Objectives and outcome of perinatal care

Ethnicity and obstetric performance in Singapore

The influence of ethnicity on obstetric performance in Singapore was assessed by retrospective analysis of all deliveries in the National University Hospital over a 7-year period. Malay mothers were younger, shorter, less educated, of higher parity, were more likely to have had no antenatal care, and had the highest incidence of premature labour. However, mothers of Indian origin had the smallest babies, the highest incidence of low birth weight and significantly higher perinatal mortality rates. Chinese mothers fared better than their Malay and Indian counterparts in all parameters assessed. The ethnic origin of the mother has an important bearing on perinatal performance. This emphasises the importance of designing appropriate strategies to improve perinatal health in the different ethnic groups.

Low birthweight, preterm, and small for gestational age babies in Scotland, 1981-1984

STUDY OBJECTIVE

The aim was to examine the effect of maternal age, gravidity, marital status, previous perinatal deaths, and parental social class on babies born low birthweight, preterm, and small for gestational age.

DESIGN

The study used data on discharge summaries from all maternity hospitals in Scotland.

SETTING

The study was based on all singleton deliveries in Scotland.

PARTICIPANTS

The analysis involved information on 259,462 singleton babies born during the four years 1981-84 in Scotland.

MEASUREMENTS AND MAIN RESULTS

Previous perinatal death was found to be the strongest predictor for both preterm and low birthweight. Single mothers were at particularly high risk of having a small for gestational age baby and those who were previously married of having a preterm baby. Women aged less than 20 years old, those over 34 years old, nulligravidae, and those of parity 3 or more were also at increased risk of adverse pregnancy outcome. Mothers and fathers in manual social classes and those who could not be assigned a social class on the basis of their occupation were at increased risk for all three adverse outcomes studied. The babies of parents who were in manual occupations were twice as likely as those of parents in non-manual occupations to be small for gestational age and almost twice as likely to be low birthweight.

CONCLUSIONS

Mother's social class is a risk factor for adverse pregnancy outcome independent of maternal age, parity, and adverse reproductive history, and also independent of father's social class. Information on both parents' occupations should be collected in maternity discharge systems.

The abilities of very low-birthweight children and their classroom controls

Forty-three children born in the Nottingham area in 1981 and weighing less than 1501g who had received treatment in the neonatal intensive care unit were followed up on entry to primary school at the age of five years. All were apparently normal, with no observable handicap or need for special educational provision. Their results on the McCarthy Scales of Children's Abilities were compared with those of closely matched classmates and significant differences were found between the two groups on all six scales, most markedly on the General Cognitive Index.

Early intervention

This paper provides an overview of the critical nced for early intervention services, the specific role of occupational therapists in early intervention settings, and the training implications for the preparation of occupational Therapists with expanded roles, responsibilities and skills. An intervention approach that is multidisciplinary, culturally relevant, and family centered in nature is proposed as one way of redefining the occupational therapist's contribution and strategy in early intervention settings. Recommendations are presented regarding the education and preparation of occupational thera ists for their new directions in early intervention and the potenliarincrease in demands for their services.

Risk factors for low birthweight in Singapore: strategies for prevention

An analysis of 9399 consecutive singleton births delivered at this unit is presented. The incidence of low birthweight (less than 2500 g) was 7.4%. Further analysis of the 698 low birth weight babies indicated that a variety of socio-demographic risk factors are operational in the etiology of low birthweight. Many of these are preventable before pregnancy so that the implementation of preventive Public Health measures utilising appropriate technology at least in developing countries may be socially and economically preferable to continued financial investment in intensive perinatal services.