Trends in the modes of delivery and their impact on perinatal mortality rates.
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OBJECTIVE: To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. METHODS: A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. RESULTS: Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0 per thousand), early neonatal mortality (from 30.6 to 9.0 per thousand), and perinatal mortality (from 56.4 to 19.3 per thousand). CONCLUSIONS: The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery. (+info)
The effect of parental race on fetal and infant mortality in twin gestations.
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Previous work has found that singleton birth outcomes are better if the father is black and the mother is white than if the father is white and the mother is black. We sought to examine the effects of parental race on fetal and infant mortality in twins. We analyzed the fetal and infant mortality rates in four groups [both parents white (W-W), both parents black (B-B), father black and mother white (FB-MW), and father white and mother black (FW-MB)], using the 1995--1997 U.S. twin registry data (249,221 twins). Compared to W-W, the infant mortality for B-B, FW-MB, and FB-MW (respectively, relative risk [RR] 1.84, 95% confidence interval [CI] 1.73-1.95; RR 1.39, 95% CI 1.03-1.51; and RR 1.49, 95% CI 1.26-1.77) were all significantly different from W-W but not from each other. When fetal mortality was added to infant mortality, the combined mortality was highest for B-B (RR 1.66, 95% CI 1.58-1.75), intermediate for FW-MB (RR 1.18, 95% CI 0.92-1.51) and FB-MW (RR 1.37, 95% CI 1.19-1.58) and lowest for W-W. Thus, twin infants born to black parents have higher risk of fetal and infant mortality compared with twin infants born to white parents and infants of mixed race parents generally have intermediate outcomes. (+info)
Perinatal outcome among non-residents in Israel.
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BACKGROUND: Foreign workers in Israel are not covered by the comprehensive medical insurance that all Israelis receive. They have national insurance and injury-related coverage, which does not include routine pregnancy follow-up OBJECTIVES: To compare perinatal outcome between partially insured non-resident migrants in Israel and comprehensively insured Israeli women. METHODS: Parameters of perinatal outcome were compared between 16,012 Israeli and 721 foreign women living in Israel. Outcome measures included birth weight, distribution of gestational age at delivery, neonatal complications, cesarean section, neonatal intensive care unit admission, intrauterine fetal death rates, and duration of post-partum hospitalization. RESULTS: Deliveries prior to 28 weeks gestation occurred more frequently among non-residents (1.3% vs. 0.6%, P < 0.001). Gestational diabetes and preeclamptic toxemia were significantly more prevalent among non-residents (3.2% vs. 1.9%, P < 0.05 and 4.9% vs. 3.1%, P < 0.05, respectively). The cesarean rates were 18% and 35% for residents and non-residents, respectively (P < 0.001), and the post-cesarean recovery period was longer among non-residents (4.8 vs. 3.6 days, P < 0.05). The mean birth weight was similar in the two groups (3,214 vs. 3,231 g), although macrosomia (>4,000 g) was more prevalent among non-residents, who also had higher rates of NICU admission ((9.6% vs. 8%, P < 0.05) and intrauterine fetal death (6.6/1,000 vs. 3.7/1,000, P < 0.05). CONCLUSIONS: Non-resident parturients in Israel are more susceptible to an adverse perinatal outcome than their Israeli counterparts. We suggest that government subsidization of non-residents' health expenditures would reduce the differences in perinatal outcome between these two groups. (+info)
Validity of maternal and perinatal risk factors reported on fetal death certificates.
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We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately. Additional population-based studies are needed to identify strategies to improve fetal death certificate data. (+info)
Coffee and fetal death: a cohort study with prospective data.
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The authors conducted a cohort study within the Danish National Birth Cohort to determine whether coffee consumption during pregnancy is associated with late fetal death (spontaneous abortion and stillbirth). A total of 88,482 pregnant women recruited from March 1996 to November 2002 participated in a comprehensive interview on coffee consumption and potentially confounding factors in pregnancy. Information on pregnancy outcome was obtained from the National Hospital Discharge Register and medical records. The authors detected 1,102 fetal deaths. High levels of coffee consumption were associated with an increased risk of fetal death. Relative to nonconsumers of coffee, the adjusted hazard ratios for fetal death associated with coffee consumption of 1/2-3, 4-7, and > or =8 cups of coffee per day were 1.03 (95% confidence interval (CI): 0.89, 1.19), 1.33 (95% CI: 1.08, 1.63), and 1.59 (95% CI: 1.19, 2.13), respectively. Reverse causation due to unrecognized fetal demise may explain the association between coffee intake and risk of fetal death prior to 20 completed weeks' gestation but not the association with fetal loss following 20 completed weeks' gestation. Consumption of coffee during pregnancy was associated with a higher risk of fetal death, especially losses occurring after 20 completed weeks of gestation. (+info)
Estimation of optimal birth weights and gestational ages for twin births in Japan.
