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1.
Arthritis research & therapy ; 9(6): [1-11], 2007. tab
Artigo em Inglês | MedCarib | ID: med-17702

RESUMO

The objective of the study was to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE) and population controls in Trinidad. We performed a cross-sectional analysis of adverse outcomes in pregnancies of Afro-Caribbean women with SLE and without SLE. One hundred and twenty-two female adult cases of SLE and 203 neighbourhood age-matched women without SLE were interviewed concerning details of their reproductive history, and the anticardiolipin antibody (ACL) status was established for women with SLE. A total of 1,029 pregnancies were reported (356 by women with SLE, 673 by women without SLE). In women with > or = 1 pregnancy the total number of pregnancies was similar in women with a diagnosis of SLE and women without; however, a lower proportion of women with SLE had ever been pregnant compared with women without SLE (80% versus 91%, P = 0.002). In multivariate logistic regression analyses adjusted for maternal age, district of residence, pregnancy order and smoking, SLE pregnancies were more than twice as likely to end in foetal death than non-SLE pregnancies (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2-4.7). This effect was driven by a large increase in the odds of stillbirth (OR, 8.5; 95% CI, 2.5-28.8). The odds of early miscarriage (OR, 1.4; 95% CI, 0.6-3.1) and of mid-trimester miscarriage (OR, 1.9; 95% CI, 0.4-9.5) were higher, but were not statistically significantly different, in SLE pregnancies than in non-SLE pregnancies. The odds of ectopic pregnancy (OR, 7.5; 95% CI, 0.9-62.5) and of preterm birth (OR, 3.4; 95% CI, 1.2-10.0) were higher in SLE pregnancies conceived after diagnosis than in non-SLE pregnancies. There was no evidence of raised levels of IgG or IgM ACL among the majority (93/97 women, 96%) of SLE cases who reported sporadic mid-trimester miscarriage or stillbirth, although there was evidence of high levels of IgM and IgG ACL among women reporting three or more miscarriages and three consecutive miscarriages, and of raised IgG ACL among those experiencing ectopic pregnancy. In conclusion, we found evidence for a large increase in risk of stillbirth in the pregnancies of Afro-Caribbean Trinidadian women with SLE (not accounted for by high ACL status). There was some evidence of an increased risk of preterm delivery and ectopic pregnancy in pregnancies conceived after a diagnosis of maternal SLE.


Assuntos
Gravidez , Recém-Nascido , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Feminino , Research Support, Non-U.S. Gov't , Aborto Espontâneo/epidemiologia , África/etnologia , Anticorpos Anticardiolipina/sangue , Estudos de Casos e Controles , Estudos Transversais , Morte Fetal/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/imunologia , Resultado da Gravidez , Inquéritos e Questionários , Fatores de Risco , Trinidad e Tobago/epidemiologia
2.
West Indian med. j ; 50(1): 42-6, Mar. 2001. tab, gra
Artigo em Inglês | MedCarib | ID: med-321

RESUMO

Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal out-come, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8 percent), birth asphyxia (22.2 percent) and sepsis (13.5 percent). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended. (AU)


Assuntos
Feminino , Humanos , Masculino , Recém-Nascido , Gravidez , Mortalidade Infantil , Auditoria Médica , Região do Caribe/epidemiologia , Peso ao Nascer , Causas de Morte , Morte Fetal , Estudos Prospectivos , Complicações na Gravidez
3.
Br J Obstet Gynaecol ; 101(9): 770-3, Sept. 1994.
Artigo em Inglês | MedCarib | ID: med-7226

RESUMO

OBJECTIVE; To examine the association between fetal outcome and the steady state haematology of mothers with homozygous sickle cell disease. DESIGN; A retrospective observational study. The data were taken from the dockets, kept at the Sickle Cell Clinic at the University Hospital of the West Indies or two peripheral clinics operated by the staff of the MRC Laboratories. SUBJECTS; All women aged 14 years or older with homozygous sickle cell disease who had experienced at least one pregnancy in the period 1977 to 1986. MAIN OUTCOME MEASURES; Three fetal outcomes including miscarriages, perinatal deaths, and birthweight. RESULTS; There were 270 singleton pregnancies in 175 women with an overall fetal wastage of 32.2 percent. There was a significant increased risk of perinatal death with low maternal fetal haemoglobin level, but there was no haematological associations with miscarriages or birthweight. CONCLUSIONS: These data suggest that maternal steady-state haemoglobin has little influence on fetal outcome, with the exception that mothers with high HbF levels are less prone to perinatal deaths. Further study is required to investigate acute haematological changes associated with pregnancy. (AU)


