Characteristics of babies born through meconium-stained liquor - abstract

Antepartum passage of meconium remains a common perinatal problem in the Caribbean, and the purpose of this study was to compare maternal, obstetric and neonatal characteristics of babies born with and without meconium-stained liquor (MSL). The medical records of 4093 of 5397 live births (76 percent) at the Mount Hope Women's Hospital (MHWH) during 1991 were reviewed, and relevant data were collected and analyzed, using an Epi-Info software programme. Meconium staining of the amniotic fluid (MSL) was present in 458 live births, giving a prevalence of 11.2 percent of live births which is comparable to values reported in other studies. MSL was more common in mothers of African than East Indian origin. The mean ages of women with and without MSL were similar (26.3 ñ S.D. 5.90 and 25.53 ñ 5.98 years, respectively). The 3 commonest maternal problems in the 458 women with MSL were foetal distress (20.7 percent), hypertension in pregnancy (14.0 percent) and postdatism (10.9 percent), all of which were significantly more common than in women without MSL. Babies born through MSL were significantly heavier at birth 93263 ñ 514 vs 3008 ñ 625 gm). Preterm was less common (2.2 percent vs 13.6 percent) and post-term more common (10.7 percent vs 3.1 percent) in babies born through MSL. Asphyxia at 1 and 5 minutes was more common in babies born through MSL. Neonatal problems were encountered in about one-third of babies with and without MSL. Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (3.3 percent) to give an incidence of 3.7/1000 live births. There were 73 deaths among the 4093 live births to give a crude mortality rate of 1.8 percent as compared to a rate of 0.9 percent for babies born through MSL (AU)

Deaths associated with intrapartum asphyxia in Jamaica

The Jamaican Perinatal Mortality Survey compared all 2069 perinatal deaths occurring during the 12 months between 1 September 1986 and 31 August 1987 with 10086 survivors born in the 2 months of September and October 1986. The Wigglesworth classification identified 44 percent of the deaths as attributable to intrapartum asphyxia (IPA), and this grouping was largely confirmed by post-mortem examination where it had been carried out. About half of these babies weighed 2500g+ and death should have been largely preventable. Comparison of the 813 IPA singleton deaths with 9919 singleton survivors using logistic regression showed independent associations with maternal employment status, the number of children in the household, maternal height, whether or not the mother was trying to get pregnant, or had ever used an intrauterine contraceptive device. Medical conditions such as syphilis, untreated vaginal infection, bleeding < 28 weeks, bleeding 28+ weeks, highest diastolic and first blood pressures and eclamptic fits antenatally were all strongly associated. Mothers who commenced antenatal care in the first trimester were at reduced risk as were those who took iron during pregnancy. There were at substantial reductions in mortality in areas where better medical facilities were available. To this model, features of previous obstetric history were offered, but the only variables which entered were those relating to prior perinatal deaths and immediately preceding miscarriage and termination. Examination of specific features in the management of labour and delivery is a logical basis for the introduction of changes in practice. Caesarean section is unlikely to be apropriate but it is suggested that more active interventions in terms of use of forceps and/or vacuum extraction may be useful (Summary)

Antenatal and perinatal care in Jamaica: do they reduce perinatal death rates?

Information concerning 9919 singleton pregnancies delivered in Jamaica in the 2-month period of September and October 1986 and surviving the early neonatal period were compared with 1847 singleton perinatal deaths occurring in the 12-month period from 1 September 1986 to 31 August 1987, classified according to the Wigglesworth schema. Logistic regression was used to assess features of antenatal and intrapartum care that were associated with the different groups of perinatal death after taking account of environmental, maternal and medical factors. In Jamaica, 67 percent of all mothers took iron during pregnancy. There mothers appeared to have a lower risk of perinatal death. This does not appear to be an artefact related to the gestation at which the mother delivers, and was particularly associated with antepartum fetal deaths. Commencement of antenatal care in the first trimester appeared to reduce the risk of all perinatal deaths, and for intrapartum asphyxia in particular. It is speculated that the mechanism may involve early detection and treatment of anaemia and syphilis. Quality of perinatal care available in the area of residence, as measured by the presence of consultant obstetricians and a paediatric consultant unit, is shown to be significantly related to a reduction in deaths from intrapartum asphyxia, but it appeared no to be related to antepartum fetal deaths (Summary)

Medical conditions present during pregnancy and risk of perinatal death in Jamaica

