Classification of perinatal death

Article Abstract:

Classification of fetal or infant deaths that occur near the time of birth is important for identifying ways to reduce infant mortality. Such a classification scheme must be as simple as possible and yield similar results when used by health care professionals with different backgrounds. The authors, a group of three perinatal pathologists, a perinatal pediatrician, an obstetrician, and an epidemiologist, evaluated and redefined the Wigglesworth criteria using information from 239 perinatal deaths to clarify and improve this classification system. The classification was originally arranged into five groups: (1) normally formed macerated stillbirth; (2) congenital malformations (stillbirth or neonatal birth); (3) conditions associated with immaturity (neonatal deaths only); (4) asphyxial conditions developing in labor (fresh stillbirth/neonatal death); and (5) specific conditions other than the above. Group 1 was renamed 'deaths before the start of labor'. Group 3 was designated 'conditions associated with preterm birth or immaturity' and included only live births under 37 weeks' gestation. Group 4 was expanded to encompass all fetal deaths without malformations or specific disorders, given the death occurred during labor. Lastly, it was suggested that group 5 include conditions such as inborn errors of metabolism, blood group incompatibilities, twin-to-twin transfusion syndrome, specific or unusual infections, deaths that are completely unexplained or anything extraordinary. The authors agree that the changes clarify any ambiguities and improve the system so that reproducible results in classifying perinatal deaths can be accomplished. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Infants (Newborn), Newborn infants, Identification and classification, Epidemiology, Perinatal death

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Life saving intervention in the neonatal period: dilemmas and decisions

Article Abstract:

There is much discussion these days regarding the so-called 'right to die' which, in the final analysis, is nothing more than the right of adult, clear-thinking individuals to refuse medical treatment. However, in cases involving newborns, the individual involved does not have the capacity for such a decision. Decisions to treat or not treat severely ill neonates falls into the hands of physicians and emotional, grief-stricken parents. At some institutions, committees have been set up to review cases which may involve withholding life-support from a newborn. Unfortunately, such committees may only add further stress to the parents' lives; committees also tend to err on the side of continued life-support, which may sometimes act against the parents' wishes and best interests. Perhaps the strongest argument in favor of such committees is only that they protect individual physicians from possible repercussions. In general, however, such decisions are made by the parents in consultation with the physician. The physician must ask many questions of the parents, but often this is to obtain insight into the parents' perspectives rather than merely obtain a yes-or-no decision. It is also possible that the physician may have to express an opinion more strongly than he may actually feel it. This can take some of the burden off the shoulders of the parents, and in such cases, is a part of being a good physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Ethical aspects, Infants, Right to die, Life support systems (Critical care), Life support care

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Financial difficulties, smoking habits, composition of the diet and birthweight in a population of pregnant women in the South West of England

Article Abstract:

The relationships between financial hardships, smoking, diet and birthweight for a population of pregnant women in southwestern England are studied. Results show that pregnant women with financial difficulties consumed more meat products, chips and green vegetables. They consumed less nutrients such as iron and magnesium which affect birthweight. Women who smoked also consumed more sugar, fat and energy and less vitamins and minerals.

Food and nutrition, Pregnant women

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