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Anemia Falciforme/sangue , Hemoglobina Fetal/análise , Hemoglobinas/análise , Complicações Hematológicas na Gravidez/sangue , Aborto/sangue , Anemia Falciforme/mortalidade , Peso ao Nascer , Morte Fetal , Complicações Hematológicas na Gravidez/mortalidade , Estudos Retrospectivos , Fatores de Risco
5.
Paediatr Perinat Epidemiol ; 8(suppl 1): 166-73, April 1994.
Artigo em Inglês | MedCarib | ID: med-7240

RESUMO

Data from the Jamaican Perinatal Mortality Survey had been used to create a statistical model using logistic regression. From this a simple additive scoring system to predict perinatal death was devised and tested on the 2 cohort months of the study. The score had a theoretical range of 0-28 points, with the higher the score, the greater the likelihood of a perinatal death. For a cut-point of 7 sensitivity was 43 percent and specificity 84 percent. A cut-point of 8 resulted in 27 percent sensitivity and 94 percent specificity. Higher cut-points resulted in much reduced sensitivity but enhanced specificity (e.g. cut-point 10: 11 percent sensitivity, 99 percent specificity). However, it is likely that these estimates are optimistically high, and to achieve unbiased estimates of sensitivity and specificity the score needs to be tested on a sample of the population from which it was not derived before implementation takes place. Meanwhile, the cut-off level for implementation will depend on appropriate resources available (Summary)


Assuntos
Gravidez , Humanos , Feminino , Morte Fetal , Mortalidade Infantil , Modelos Estatísticos , Estudos de Coortes , Previsões , Jamaica/epidemiologia , Tocologia , Mães/classificação , Complicações na Gravidez , Fatores de Risco , Sensibilidade e Especificidade , Fatores Socioeconômicos
6.
Paediatr Perinat Epidemiol ; 8(suppl 1): 158-65, April 1994.
Artigo em Inglês | MedCarib | ID: med-7241

RESUMO

The Jamaican Perinatal Mortality Survey collected data that have been used in this paper to estimate: (1) the rate of multiple deliveries on the island; (2) the way in which this varies with demographic features; and (3) the causes of perinatal mortality among twins on the island. The survey consisted of two phases: a study of all births in the months of September and October 1986 (the cohort months) and a study of all perinatal deaths in the 12 months from 1 September 1986 to 31 August 1987. Among the 10408 pregnancies in the cohort months, 99 (1.0 percent) were multiple pregnancies. The Twinning rate showed statistically significant trends with maternal age and parity but no association with social factors. Among the 2020 perinatal deaths occurring in the 12-month period, 173 (8.6 percent) were twins, with particularly high contribution to the Wigglesworth group 'deaths from immaturity'. Mortality rate of twins was significantly lower if mothers resided in areas where there were good obstetric and paediatric facilities (Summary)


Assuntos
Gravidez , Recém-Nascido , Adolescente , Adulto , Humanos , Masculino , Morte Fetal , Gravidez Múltipla , Gêmeos , Mortalidade Infantil , Estudos de Coortes , Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Jamaica/epidemiologia , Serviços de Saúde Materna , Gêmeos/estatística & dados numéricos
7.
Paediatr Perinat Epidemiol ; 8(suppl 1): 143-57, April 1994.
Artigo em Inglês | MedCarib | ID: med-7242

