who had undergone a previous abortion was 2.8; relative risk for parous women compared to nulliparous women was 3.4. After controlling for parity, previous induced abortion was not a significant variable for fetal death rate.

Perinatal mortality rates do not contain what they purport to contain

Three cases of perinatal death, of which two needed to be included in and one excluded from national perinatal mortality statistics, were presented to 1004 specialist and trainee obstetricians in northern Belgium (ie, Flanders) and the Netherlands. Of the respondents (52%), 69% admitted that they would report none of the cases and 13% would report all of them. Overreporting occurred twice as often and underreporting ten times as often as correct reporting--only 6% would apply the current regulations for registration of perinatal mortality correctly in all three cases. Although the statutory regulations with regard to the cases were similar in the two countries, there were differences between Belgian and Dutch doctors in their reporting of these three cases. This indicates that Belgian and Dutch perinatal mortality statistics do not measure the same thing and that neither contains what it purports to contain. The findings cast doubts on the validity of using national perinatal mortality figures as indicators of perinatal health or perinatal care in and between European countries.

Maternal plasma estradiol and progesterone levels during therapeutic abortion induced by 16, 16 dimethyl PGE2 p-benzaldehyde semicarbazone ester

Estradiol and progesterone levels in maternal plasma after administration of 16, 16-dimethyl-PGE2 p-benzaldehyde semicarbazone ester (16,16-PGE2) 6 hourly for abortion were studied in 27 women in the second trimester of pregnancy and in 49 patients with fetal death in utero. Basal maternal plasma levels of estradiol and progesterone measured before prostaglandin injection were significantly lower in cases of fetal death in utero than in the other subjects. After 16,16-PGE2 injection, plasma levels of estradiol and progesterone fell more rapidly and to a greater extent in cases of fetal death in utero than those with normal pregnancy at corresponding gestations; the decline of plasma estradiol levels was quicker and more marked than that of progesterone. Thus, 16,16-PGE2 appears to exert a differential effect on estradiol and progesterone biosynthesis.

Perinatal mortality with particular reference to the Singapore situation

Perinatal mortality rates have been gradually declining in all countries. The initial decline mainly resulted from improvements in the late foetal mortality rates. Later with improvements in neonatal care, early neonatal mortality rates also improved. The developed countries have consistently shown better results than the developing countries, an indication of the higher standard of living, general health as well as the delivery of health care in these countries. In the Singapore situation, a rapid improvement in perinatal mortality was initially observed due to improvements in the late foetal mortality, followed later by reduction in the early neonatal mortality due to upgrading of neonatal intensive care. The perinatal mortality rate is lowest in the Chinese compared to the Indians and Malays, most likely due to the dietary practices of the three ethnic groups in Singapore; while the Chinese encourage extra nutrition in the pregnant female, the Malays and Indians tend to practise dietary restriction during this period. The improved nutrition of the pregnant mother is a factor in improving the perinatal mortality.

Safety and efficacy of vaginal prostaglandin E2 suppositories in the management of third-trimester fetal demise

Prostaglandin E2 vaginal suppositories are well established in the management of intrauterine fetal demise in the second trimester of pregnancy. However, approval for their use in the third trimester has been withheld pending evaluation of safety and efficacy. In this study 46 patients with intrauterine fetal demise in the third trimester were managed in a similar fashion except that only a 10-mg dose of prostaglandin E2 was employed. Forty-four of the 46 patients were delivered successfully. One patient experienced a cervical laceration that necessitated a hysterectomy; in her, oxytocin was used to supplement the prostaglandin. It appears that prostaglandin E2 vaginal suppositories can be used safely in the management of fetal demise in the third trimester of pregnancy. Use of a lower dose of the medication as well as tocodynamometry is recommended because the absorption of and sensitivity to this medication vary from patient to patient. The frequency of administering the medication should depend on the patient's response rather than on any given formula.

Building a family: unplanned events

Couples in developed societies are often unsuccessful in achieving precise family building goals despite the widespread use of birth control. Unplanned events that frustrate reproductive intentions to varying degrees include contraceptive failure, sterility, miscarriage, prolonged conception delay, undesired sex combination of offspring, divorce, and the death of a spouse or a child. This paper reviews the probability of the occurrence of these events using US data. It is concluded that the large majority of newlyweds will experience at least one unplanned event during the family building phase of the life cycle.