In an attempt to identify causes of perinatal mortality and hence devise preventative strategies on the island of Jamaica, a study was made of the 1847 singleton perinatal deaths occuring over the 12 month period between 1 September 1986 and 31 August 1987. Complications of the pregnancy were elicited by questioning the mothers as well as abstracting data from the antenatal and clinical obstetric records. The deaths were classified using the Wigglesworth categorisation and the three largest groups were chosen for special study: antepartum fetal deaths, deaths of live births from immaturity and deaths from intrapartum asphyxia. The medical features of the pregnancies were compared with data similarly obtained from 9919 women delivering singletons in the 2 months of September and October 1986 and who survived the first week of life. Unadjusted statistically significant associations were found with maternal syphilis, vaginal infection or discharge, bleeding in the first two trimesters, bleeding in the third trimester, lowest haemoglobin, highest diastolic and first diastolic blood pressures, highest level of proteinuria, diabetes and antenatal eclampsia. Logistic regression taking account of social, environmental and health behaviour variables showed the following significant relationships. Antepartum fetal death was associated with adjusted odds ratio (AOR) for syphilis 2.88[95 percent confidence interval (CI): 1.91, 4.32], bleeding in third trimester 3.86 [2.73, 5.44], highest diastolic blood pressure (P<0.0001), highest level of proteinuria (P<0.0001), lowest Hb (P<0.0001) and antenatal eclamptic fits AOR 4.62 [1.47, 14.50]. Deaths from immaturity were independently associated with bleeding < 28 weeks AOR 3.50 [2.39, 5.13], bleeding 28+ weeks AOR 1.93 [1.16, 3.22], highest diastolic blood pressure (P<0.01) and highest level of proteinuria (P<0.0001). Infection featured in deaths associated with intrapartum asphyxia, with syphilis AOR 2.17 [1.44, 3.26] and vaginal infection/discharge (P<0.01) independently associated; other strong associations were bleeding <28 weeks AOR 2.10 [1.57, 2.81], bleeding 28+ weeks AOR 2.32 [1.62, 3.33], highest diastolic blood pressure(P0.0001), first diastolic blood pressure (P<0.0001) and antenatal eclampsia AOR 6.70 [2.63, 17.13]. For all perinatal deaths combined, independent features were syphilis AOR 2.06 [1.49, 2.85], vaginal infection/discharge (P<0.001), bleeding < 28 weeks AOR 2.01 [1.60, 2.53], bleeding 28+ weeks AOR 2.65 [2.02, 3.48], highest diastolic blood pressure (P<0.0001), and antenatal eclampsia AOR 4.22[1.76, 10.14]. The results help identify areas for monitoring and identifying pregnancies at highest risk (Summary)

Does maternal behaviour influence the risk of perinatal death in Jamaica?

Features of behaviour of mothers of singleton perinatal deaths collected over the 12-month period from 1 September 1986 to 31 August 1987 were compared with 9919 mothers of singleton infants born in September and October 1986 and surviving the first week of life, as part of the Jamaican Perinatal Mortality Survey. For perinatal deaths as a whole, and in the presence of maternal age and social environmental features, logistic regression analyses showed that the following were independently related with higher risk of mortality: (1) deliberately trying to get pregnant; (2) ever having used Depo Provera; (3) not drinking alcohol in pregnancy; and (4) smoking cigarettes in pregnancy. There were no associations with coital frequency, ever using the contraceptive pill or smoking ganja (cannabis). Deaths were classified using the Wigglesworth scheme, and separate analyses carried out for the three major groups-antepartum fetal deaths, deaths from immaturity and deaths from intrapartum asphyxia. Antepartum fetal deaths were at increased risk if (1) mothers were deliberately trying to get pregnant or (2) they had ever used Depo Provera. Deaths from immaturity were not associated with any health behaviour variables. Deaths from intrapartum asphyxia were more likely if (1) the mother was deliverately trying to get pregnant or (2) she had never used and used and intrauterine contraceptive device (Summary)

Association between social and environmental factors and perinatal mortality in Jamaica

Social and environmental factors in Jamaica were compared between 9919 mothers delivering in a 2-month period a singleton who survived the early neonatal period and 1847 mothers who were delivered of a singleton perinatal death in a continuous 12-month period. Logistic regression showed independent positive statistically significant increased odds of having a perinatal death among mothers who lived in rural parishes, older mothers (aged 30+), single parents, no other children in the household, large number of adults in the household, mother unemployed, the major wage earner of the household not being in a managerial, professional or skilled non-manual occupation, the household not having sole use of toilet facilities, smaller mothers and those classified as obese or undernourished. Variations were found for different categories of death. Intrapartum asphyxia deaths were not related to union (marital) status, occupation of major wage earner, number of adults nor to the use of the toilet. Antepartum fetal deaths did not vary significantly with occupation of major wage earner or maternal height, but did show a relationship with maternal education, mothers with lowest levels having reduced risk. Deaths from immaturity were significantly related only to occupation of major wage earner, number of children in the household, number of social amenities available (negative relationships) and maternal age (<17 at highest risk). In conclusion there was little to indicate that social deprivation per se was related to perinatal death, although specific features of the environment showed strong relationships (AU)