RESUMO

Information from the Jamaican Perinatal Mortality Survey was used to identify features of mothers and their pregnancies that were independently associated with perinatal death. social, biological, environmental, life style and medical aspects of mothers and their pregnancies were collected on two inter-locking subsamples: (1) all births on the island of Jamaica in the 2 months of September and October 1986, the 'cohort months', and (2) all fetal deaths of weight 500g or more, together with all neonatal deaths, in the 12-month period from 1 September 1986 to 31 August 1987. Singleton survivors from the cohort months were compared with all perinatal deaths in the 12-month period using logistic regression. The first model omitted items concerning past obstetric history, but these were included in the second model. In total, 21 variables entered the first model and 24 the second. The only item that became non-significant when past obstetric history was included was maternal age. The final model compared 1017 perinatal deaths with 7672 survivors. It consisted of the following: union (marital) status (married being at lower risk, P<0.01), maternal employment status (housewives at lowest risk, P<0.001), number of adults in household (the more the higher the risk, P<0.05), the number of children aged <11 (the more the lower the risk, P<0.0001), use of toilet facilities (shared with other households increased risk, P<0.001), maternal height (tall women at reduced risk, P<0.001), mother's report that she was trying to get pregnant (P<0.001), maternal alcohol consumption (drinkers had lower risk, P<0.05), maternal syphilis (higher risk, P<0.0001), bleeding before 28 weeks or more (higher risk, P<0.0001), first diastolic blood pressure (80mm + at higher risk, P<0.0001), highest diastolic blood pressure (100mm + at increased risk, P<0.0001), highest proteinuria (++ or more at increased risk, P<0.0001, vaginal discharge/infection (untreated at increased risk, P<0.001), pre-eclampsia diagnosed in antenatal period (increased risk, P<0.01), maternal diabetes (increased risk, P<0.05), start of antenatal care (first trimester at reduced risk, P<0.01), iron taken (reduced risk, P<0.0001), type of perinatal care available in parish of residence (reduced risk if consultant obstetricians and paediatricians available at all times, P<0.0001), number of miscarriages and terminations (the more the higher the risk, P<0.0001), previous stillbirth (higher risk, P<0.0001), previous early neonatal death (higher risk, P<0.001), previous Caesarean section (higher risk, P<0.01). The implications for reduction in perinatal mortality rates are discussed (Summary)


Assuntos
Gravidez , Recém-Nascido , Feminino , Humanos , Epidemiologia , Morte Fetal/epidemiologia , Mortalidade Infantil , Estudos de Coortes , Jamaica/epidemiologia , Comportamento Materno , Complicações na Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos
8.
Paediatr Perinat Epidemiol ; 8(suppl 1): 98-100, April 1994.
Artigo em Inglês | MedCarib | ID: med-7245

RESUMO

All perinatal deaths occurring over a 12-month period on the island of Jamaica were classified using the Wigglesworth schema. In all, there were 584 antepartum fetal deaths (incidence 10.7 per 1000 total births). Comparison of the 558 singleton deaths with 9919 singleton survivors revealed, using logistic regression, strong associations with union (marital) status, maternal employment status, the composition of the household, the sole use of a toilet by the household, the parish of residence, whether the mother was trying to get pregnant and the mother's age (the older the mother the higher the risk). Independent of these factors were strong statistically significant relationship with syphilis, diabetes, maternal anaemia, third-trimester bleeding, highest diastolic blood pressure of 90mm or more and highest proteinuria of ++ or more. Mothers who had taken prophylactic iron were at substantially lower risk compared with those who had not. We conclude that appropriated identification and treatment of syphilis, diabetes, anaemia and hypertension give the best chance of reduction of the high antepartum fetal death rate on the island (Summary)


Assuntos
Gravidez , Recém-Nascido , Feminino , Masculino , Humanos , Estudo Comparativo , Morte Fetal/epidemiologia , Incidência , Jamaica/epidemiologia , Complicações na Gravidez , Fatores Socioeconômicos , Fatores de Risco
9.
Paediatr Perinat Epidemiol ; 8(suppl 1): 86-97, April 1994.
Artigo em Inglês | MedCarib | ID: med-7246

RESUMO

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)


Assuntos
Gravidez , Recém-Nascido , Feminino , Humanos , Estudo Comparativo , Morte Fetal/epidemiologia , Mortalidade Infantil , Serviços de Saúde Materna/estatística & dados numéricos , Asfixia Neonatal/epidemiologia , Estudos de Coortes , Acesso aos Serviços de Saúde , Recém-Nascido Prematuro , Jamaica/epidemiologia , Modelos Logísticos
10.
Paediatr Perinat Epidemiol ; 8(suppl 1): 66-85, April 1994.
Artigo em Inglês | MedCarib | ID: med-7247

RESUMO

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)


Assuntos
Gravidez , Humanos , Feminino , Recém-Nascido , Estudo Comparativo , Morte Fetal/epidemiologia , Mortalidade Infantil , Complicações na Gravidez , Asfixia Neonatal/epidemiologia , Hipertensão , Recém-Nascido Prematuro , Jamaica/epidemiologia , Modelos Logísticos , Complicações Infecciosas na Gravidez , Fatores de Risco , Hemorragia Uterina
11.
Paediatr Perinat Epidemiol ; 8(suppl 1): 54-65, April 1994.
Artigo em Inglês | MedCarib | ID: med-7248