Maternal occupation and industry and the pregnancy outcome of U.S. married women, 1980

Data from the 1980 National Natality and National Fetal Mortality Surveys were used to characterize the occupations of women during the year before delivery; to search for disproportionate numbers of adverse pregnancy outcomes in specific occupational groups; and to compare demographic, reproductive, and lifestyle characteristics of employed mothers to those of mothers not employed in the year before delivery. National estimates were derived from the sample through a complex poststratified ratio adjustment procedure. For all pregnancy outcome groups, the greatest proportion of mothers were employed in three industry categories: professional and related services, wholesale and retail trade, and manufacturing; and in four occupation categories: clerical and kindred workers; professional, technical, and kindred workers; service workers; and operatives. Compared with employed mothers of live-born infants, a greater proportion of employed mothers of low birth weight infants worked full-time but stopped working before the third trimester. Compared with unemployed mothers, a larger proportion of employed mothers were between 20-29 years old, college educated, had a total family income of $21,000 or more per year, received early prenatal care, had no previous pregnancy, and drank alcohol during pregnancy. Estimates from this study may be used to (a) provide a better perspective of the magnitude of reproductive health problems, (b) target certain industrial populations for further research, and (c) assist in identifying causes of reproductive failure.

The pathology in perinatal mortality in Nairobi, Kenya

The clinico-pathological causes of death in 497 stillbirths and 1st 24 hour neonatal deaths in Nairobi are described. The major factors in stillbirth (303 cases) were cord compression and prolapse, birth trauma, and prolonged labour. Hyaline membrane disease and intraventricular haemorrhage caused death in 52% of the neonatal cases. The importance of intra-uterine infection is discussed.

Effects of vaginal spermicides on pregnancy outcome

The effects of spermicide use around the time of conception on fetal loss, birth weight and sex were examined using data from the 1976 National Survey of Family Growth (NSFG). There was no evidence that cessation of spermicide use at least one month prior to conception had any effect on the pregnancy outcomes examined. However, the proportion of female births was approximately 25 percent higher among women who used spermicides around the time of conception than among nonusers of spermicides. In addition, women who used spermicides after conception were found to have approximately double the rate of fetal loss experienced by former users, including those who had used spermicides close to the time of conception. The effects of spermicides on birth weight were not statistically significant.

Teratogenic aspects of abdominal wall defects

The article describes two methods used to reveal possible teratogenic factors involved in the aetiology of abdominal wall defects. Forty-six mothers to children with gastroschisis and omphalocele were questioned about heredity, occupation, use of drugs etc. during early pregnancy (case history study). Seventy-four mothers to children with gastroschisis and omphalocele were randomly selected from a national register and their maternal health service record forms were studied and compared with the forms of 144 matched controls (case control study). None of the analyzed factors was found to be of significant teratogenic importance in the aetiology of abdominal wall defects, nor was it possible to explain the increase in the incidence of gastroschisis taking place during the early 70s.

Fertility of Indian Tamil concentrations in Sri Lanka

The paper uses multiple regression analysis to examine the variation in fertility among Indian Tamil concentrations in the Grama Sevaka divisions of Sri Lanka. Significant contributions are made by the proportion of females employed in agriculture, and the proportion of females aged 5–14 attending school, which together account for 85% of the variability. These variables serve as an index to the underlying attitudes to fertility and reproductive behaviour.

Infant and child mortality in Kuwait

This paper examines the levels, trends and Kuwaiti–non-Kuwaiti differentials in stillbirth, infant and child mortality rates during the 1957–79 period. The present infant mortality rate (33 per 1000) and its component parts are high in contrast to those in more developed countries. But during the last few decades, the rates showed definite decline. The decline in infant and child mortality was rapid between 1955 and 1970 when the infant death rate was about 100 or more per thousand livebirths, but slowed after the infant mortality rates were brought down to around 50 in 1970. The large scale reduction in mortality since 1950 is closely associated with socioeconomic progress and improvements in standards of living as well as wider availability and better accessibility of health services. Kuwait is still in a position where mortality can be reduced further, provided that investment in health and education continues.