Gestational stage sensitivity to ultrasound effect on postnatal growth and development of mouse [abstract]

Pregnant Swiss albino mice were exposed to diagnostic ultrasound (3.5 MHz, 65 m W, Isptp= 1 W/cm2, 1sata=240 W/ccm2) for 30 min on any one day from day 10 to 18 gestation. A sham exposed control group was maintained for comparison. A minimum of 15 pregnant mice were exposed in each group. Exposed as well as control animals were left to complete gestation and parturition. Then offspring were observed during early postnatal development for any changes in physiological reflexes like pina detachment, eye opening, fur development, postnatal mortality, body weight, body length, head length and head width up to 6 weeks of age. Ultrasound exposure at any of the gestational age did not have any effect on the timing of onset of the physiological reflexes. But there was a significant change in the postnatal mortality, body weight, body length after exposure to ultrasound on the 14th and 16th day post coitus. Head length and head width also significantly decreased in all the exposed groups when compared to the control. The present study demonstrates that ultrasound can induce harmful effects on mouse growth and development when given at certain critical periods of gestation. (AU)

Survival of neonates born below thirty-five weeks gestation in a developing country (Barbados, West Indies)

A retrospective study of the survival of babies born below 35 weeks of gestation over a period of five years from 1987 to 1991 at Queen Elizabeth Hospital was analyzed. The births of 433 were evaluated taking into consideration the birth weights, periods of gestation and mode of delivery. The fetal outcome in relation to these parameters were examined. Twin pregnancies were excluded. A poor outcome was noted in babies below 1000 g. Increasing survival rates were observed with increasing birth weight and increasing period of gestation. Babies below 30 weeks gestation had a poor survival rate. Caesarean section was found to be better than vaginal delivery for a favourable outcome when all 425 births were considered. (AU)

The glucose tolerance test in pregnancy: at which gestational age should it be performed

Gestational diabetes is defined as intolerance detected during pregnancy. To investigate the effect of time on the screening test for gestational diabetes, patients were administered a 50g oral glucose screening test at 7-13; 24-36 weeks of gestation. There was an increase in the plasma glucose value up to 32 weeks of gestation and a gradual decrease to term. Of the 850 patients screened between 7 and 13 weeks of gestation, 22.2 percent were positive, and of these 2.9 percent were confirmed to be diabetic by the two-hour 75 g oral glucose tolerance test. Patients with negative screen or confirmatory tests between 7 and 13 weeks were rescreened at 24 weeks; 8.3 percent were positive, and of them 3.5 percent were confirmed as gestational diabetics. Patients who tested negative at 24 weeks were retestet between 28 and 36 weeks; 7.5 percent were positive, and of these 0.5 percent were confirmed as having gestational diabetes was found to be 4.25 percent. Currently, glucose screening for gestational diabetes is recommended between 24 and 28 weeks of gestation. From the data collected most cases were detected (3.5 percent) at 24 weeks. This study supports screening of all patients without any previous history of diabetes mellitus at or around 24 weeks of gestation (AU)

Factors influencing low birth weight at the University Hospital of the West Indies, Jamaica: a review of births January to March 1996

A case control study was done on mothers who delivered low birth weight babies during a three month period at the maternity ward of the University Hospital of the West Indies. Fifty cases were identified and 50 controls were selected according to the date and time of birth. A case was defined according to WHO internatinal standard, as an infant weighing less than 2,500 grams, up to and including 2,499 grams (WHO Bulletin, 1992). A control was any infant who weighed over 2,500 grams but less than 4,000 grams. A questionnaire was used to collect data from these mothers of the infants. The study was designed to determine association between the dependent variable, low birth weight and the independent variables which were divided into social and medical factors. From the results of the study, the incidence of low birth weight infants was 100/1000. More medical factors than social factors were associated with low birth weight babies. Factors statistically associated (p value < 0.05) were educational achievement, duration of pregnancy, blood pressure on admission to hospital, previous medical conditions and haemoglobin levels. It is hoped that the findings of this study will help health professionals working in maternal and child health to plan intensive antenatal programmes to address these risk factors. (AU)

Risk factors for caesarean section in primiparas delivering at the University Hospital of the West Indies and Victoria Jubilee Hospital January-February 1996

The study was conducted at the University Hospital of the West Indies (UHWI) and the Victoria Jubilee Hospital (VJH). Risk factors for caesarean section were looked at in relation to primiparas who delivered at both UHWI and VJH Janauary - Febraury, 1996. A total of 249 primiparas were interviewed making use of a 28 item questionnaire developed for the purpose. The results indicate that both UHWI and VJH had different rates for caesarean section. There was a statistical significance betweeen primiparas who had medical compications with their pregnancy and caesarean section (p < 0.01). Caesarean sections were done most frequently for "failure to progress" at UHWI, while at VJH the hypertensive disorders of pregnancy and "failure to progress" had equal proportion. A relationship existed between the gestation of pregnancy and the time the mother attended for antenatal care and caesarean section. The study points to the need to develop a written protocol for care of the primigravid mother, thus assisting in the uniformity and maintenance of quality care, also to conduct research at both institutions to determine the relationship between the amount of antenatal acare, caesarean section and infant outcome. (AU)