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BACKGROUND: As multiple pregnancies show a higher incidence of complications than singletons and carry a higher perinatal risk, the calculation of birth weight - and gestational age (GA)-specific perinatal mortality rates (PMR) for multiple births is necessary in order to estimate the lowest PMR for these groups. METHODS: Details of all reported twins (192,987 live births, 5,539 stillbirths and 1,830 early neonatal deaths) in Japan between 1990 and 1999 were analyzed and compared with singletons (10,021,275 live births, 63,972 fetal deaths and 16,862 early neonatal deaths) in the annual report of vital statistics of Japan. The fetal death rate (FDR) and PMR were calculated for each category of birth weight at 500-gram intervals and GA at four-week intervals. The FDR according to birth weight and GA category was calculated as fetal deaths/(fetal deaths + live births) x 1000. The perinatal mortality rate (PMR) according to birth weight and GA category, was calculated as (fetal deaths + early neonatal deaths)/(fetal deaths + live births) x 1000. Within each category, the lowest FDR and PMR were assigned with a relative risk (RR) of 1.0 as a reference and all other rates within each category were compared to this lowest rate. RESULTS: The overall PMR per 1,000 births for singletons was 6.9, and the lowest PMR was 1.1 for birth weight (3.5-4.0 kg) and GA (40-weeks). For twins, the overall PMR per 1,000 births was 36.8, and the lowest PMR was 3.9 for birth weight (2.5-3.0 kg) and GA (36-39 weeks). At optimal birth weight and GA, the PMR was reduced to 15.9 percent for singletons, and 10.6 percent for twins, compared to the overall PMR. The risk of perinatal mortality was greater in twins than in singletons at the same deviation from the ideal category of each plurality. CONCLUSION: PMRs are potentially reduced by attaining the ideal birth weight and GA. More than 90 percent of mortality could be reduced by attaining the optimal GA and birth weight in twins by taking particular care to ensure appropriate pregnancy weight gain, as well as adequate control for obstetric complications. (+info)
Fetal echocardiographic findings are not predictive of death in twin-twin transfusion syndrome.
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OBJECTIVE: The purpose of this study was to determine whether fetal echocardiographic findings are predictive of prognosis in recipient fetuses with twin-twin transfusion syndrome (TTTS). METHODS: A cohort of 30 pregnancies with TTTS between 1990 and 2001 was included. Diagnosis and staging of TTTS were made according to the Quintero system. Fetal echocardiographic findings of cardiomegaly, right ventricular hypertrophy, and tricuspid regurgitation were evaluated for relationship with fetal death. Power analysis revealed an approximately 80% power to detect a 2-fold increased risk of fetal death, with alpha = .05. Logistic regression was used to determine the relationship between echocardiographic findings and death. RESULTS: Most pregnancies were Quintero stage 1, n = 13 (43%), and ranged in severity to Quintero stage 5, n = 4 (13%). Cardiac findings in the recipient fetus that were assessed for a relationship with death included cardiomegaly at the initial appearance of TTTS or at the most severe evaluation findings, right ventricular hypertrophy at initial appearance or at the most severe evaluation findings, or tricuspid regurgitation at initial appearance or at the most severe evaluation findings. Fetal or neonatal death in the recipient twin was not related to the presence of cardiac findings (odds ratio, 0.77; 95% confidence interval, 0.16-3.74). CONCLUSIONS: Fetal echocardiographic findings, whether evaluated at initial appearance or over the course of serial evaluations, were not related to fetal or neonatal death in recipient twins with TTTS. (+info)
Direct responses to six generations of selection for ovulation rate or prenatal survival in Large White pigs.
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Effects of selection for ovulation rate or prenatal survival were examined using data from 3 pigs lines derived from the same base Large White population. Two lines were selected for 6 generations on high ovulation rate at puberty (OR line) or high prenatal survival corrected for ovulation rate in the first 2 parities (PS line). The third line was an unselected control line. Genetic parameters for ovulation rate on the left, right, and both ovaries at puberty (ORPL, ORPR, and ORP, respectively) and at fertilization (ORFL, ORFR, and ORF, respectively), total number of piglets born (TNB) per litter, prenatal survival (PS = TNB/ORF), and PS corrected for ovulation rate (CPS = PS + 0.018ORF) were estimated using REML methodology. Responses to selection were estimated by computing differences between OR or PS and control lines at each generation using least squares and mixed models methodology. Average genetic trends were computed by regressing line differences on generation number. Realized heritabilities were estimated using standard procedures. Heritability estimates were 0.17, 0.11, 0.34, 0.13, 0.09, 0.33, 0.14, 0.11, and 0.17 (SE = 0.01 to 0.03) for ORPL, ORPR, ORP, ORFL, ORFR, ORF, PS, CPS, and TNB, respectively. Realized heritabilities were 0.37 +/- 0.08 and 0.10 +/- 0.09 for ORP and CPS, respectively. The different measures of ovulation rate had strong genetic correlations (r(g) > 0.7). The ORF had midrange negative genetic correlations with PS and CPS (-0.45 +/- 0.07 and -0.42 +/- 0.08, respectively). The ORP also had an antagonistic genetic relationship with PS (-0.26 +/- 0.07) but was almost independent from CPS (-0.02 +/- 0.11). The TNB was moderately correlated with ORP and ORF (r(g) = 0.41 +/- 0.09 for both traits). Average genetic trends in OR and PS lines were, respectively, 0.49 +/- 0.10 and 0.11 +/- 0.10 for ORP, and 0.43 +/- 0.11 and 0.11 +/- 0.11 for ORF. Responses to selection were slightly superior in the left than in the right ovary. No significant difference was found for PS or CPS in any of the lines. The TNB did not change in the OR line but significantly improved in the PS line (0.24 +/- 0.11 piglets/generation). (+info)