Maternal and Perinatal Mortality Associated with Cesarean Section in Alberta (1955-1959)

A province-wide study of perinatal mortality was initiated in Alberta (population 1,283,000) in 1955. The period 1955-1959 covered 182,028 total births and 4219 perinatal deaths of which 260 were from 3813 Cesarean sections.

The perinatal mortality rate in Cesarean-section births in rural hospitals (101.4 per thousand Cesarean births) was compared with that for urban hospitals (55.7 per thousand).

Examination of the indications for primary Cesarean section in which a perinatal death occurred showed that hemorrhage accounted for 54 out of 85 of these deaths in rural hospitals, and 49 out of 110 similar urban deaths. Of 33 perinatal deaths associated with elective repeat sections, 17 were of premature babies.

Eleven of the 85 maternal deaths during 1955-1959 were associated with Cesarean section, a maternal mortality rate of 28.8 per 10,000 Cesarean section births. Preventable factors were present in 8 of the 11 cases. Hemorrhage was the primary cause of death.

     

PERINATAL MORTALITY RATE IN 11 JIANGSU CITIES

This prospective collaborative study investigated the perinatal mortality rate and causes of perinatal death in 11 cities in China's Jiangsu Province in the 1 year between September 1, 1980 and August 31, 1981. Of the 86,913 perinatals born during this period, there were 2131 deaths, including 1140 stillbirths and 991 early neonatal deaths, for a perinatal mortality rate of 24.52. Causes of perinatal mortality included hypoxia (37.5%), respiratory disturbance (25.0%), congenital anomaly (11.3%), birth trauma (8.5%), prematurity (6.1%), and miscellaneous or unknown causes (11.6%). These results indicate the importance of the prevention of hypoxia and respiratory disturbance, which together accounted for 62.5% all of perinatal deaths. In the hypoxic category, 54.2% of the deaths were due to umbilical cord factors; in the respiratory disturbance group, 45.6% of deaths were a result of asphyxia neonatorum. Setting up facilities to detect congenital anomalies and determine fetal maturity would further lower perinatal mortality, as would improved fetal monitoring and abandonment of methods of delivery such as version extraction. In the 5 cities south of the Yangzi River, where medical care and living standards are better, the perinatal mortality rate was 21.8-23.8 compared with 24.5-38.4 in the 6 northern cities of the province.     

Pregnancy in women with diabetes mellitus. Fifteen years' experience: 1970-1985

The perinatal mortality of 613 children who were born to women with diabetes mellitus who attended the Diabetic Clinic of The Royal Women's Hospital between 1970 and 1985 was 4.5%. In 399 children who were born to mothers with pre-existing diabetes (95% of whom were insulin-dependent) the over-all perinatal mortality was 7.5%. In successive five-year periods, perinatal mortality in this group declined from 12.2% to 3.9% (1981-1985). In 214 children who were born to mothers with gestational diabetes, the perinatal loss was 1.4%. Between 1970 and 1985, the fetal loss that was attributed to poor control of diabetes declined; however, the prevalence of congenital abnormalities remained unchanged and these were the major cause of fetal loss in 1981-1985. Other high-risk categories that were identified included obstetric complications, particularly that of pre-eclampsia. Neonatal complications had little effect on the eventual outcome, but respiratory distress, macrosomia, hypoglycaemia, jaundice, polycythaemia, hypocalcaemia and hypomagnesaemia were documented frequently and required specialized assessment. The causes of the improvement in the outcome of pregnancy in women with pre-existing diabetes appear to be multifactorial and due to team management in a specialized unit. A reduction in the increased prevalence of major congenital abnormalities is the major challenge for the future.     

396例围产期婴儿的尸检分析

本文对20年中396例围产期婴儿尸检资料进行了统计分析,主要疾病包括肺部疾病,先天性畸形、产程损伤、肿瘤及其他疾病和病变。讨论了不同时期各类疾病的不同变化情况和原因。认为动脉导管异常粗大是一种新的先天性畸形,应引起高度重视。     

The perinatal autopsy: its conduct and reporting in Australia.

OBJECTIVE: To assess the conduct and reporting on death certificates of perinatal autopsies in Australia. DATA SOURCES: (i) Medical certificates of cause of perinatal death in all States and Territories; (ii) registrations of perinatal deaths in New South Wales in 1985 and 1986. DATA EXTRACTION: Death certificates are assessed on three criteria: (i) an indication that an autopsy was performed; (ii) an indication whether the stated causes of death were based on autopsy findings; and (iii) an indication whether the clinical diagnosis was confirmed by autopsy. DATA SYNTHESIS: Perinatal death certificates give insufficient information in all three areas. Assessment of the accuracy and usefulness of autopsies requires better information. CONCLUSION: A two-part death certificate is suggested. The first part would report clinical diagnoses of the causes of death. The second part would compare these results with those of any autopsy.     