Amniotic fluid index in the management of the postdates pregnancy

This is a prospective evaluation of the relationship between the amniotic fluid index (AFI) and perinatal outcome in 55 postdates pregnancies. The gravid abdomen was divided into four quadrants, using real-time ultrasound with a 3.5 mHz transducer, the largest pocket of amniotic fluid in each quandran was measured and their sum totalled to arrive at the amniotic fluid index. AFI in this study ranged from 2.8 cm to 22.6 cm. The mean for 41 weeks was 13.52 ñ 4.6 cm and for 42 weeks, 9.93 ñ 4.37 cm. Oligohydramnios was noted in four patients, AFI less than 5.3 cm. Two of these cases developed intrapartum foetal distress and had caesarean section. All four babies were admitted with meconium aspiration and one died from this complication. (AU)

Effect of ethnic origin of mother on fetal outcome

The outcomes of 11046 infants, from 20 weeks gestation, born to mothers of different ethnic origins within one London borough has been analysed. There was no difference in perinatal death rates between the Asian and white infants. Among those with mothers from Africa and the West Indies there were overall significantly more intrauterine deaths (26.8/1000) and 20.0/1000) and neonatal deaths (8.6/1000) and 9.6/1000) than for the white mothers (intrauterine deaths 8.3/1000; neonatal deaths 3.7/1000). At less than 28 weeks's gestation specific death rates were similar in all groups and the overall higher death rates were due to an increase in the proportion of preterm deliveries among black mothers. From 28 to 36 week's gestation, black infants born alive had lower neonatal death rates (7.7/1000) than the white infant (19/1000). The cause of the increased incidence of preterm labour among the black mothers is uncertain, though differences in intrauterine infection rates may be an important factor (AU)

Gender-specific birthweight for gestational age charts for the island of Jamaica - abstract

Previous authors have shown that when population-based surveys of the birthweight of newborns by gestational age are conducted with limited control of data collection, the birthweight of pre-term infants shows a bimodal distribution. This was also found during the 1986 Jamaican Perinatal Mortality and Morbidity Surveys, when birthweights were collected on some 10,000 live births occurring in Jamaica over a two-month period. A combination of statistical methods was used to overcome the inherent inaccuracies occurring during large surveys. First, for pre-term births the two normal distributions for birthweights by gestational age were determined for each gender, using moment estimators. The normal distribution with the lower mean birthweight was accepted as correct, that with the higher mean birthweights representing either inaccuracies of measurement or of documentation of the last menstrual period. Mean birthweights for gestational ages 26 to 44 weeks were then fitted to the best curve by regrssion analysis. In this way, gender-specific birthweight for gestational age charts for Jamaica were produced. The charts produced by applying statistical methods to population-based data were comparable to those obtained under more carefully controlled situations (AU)

Perinatal mortality at the Mount Hope women's hospital the first nine years, 1981-1989

The objectives of this retrospective study were to document mortality rates for early and late neonatal deaths (NND) and stillbirths (SB) and determine the frequency of major maternal conditions and neonatal problems in perinatal deaths at the Mount Hope Maternity Hospital (MHWH) from January 1981 to December 1989. Sources of data were the Medical Records Department, birth register, death register of the MHWH and the admittance register of the Neonatal Unit. Of 52,473 births, there were 736 SBs, 711 NNDs for a total of 1,447 perinatal deaths. The overall SB rate was 14.0/1,000 births, the neonatal mortality rate (NNMR) was 13.7/1,000 live births, and the perinatal mortality rate (PNMR) was 27.5/1,000 births. 73.5 percent of NNDs occurred in babies < 37 weeks gestation and 65 percent of NNDs occurred in the first 48 hours after birth. In babies <1,000g, 12 percent survived, o1,000g to <1,500g, 51.2 percent survived, o1,500g to <2,000g, 80.5 percent survived and in those o2,000g 98.7 percent survived. The commonest clinical problems in women with perinatal death were preterm labour (35.4 percent), intrauterine death (18.5 percent) and hypertensive disorders (17.3 percent). Respiratory distress from all causes was present in all NNDs, immaturity, 60.2 percent, and asphyxia and trauma in 50.9 percent of NNDs. Perinatal deaths classified according to Wigglesworth (10) identified intrapartum asphyxia (30.9), antepartum SB (25.6 percent) and conditions associated with immaturity (29.6) as problem areas to be addressed(AU)

Triplet pregnancies at the University Hospital of the West Indies: 1968-1987

Thirteen triplet gestations delivered at the University Hospital of the West Indies, Mona, from 1968-1987 are reviewed. The incidence was 1 per 4,491 births. The perinatal mortality rate was 28.2 percent. Prematurity and congenital malformations were the main causes of death. Malpresentations were present in 64 percent of cases. Earlier diagnosis with close surveillance of the pregnancy and liberal use of delivery by Caesarean section should improve the outcome for the babies (AU)