RESUMO

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)


Assuntos
Gravidez , Recém-Nascido , Humanos , Feminino , Morte Fetal/epidemiologia , Mortalidade Infantil , Comportamento Materno , Asfixia Neonatal/epidemiologia , Coito , Anticoncepção , Recém-Nascido Prematuro , Jamaica/epidemiologia , Modelos Logísticos , Resultado da Gravidez , Fatores de Risco
12.
Paediatr Perinat Epidemiol ; 8(suppl 1): 40-53, April 1994.
Artigo em Inglês | MedCarib | ID: med-7249

RESUMO

Singleton survivors born to multigravidae in the whole island of Jamaica in 2 months (September-October 1986) were compared with singleton perinatal deaths occurring to multigravidae throughout the island in the 12-month period September 1986 to August 1987. Past obstetric history was obtained from the mothers using a structured questionnaire. Deaths were categorised using the Wigglesworth classification. Logistic regression was used to compare current outcomes in women who had had at least one previous pregnancy. Antepartum fetal deaths were associated with (1) outcome of last pregnancy; (2) previous Caesarean section; (3) previous stillbirth; and (4) increasing gravidity. In the presence of these factors maternal age ceased to be statistically significant. Deaths from immaturity were strongly associated with the past obstetric history, with increased risks for pregnancies to mothers with history of previous miscarriage, perinatal death and premature live births. In general, however, the higher the gravidity the lower the risk. In the presence of these factors, maternal age showed no significant association. Intrapartum asphyxia was also associated with the outcome of the last pregnancy, history of prior stillbirth or neonatal death. First pregnancies were at significantly higher risk than second pregnancies (P<0.05). For perinatal deaths as a whole, and in the presence of maternal age, the following were statistically significant independent factors: (1) the outcome of the immediately preceding pregnancy (high risks associated with prior miscarriage, stillbirth and premature live births); (2) previous Caesarean section (increased risk); (3) previous perinatal deaths; and (4) more than one prior early fetal loss. The results indicated that prior poor obstetric history bears similar risks of subsequent adverse outcome in the developing as in the developed world. There was no variation in risk, however, with interpregnancy interval or previous termination. Much of the variation in risk of perinatal death with maternal age among multigravidae appears largely to be secondary to past obstetric history (Summary)


Assuntos
Gravidez , Recém-Nascido , Adulto , Humanos , Feminino , Morte Fetal/epidemiologia , Mortalidade Infantil , Complicações na Gravidez , Aborto/epidemiologia , Intervalo entre Nascimentos , Jamaica/epidemiologia , Resultado da Gravidez , Fatores de Risco
13.
Paediatr Perinat Epidemiol ; 8(suppl 1): 17-39, April 1994.
Artigo em Inglês | MedCarib | ID: med-7250

RESUMO

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)


Assuntos
Gravidez , Recém-Nascido , Humanos , Feminino , Adolescente , Adulto , Criança , Meio Ambiente , Morte Fetal/epidemiologia , Mortalidade Infantil , Fatores Socioeconômicos , Asfixia Neonatal/epidemiologia , Estatura , Peso Corporal , Estudos de Coortes , Recém-Nascido Prematuro , Jamaica/epidemiologia , Idade Materna , Fatores de Risco , Estudo Comparativo
14.
Paediatr Perinat Epidemiol ; 8(suppl 1): 6-16, April 1994.
Artigo em Inglês | MedCarib | ID: med-7251

RESUMO

The Jamaican Perinatal Mortality survey was designed to identify the true perinatal mortality rate, and assess the factors which could contribute towards a reduction in perinatal mortality on the island. All births in a 2-month period (n=10527) were compared with all perinatal deaths occurring over a 12-month period (n=2069). Over half the deaths (n=1058) received a detailed post-mortem examination. Use of the Wigglesworth classification identifies the major component of perinatal death in this country to be associated with intrapartum asphyxia (44 percent of deaths). Deaths due to congenital malformations and miscellaneous causes contribute relatively little (<10 percent) to the overall mortality rate. Over a quarter of deaths apparently occur before the onset of labour, a a fifth are prematurely liveborn but die of causes related to immaturity (Summary)