Perinatal implications of meconium stained liquor: The Third Ester Archer Memorial Lecture

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital (MHWH), Trinidad during the period January 1 to December 31, 1991. The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analysed using Epi-Info software. Meconium staining of the amniotic fluid was present in 336 live births, giving a prevalence of 6.2 percent of live births which is low compared to values reported in other studies. There was no significant ethnic differences among women who had MSL and 81.3 percent were aged <32 years with a mean of 26.4 years. The majority were primiparous (46.4 percent) and 97 percent had antenatal care. The 3 commonest maternal problems in the 336 women with MSL were foetal distress (23.9 percent), hypertension in pregnancy (14.9 percent) and postdatism (10.4 percent). Birth weight of babies ranged from 1,040 to 4,960 g with a mean of 3,258 g, 8 percent were <2,500 and 9.8 percent were >4,000 g. 86.3 percent were term, 10.7 percent were post-term and 3.0 percent were preterm. One and 5 minute Apgar scores of <7 were found in 45.5 percent and 12.2 percent of babies, respectively. Neonatal problems were encountered in 146/336 neonates (43.8 percent) and respiratory distress was the commonest (72 or 49.3 percent). Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (4.5 percent) to give an incidence of 2.8/1000 live births and was associated only with the presence of old and thick meconium in the amniotic fluid. There were 6 (40 percent) deaths among the 15 with MAS. These findings clearly indicate the need for improvement in delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment. (AU)

Obstetrical condition and neonatal neurological outcome in Dominica, the Caribbean - a comparative study

Risk factors during pregnancy and delivery and neurological morbidity of newborns were assessed in a birth cohort in Dominica, the Caribbean. The data were compared with two reference groups, one from Grenada, the Caribbean, and the other from Groningen, the Netherlands. Despite variations in cultural and socio-economic situation, the similarities in obstetrical conditions, neonatal neurological morbidity and perinatal relationships between the three groups were more striking than the differences. The Dominican group showed a significantly higher rate of preterm births than the two other groups. Preterm birth was associated with a significant increase in neurological deviancy. In general motility and muscle tone were found to be lower in the Caribbean region than in the Netherlands (AU)

Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51 percent of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70 percent to the rest of the time period when the post-mortem rate was only 40 percent. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 percent of deaths overall and 59 percent of deaths of infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20 percent of deaths. Sixty percent of the infants in this group weighted less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care. (AU)

Neonatal mortality determinants in Jamaica

The Jamaican Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths (Wigglesworth Classification), and the determination of characteristics of both mother and infant that are associated with increased mortality. A death questionaire was completed on babies who were born between September 1986 and August 1987, and who died in the neonatal period throughout the island of Jamaica. The neonatal mortality rate was 17.9 per 1000 live births with early and late rates of 16.0 and 1.9 per 1000 respectively. The major contributors to neonatal demise were prematurity and intrapartum asphyxia (74 per cent). Twins had a seven- fold greater risk of dying than singletons. Babies born to mothers under 15 years had a four-fold greater risk of dying than those of mothers 25-29 years. The neonatal mortality rate for Jamaica is high, with room for improvement, particularly in the prevention of perinatal asphyxia. (AU)

Birth asphyxia versus the quality of obstetric care in Curacao - abstract

In order to evaluate the quality of obstetric care in Curacao, a systematic and comprehensive investigation of foetal and neonatal deaths was carried out in the 2-year period, 1984-1985. Two hundred and twenty-three (223) consecutive foetal and neonatal deaths occurred in the Island during this period. Asphyxia during labour was the principal cause of death in 35 (15.7 per cent) cases most of which occurred in term infants (25/35, 71 per cent). Intrapartum death occurred in 25 (71 per cent) cases and 10 (29 per cent) infants died in the early neonatal period. On the whole, patients' compliance with antenatal care was satisfactory. However, when the woman presented in labour, the attending physician or midwife often lacked information on the antecedents of the mother and pregnancy. In addition, inadequate intrapartum surveillance together with failure to respond appropriately to abnormalities in labour constituted the main factors which were associated with asphyxiated deaths. Moreover, asphyxial conditions were often preceded by inappropriate administration of oxytocin agents. On the basis of these findings, it is recommended to identify more clearly women whose pregnancies are considered to be at medium or high risk, to improve intrapartum surveillance and to reappraise criteria for referral to the hospital classified as level 2 (secondary care) (AU)