Perinatal outcome in diabetic pregnancies

The perinatal mortality rate among 151 pregnant diabetics was 9.3 per cent, which is less than that reported elsewhere. This is attributable to strict control of maternal blood glucose levels, planned delivery at 38 weeks and a liberal use of Caesarean Section. Our results defend the concept of delivery of the infant of the diabetic mother not later than the 38th week of pregnancy, since 60 per cent of perinatal deaths occurred beyond this period of gestation (AU)

Whole-body protein turnover in Jamaican women during normal pregnancy

A cross-sectional study was carried out among 18 Jamaican pregnant women divided in three groups of 6 subjects according to the stage of pregnancy: group B, 12 weeks, group C, 24 weeks and group D, 33 weeks. A group (group A) of 6 non-pregnant women was selected as control. The rate of whole-body protein turnover was measured by continuous oral administration of 15N-glycine and the resting metabolic rate by the open circuit method. All subjects had a normal pregnancy outcome. The composition of the diet on the day of the study was comparable between the four groups (approximately 80 g protein and 9.45 MJ energy) and not significantly different from the composition of the diet during the 2 d prior to the experiment. The rates of protein synthesis and breakdown were higher in groups Band C compared to group A and lower in group D where they reached values slightly higher than in group A. Estimated from urea enrichment, these rates did not vary significantly among the groups, while estimated from ammonia enrichment the difference was significant (P less than 0.05) and there was a negative correlation between the gestational age and the rate of snythesis (r= -0.63) and breakdown (r= -0.69). Nitrogen retention was comparable between the three groups of pregnant women and significantly higher than in the group A. The resting metabolic rate was similar between the groups of pregnant women. These results suggest that the rates of protein turnover observed during gestation reflect more the changes that occur in maternal than those in fetal tissues. The values for protein synthesis and nitrogen retention indicate that the amount of protein deposited during pregnancy is greater than that expected on the basis of body composition analysis. It is also suggested that as pregnancy proceeds whole-body protein turnover represents a smaller part of the resting metabolic rate. (AU)

A comparative analysis of breech deliveries between 1974/1975 and 1979/1980 at the University Hospital of the West Indies

Comparative data for breech deliveries at the University Hospital of the West Indies for the years 1974/1975 and 1979/1980 are presented. An increase in the Caesarean section delivery rate to 36 per cent is noted. Birthweight, route of delivery and parity are analysed with respect to perinatal outcome. Whereas the perinatal mortality rates are comparable to international standards for the greater than 2.0 kg neonate, there seems to be room for improvement in the 1.5-1.99 kg birthweight category. To this end, individualization with a more liberal attitude towards abdominal delivery in this group is recommended (AU)

The size of Jamaican newborns from 27-42 weeks gestation

Birth-weight, vertex-heel length and head circumference were measured in 1,230 new-born infants delivered at the University Hospital of the West Indies and admitted to the New-born Nursery between January, 1974, and December, 1976. Twins, babies with congenital malformations and those of mothers with haemoglobinopathies or diabetes mellitus were excluded, as were those born outside the Hospital. Gestational age, assessed by physical examination differed by two weeks or more from that based on the unconfirmed mentrual history in 35 percent of the babies studied. The patterns of birth-weight at gestational ages based on mentrual history indicated that the menstrual history, when used alone, was not a reliable indicator of gestational age. Data for weight, length, head circumference and weight:length ratio at gestational periods from 27 - 42 weeks as determined by menstrual history confirmed by physical examination are presented. Jamaican babies weighed up to 200 grams less than their North American counter-parts from 32 to 38 weeks of gestation, whereas this difference was not notable at term (AU)

Paramedical assessment of gestational age in the newborn

Two paramedical workers from the Jamaican Youth Service were taught a system of gestational assessment of the newborn. The results, in a series of 43 newborns, indicate that paramedicals can produce results comparable ( ñ one week) to a medical examiner by more than two weeks in only 5 percent of babies examined (AU)

Teenage pregnancy in Trinidad

The reproductive performance of 368 Negro and 87 East Indian mothers under 16 years of age was studied. Their marital status, desire for the pregnancy, and outcome of the pregnancy were recorded. There was a high incidence of unwanted pregnancies in both groups of patients. Hypertension, prolonged labour and postpartum haemorrhage occurred more commonly among Indians but the operative delivery rate was higher in Negroes (AU)

Pregnancy and progeny in rats treated with the pyrrolizidine alkaloid fulvine

The pyrrolizidine alkaloids are naturally-occurring plants toxins which are considered significant in the etiology of certain liver diseases, particularly in some tropical and sub-tropical regions. Fulvine, a hepatotoxic alkloid present in the medicinal herb Crotolaria fulva, was observed to be fetotoxic and highly teratogenic in rats. The occurrence of fetal resorptions showed a dose-effect relationship. The highest incidence of developmental defects was induced by fulvine at a dose-level of 80 mg/kg which in other studies produced significant chromosomal damage. Microscopic examination of fetal liver, following maternal exposure of fulvine, did not reveal hepatic lesions.(Summary)

Birth weight in Jamaican twins

The birth weights of infants delivered in 100 uncomplicated twin pregnancies in Jamaica are discussed in relationship to gestational age, maternal age, parity of the mother, infant's sex, zygosity and birth order (AU)