Occipital osteodiastasis in Jamaica

The Jamaican Perinatal Morbidity and Mortality Survey (1986 - 1987) revealed nine cases of a previously unreported form of birth-related injury in the English-speaking Caribbean - occipital osteodiastasis. Aspects of the clinical and pathological features of this form of occipital bone injury are presented and discussed. Our findings suggest that this lesion might occur more often than is currently accepted (AU)

Perinatal implications for macrosomic babies

A five-year record review was undertaken for all babies with a diagnosis of foetal macrosomia. The perinatal mortality rate of 23 per 1,000 total births was similar to the overall hospital rate. Neonatal morbidity was significant, and the most important contributory factor to foetal injury was impaction of the shoulders during parturition. In order to avoid this catastrophe, elective abdominal delivery may be prudent if the foetal weight is estimated at greater than 4,500 grams.(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 trauma: a review of 84 babies presenting at the Mount Hope Women's Hospital - abstract

A retrospective study of mechanical birth trauma at the Mount Hope Women's Hospital during the period June, 1981 to December, 1984, revealed that 84 neonates with birth trauma were admitted to the Neonatal Unit with a total of 113 birth injuries. Birth trauma occurred in 4.0 babies per 1,000 live births (LB): one injury for every 185 LB babies weighing 3,000 gm and over accounted for 71 percent of those injured. Injuries occurred regardless of the mode of delivery. The risk of birth trauma was 42 times higher in forceps delivery occurred in babies weighing 3,000 gm and over. Junior medical staff accounted for 56 percent of all birth-injured babies, all those (24) injured after forceps delivery, and 5 of 6 of those injured during breech delivery. Brachial plexus injury was the commonest single injury (31 or 27 percent). The total number of deliveries increased by 85 percent during the period 1982-84. Both the number and rate of forceps deliveries declined markedly while the number and rate of caesarian sections increased significantly over the same period. The incidence of birth trauma following caesarian section fell by about one-half from 1982 to 1984 although the absolute number of Caesarian sections performed had increased. There was a small increase in both the incidence and frequency of trauma following forceps delivery between 1981 and 1982, with a marked increase in 1983. Important risk factors predisposing to mechanical birth trauma were forceps and breech deliveries, birth weight of 3,000 gm over, and deliveries performed by junior medical staff (AU)