Neonatal mortality determinants in Jamaica - abstract

The Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths and the determination of characteristics of both mother and infant that are associated with an increased risk of death, so that intervention and reduction would be possible. Data were collected on babies born between September 1986 and August 1987 and who died in the first 28 days of life, anywhere in Jamaica. Postmortems were performed where feasible. A death questionnaire provided information on date, place and time of death, age of mother and classification of death by the Wigglesworth method. Additional social, environmental, medical, obstetric and neonatal data were included on a main questionnaire. Data from the death questionnaire were analyzed, using SPSS. There were 950 neonatal deaths identified over the 12-month period of study. The neonatal mortality was 17.9 per 1,000 live births, with the early and late neonatal mortality rates being 16.0 and 1.9 per 1,000 respectively. The major contributors to neonatal death were prematurity and perinatal asphyxia (73.5 percent). The majority of deaths (56.2 percent) occurred in the first day of life. Twins had a sevenfold greater risk of dying than singletons, with 58.6 per cent of deaths among second twins. One-third of neonatal deaths were to teenage mothers although they accounted for 26 percent of total births. Babies born to mothers under 15 years of age were four times more likely to die than infants of mothers 25 - 29 years of age. The neonatal death rate in Jamaica is high with room for improvement, particularly in the prevention of perinatal asphyxia and the early identification and management of mothers whose infants are at high risk of neonatal death (AU)

Perinatal mortality in Jamaica: the role of intrapartum asphyxia and birth trauma

Data from the Jamaican Perinatal Morbidity and Mortality Survey, 1986-1987, were analysed in order to examine the frequency of pathological markers of asphyxia and birth trauma amongst fresh stillbirths and neonatal deaths in babies coming to necropsy. A total number of 1112 necropsies were performed. There were 295 normally formed fresh stillbirths and 463 neonatal deaths, 264 of whom died on the last day of life. One hundred and seventy (57.6 percent) fresh stillbirths showed signs of asphyxia and 64 (21.7 percent) had evidence of birth trauma. Signs of asphyxia were common in all the birth weight groups in 1st day neonatal deaths, being least common in the 0-999g group (19.6 percent) and most common in those weighing 2500-3499g (48.7 percent). Birth trauma was most common in infants with birth weights of over 2500g. It is of great concern that a large proportion of mature fresh stillbirths and neonatal deaths in Jamaica show pathological evidence of intrapartum asphyxia or birth trauma at necropsy. The problems underlying these deaths and the methods of preventing them need urgent attention. (AU)

Birth asphyxia at the Mount Hope Women's Hospital, Trinidad - abstract

Asphyxia, defined as an apgar score equal to or less than 3 at one minute and/or less than 5 at 5 minutes, occurred in 3.7 percent of 16,489 live births, weighing over 600 gm during the period June 1981 to May 1984. Fifty-two per cent were males and one-third were less than 2,000 gm at birth. Maternal age ranged from 14 to 45 years and 48 percent were primparous women. Thirty-four per cent developed evidence of foetal distress and 38 percent were delivered by caesarian section. Asphyxia was more common in babies < 2,000 gm and those > 3,000 gm at birth. Twenty-three per cent of the 602 asphyxiated babies died and 70 percent of the dead babies weighed less than 2,000 gm. There was an overall 12 percent incidence of neurological impairment at one year of age. The most common abnormalities were spastic diplegia, chorioathetosis, ataxia and language deficit, either singly or in combination. Impaired development was associated with lower birth weight and gestational age, presence of cerebral oedema, convulsions, abnormal tone and hypothermia in the neonatal period (AU)

Nursery admission temperature in immature newborns: the effects of birth-arrival interval and asphyxia

The results of a study on 175 immature neonates of less than 37-weeks gestation born at the University Hospital of the West Indies between August, 1973 and March, 1975 and transferred directly from the delivery area to the nursery have been presented. The mean birth weight was 1,766 grams and the mean gestation age 33.4 weeks. The mean admission temperature was 35.2§C (95.4§F) which was significantly related to a long birth-arrival interval, the mean for which was 30.2 minutes. Severe neonatal asphyxia resulted in lower mean admission temperatures in spite of more rapid transfer (AU)