Early neonatal mortality and cesarean delivery in Mexico City

Article Abstract:

Although the rate of cesarean deliveries has increased steadily during the last 20 years, the relationship between this type of delivery and neonatal mortality (death of the newborn within the first seven days) is not well understood. To learn more about this issue in one medical care system, neonatal mortality was evaluated in three types of maternity unit in Mexico City during a 14-week period. Included were seven public assistance hospital units, 14 Social Security hospitals, and four private hospitals. Babies who died were either of normal birth weight (NBW, 5.5 pounds or more; 52 cases) or low birth weight (LBW, less than 5.5 pounds; 240 cases); they were compared with a systematically selected group of surviving infants. A perinatal risk score was assigned based on the presence of certain maternal variables. Results showed that the overall rate of cesarean section was 27 percent, with the procedure performed more often in private (39 percent) than in Social Security (25 percent) or public assistance (21 percent) facilities. High-risk LBW babies (delivered either vaginally or by cesarean) had a 36-fold higher mortality rate than low-risk LBW babies; for high-risk NBW babies, mortality was three times higher than for medium-risk NBW infants. Babies in both weight categories were more likely to die after cesarean section, regardless of risk status. The increased infant death rate after cesarean section was probably due to less than optimal conditions for performing this surgery (such as inadequate respiratory care). The relative risk (RR) of neonatal death was highest in public assistance hospitals and lowest in private hospitals (where there were no neonatal deaths after cesarean section). In public assistance hospitals, a large proportion of births is supervised by interns and residents. An analysis is presented of the factors in the Mexican medical system that undoubtedly influenced these outcomes. Mexico City has no quality assurance systems to determine whether cesarean section is medically justified; criteria for such determinations need to be established. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Medical care, Mexico, Infants, Mexico City, Mexico, Obstetrics

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Winter hath hope of spring: presidential address

Article Abstract:

Perinatal mortality (infant death before, during, or after birth) has received more attention from the media than any other medical issue in the last three decades. Japan, Sweden and Finland have the lowest rates of infant death, while the US is ranked 18th in the world for infant mortality. It is estimated that there are 40,000 infant deaths and 30,000 stillbirths each year in the US. Premature birth is a common cause of low-birth-weight, and low-birth-weight is one of the best predictors of infant mortality. Many different factors associated with low-birth-weight have been identified, including smoking, drug abuse, lack of prenatal care, and socioeconomic level. Previous studies have reported that the incidence of premature birth is 20 percent greater among women who smoke one or more packs of cigarettes per day than among those who do not smoke. In a recent study conducted by the World Health Organization, it was reported that the incidence of infant death increases as socioeconomic status decreases. Other studies have reported that families of low socioeconomic status are less likely to receive prenatal care, and that inadequate or no prenatal care is associated with infant death. In Sweden and Finland, where infant mortality is low, health clinics are available and are widely used by pregnant women. It is estimated that 95 to 99 percent of women receive prenatal care at the health clinics. Also, the people in these countries are of high socioeconomic status and have a high standard of living and education. The results of these studies indicate that both social and medical issues need to be addressed in order to reduce infant mortality in the US. Increasing the availability of prenatal care and reducing personal risk factors, such as smoking and drug abuse, should help accomplish this goal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Birth weight, Low, Low birth weight, Perinatal death

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Life-table analysis of the risk of perinatal death at term and post term in singleton pregnancies

Article Abstract:

Newborn babies are least likely to die when delivered at 38 weeks's gestation, according to an analysis of 700,878 births in Scotland between 1985 and 1996. After 38 weeks, the risk of death increases because of a greater risk of stillbirth.

Death

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