[Perinatal pathology after normal pregnancies (author's transl)]. / Pathologie périnatale après grossesse normale.

ABSTRACT

We have analysed, using the score of Hobel, 326 case notes of pregnancies that were considered normal out of 500 consecutive deliveries in order to try to find out whether there was any way in which women could be selected for delivery at home without risk. We have studied among these cases complications or accidents that happened in the neonatal period and the time when the first abnormal signs appeared. These signs were discovered at the consultation which took place at the beginning of the 9th month (for example, breech presentation) in 4.6 per cent of cases of normal pregnancy, at the examination carried out on admission to the unit (for example, post-term) in 16 per cent of cases and during labour in 9.8 per cent of cases. These showed up in half the cases by clinical signs (for example, the appearance of meconium), and in the other half of the cases they were totally unpredictable (for example, compression of the cord) which was diagnosed early thanks to continual monitoring of the fetal heart rate. The figure for complications or accidents in the perinatal period (fetal death, an Apgar score less than 7 at 5 minutes, intensive resuscitation of the baby, a birth weight of less than 2000 g) was found tobe in 5.4 per cent of normal pregnancies and 15 per cent of pathological pregnancies. The presence of these complications after normal pregnancy made us look more carefully for diagnostic features which could be singled out during the pregnancy (for example, mild urinary tract infection, a little bleeding at the beginning of the pregnancy). These "small signs" could not help to make a prognosis. These findings suggest, without definite proof because a controlled study has not been possible, that the prevention of serious complications in labour is only possible when all labours are supervised intensively routinely and delivery at home means that a real risk is run by the infant even after the pregnancy has been normal.