Assuntos
Gravidez , Humanos , Feminino , Morte Fetal , Inquéritos Epidemiológicos , Mortalidade Infantil , Projetos de Pesquisa , Autopsia , Viés , Causas de Morte , Estudos de Coortes , Jamaica/epidemiologia
15.
Anon.
Paediatr Perinat Epidemiol ; 8(suppl 1): 1-5, April 1994.
Artigo em Inglês | MedCarib | ID: med-7252
16.
Arch Dis Child ; 70(1 Spec no): F40-3, Jan. 1994.
Artigo em Inglês | MedCarib | ID: med-8279

RESUMO

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)


Assuntos
Humanos , Gravidez , Recém-Nascido , Adulto , Feminino , Morte Fetal/etnologia , Mortalidade Infantil , Mães , África/etnologia , Ásia/etnologia , Causas de Morte , Idade Gestacional , Trabalho de Parto Prematuro/etnologia , Resultado da Gravidez/etnologia , Índias Ocidentais/etnologia
17.
West Indian med. j ; 42(Suppl. 1): 53, Apr. 1993.
Artigo em Inglês | MedCarib | ID: med-5103

RESUMO

In this retrospective study the following information was recorded for all 1,296 infants born in 1990 and admitted to the neonatal ward, General Hospital, Port-of-Spain: date of birth, gestational age, birthweight, Apgar scores after one and five minutes, type of delivery, foetal presentation, mother's address and data concerning death. The annual perinatal mortality rate was 25.2 per 1,000 live births. The neonatal mortality rate (NMR) equaled 12.8 per 1,000 live births and the still birth rate was 15.0 per 1,000 births. The NMR for the month of August was remarkably high. During the past ten years, the NMR showed a sharp decline since 1982. From a regression analysis, birthweight (R2 = .27), Apgar score after five minutes (R2 = .26) and gestational age (R2 = .22) emerged as predictors of neonatal mortality. Birthweight-specific NMRs in infants born in a regional hospital were equal to or higher than our monthly, yearly and interhospital variations in mortality rates, although the effects of differences in the study populations cannot be completely excluded (AU)


Assuntos
Humanos , Recém-Nascido , Assistência Perinatal , Terapia Intensiva Neonatal , Mortalidade/tendências , Trinidad e Tobago , Mortalidade Infantil , Mortalidade Infantil , Mortalidade Infantil , Índice de Apgar , Morte Fetal
18.
In. Berchel, Camille; Papiernik, Emile; DeCaunes, Francois. Perinatal problems of islands in relation to the prevention of handicaps. Paris, INSERM, 1992. p.65-78, tab.
Monografia em Inglês | MedCarib | ID: med-3616

RESUMO

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)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Mortalidade Infantil , Trinidad e Tobago , Peso ao Nascer , Idade Gestacional , Complicações do Trabalho de Parto , Complicações na Gravidez , Morte Fetal
19.
In. Berchel, Camille; Papiernik, Emile; DeCaunes, Francois. Perinatal problems of islands in relation to the prevention of handicaps. Paris, INSERM, 1992. p.52-64, tab.
Monografia em Inglês | MedCarib | ID: med-3617

RESUMO

Social factors associated with poor pregnancy outcome included high parity (3 or more previous pregnancies); and union status, particularly women in visiting and common-law unions and money available for food as women in the lowest expenditure quartile were at excess risk. Significant biological factors include previous poor outcome, the hypertensive disorders of pregnancy, bleeding at any time during pregnancy, syphilis and diabetes. Women with these biological risk factors in particular should be encouraged to deliver at a hospital with obstetric and paediatric consultant care. When these women present in labour they should be carefully monitored and if not progressing satisfactorily or if signs of fetal distress are present they should be scheduled for operative delivery. Women should be encouraged to attend early for antenatal care if the hazardous consequences of highly preventable complications from syphilis, for example, are to be avoided. (AU)


Assuntos
Feminino , Humanos , Gravidez , Recém-Nascido , Resultado da Gravidez , Indicadores de Morbimortalidade , Jamaica/epidemiologia , Morte Fetal/epidemiologia , Mortalidade Infantil , Fatores Socioeconômicos , Fatores de Risco , Estudos de Coortes
20.
Acta Paediatr Scand ; 80(8-9): 749-55, Aug.-Sept. 1991.
Artigo em Inglês | MedCarib | ID: med-15919

RESUMO

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)


Assuntos
Humanos , Recém-Nascido , Masculino , Feminino , Mortalidade Infantil , Asfixia Neonatal/mortalidade , Autopsia/estatística & dados numéricos , Peso ao Nascer , Hipóxia Fetal/mortalidade , Morte Fetal , Jamaica/epidemiologia , Gêmeos
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