'Normal but dead': perinatal mortality in non-malformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

Article Abstract:

The Northern Regional Health Authority of Great Britain is a collaborative survey of causes of perinatal death (death occurring 28 days before or 28 days after delivery). To help identify why apparently normal fetuses die, all perinatal deaths reported in 1983 involving nonmalformed infants weighing more than 5.5 pounds (2.5 kilograms) were evaluated. The characteristics and risk factors of 75 cases were examined and compared with 150 similarly matched infants (two controls for each nonmalformed death) born at the same center. Four common factors emerged in the group of infants that died. Perinatal death was significantly associated with the number of previous deliveries. Women having first pregnancies were 2.1 times more likely, and women with three or more previous pregnancies were 5.7 times more likely to have their infant die. Women who did not begin perinatal care before the 20th week of pregnancy were 15.7 times more likely to lose the child. Infants weighing less than seven pounds (3.2 kilograms) were 2.5 times more likely to not survive. The position of the fetus during delivery, and deliveries occurring after the expected date of delivery (postmature) were also associated with perinatal mortality. The deaths were examined for 38 avoidable problems related to the management of the delivery and failure to respond to fetal distress. Avoidable factors were present in half (38 cases) of the perinatal deaths. In 16 cases, the avoidable factor was not directly related to the death. In 22 cases, if the avoidable factor was absent, a different perinatal outcome may have resulted. It is concluded that 21 percent of the perinatal deaths examined could have been avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Surveys, Infant mortality, Perinatal death

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Effective care in pregnancy and childbirth

Article Abstract:

For too long, medical practice, particularly in the area of obstetrical and perinatal medicine, has not reflected the knowledge gained in medical research. A book has now been published which should remedy that situation and which should be valuable to both practitioners and researchers in obstetrics for years to come. The book, "Effective Care in Pregnancy and Childbirth", edited by Chalmers, Enkin, and Keirse with 98 contributing authors, is an assemblage of available research on the effects of midwifery and obstetrical care. Rather than being a textbook, the two volumes, which are also available on computer disks and are summarized in a paperback guide, analyze the outcome of research studies. The book reviews accepted standards for medical research and discusses the problems occurring when too few people are studied or when studies are conducted without controls (untreated subjects). Due to ease of study, many trials of different methods of inducing labor were available, but conversely, few have been done on whether such intervention influences the outcome for mother or child. Other topics covered include the effects of social support during pregnancy, monitoring during labor, obstetrical delivery methods, women's experience during pregnancy and delivery, and medical outcomes of specific treatments. This book appears to be the most significant contribution to obstetrics published in this century, and should be consulted by every obstetrical practitioner; it should also provide a starting point for anyone wishing to perform obstetrical research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Practice, Bibliography, Obstetrics, Obstetrical research, editorial

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