Perinatal and postneonatal mortality among Indigenous and non-Indigenous infants born in Western Australia, 1980-1998

OBJECTIVE: To describe cause-specific perinatal and postneonatal mortality for Indigenous and non-Indigenous infants using a new classification system. DESIGN: Total population retrospective cohort study. PARTICIPANTS AND SETTING: All registered births in Western Australia of birthweight greater than 399 g from 1980 to 1998, inclusive. MAIN OUTCOME MEASURES: Rates and time trends for all births 1980-1998, and cause-specific rates for births 1980-1993 of fetal, neonatal and postneonatal mortality among Indigenous and non-indigenous infants, using a classification system designed for use in perinatal, postneonatal and childhood deaths. RESULTS: For Indigenous infants born 1980-1998, the mortality rate before the first birthday was 2.7 times (95% CI, 2.5-2.9 times) that for non-Indigenous infants. Indigenous infants born 1980-1993 had a higher mortality rate in all cause-of-death categories. The highest relative risk was for deaths attributable to infection (8.1; 95% CI, 6.5-10.0) which occurred primarily in the postneonatal period; the source of the infection was less likely to be identified in Indigenous deaths. From 1980-1998, the rate of neonatal deaths decreased at a greater rate for Indigenous than for non-Indigenous infants. However, while stillbirth and sudden infant death syndrome rates for non-Indigenous births fell, they remained static for Indigenous births. CONCLUSIONS: The new classification system, which considers the underlying rather than immediate cause of death, enables investigation of the causes of all deaths, from stillbirths to childhood. This system has highlighted the comparative importance of infection as a cause of death for Indigenous infants, particularly in the postneonatal period.     

242例围产儿死亡原因分析

对1979～1988年在我院分娩16079例中242例围产儿的死亡原因进行了分析。新生儿死亡116例,死胎99例,死产27例。尸检102例。围产儿死亡原因以宫内缺氧为主,其次为肺部疾患,先天性畸形等.孕周<37周,体重<2500克,臀位牵引的胎儿死亡率最高.围产儿死亡在产科并发症中主要为脐带因素,其次是胎盘因素,妊高症等.为进一步降低围产儿死亡率,今后必须加强产前保健工作.     

天津市近20年女性乳腺癌患者临床病理特点及预后变化趋势分析

目的 比较1981-2000年近20年间不同时期乳腺癌临床病理特点及预后情况,了解其发病和预后变化趋势。方法 从天津医科大学附属肿瘤医院1981-2000年20年间收治的11400例乳腺癌病例中随机抽取1678例,对其临床病理及预后资料进行回顾性分析和比较。结果 1991-2000年（1990年代）和1981-1990年（80年代）相比,收治的乳腺癌病例数增加237％,平均每年上升11．8％;患者发病年龄未见明显变化,中位年龄为46～47岁;早期乳腺癌（0-I期）的检出率提高,由1981-1985年的12％上升到1996-2000年的15．5％,而Ⅲ期乳腺癌的比例明显降低,由24．9％降至16．5％,原位癌比例由3．7％上升到4．4％;同时腋淋巴结转移率和局部复发及远处转移几率降低,分别由51．8％和27．8％下降到46．3％和13．5％;生存分析显示,患者术后5年及10生存率分别从1980年代的76％、63％提高到1990年代的86％和74％。结论 近20年来乳腺癌发病率呈明显上升趋势,早期乳腺癌检出比例增加,腋淋巴结转移率和局部复发及远处转移几率降低,患者预后得到改善,5年、10生存率均有提高。     

Deaths due to sexually transmitted diseases. The forgotten component of reproductive mortality

Reproductive mortality has three principal components: deaths related to pregnancy, contraception, and sexually transmitted diseases (STDs). The last component is usually overlooked. In 1955, deaths due to STDs constituted a minimum of 32% of all reproductive mortality in the United States; in 1965 and 1975, the percentages were 32% and 20%, respectively. Pelvic inflammatory disease and syphilis account for most deaths due to STDs. In 1979, the mortality rate due to pelvic inflammatory disease was 0.29 deaths per 100,000 women aged 15 to 44 years; the corresponding figure for syphilis was 0.17. If cervical cancer is viewed as an STD, then deaths due to this cause alone (approximately 6,800 per year) would far outnumber deaths due to all other reproductive causes combined. Surveillance of reproductive mortality in the United States should be expanded to encompass deaths due to STDs.     

A perinatal perspective on South Australia in the 1980s.

OBJECTIVE: To assess changes in sociodemographic characteristics of mothers, their obstetric management and perinatal outcomes in the 1980s. DESIGN: A survey of data recorded in the South Australian perinatal data collection. For singleton births, we compared risks of stillbirth, neonatal death and perinatal death by year of birth, after adjusting for risk factors. SUBJECTS: There were 176,637 births of at least 400 g birthweight (or at least 20 weeks' gestation) notified to the perinatal data collection between 1981 and 1989. MAIN OUTCOME MEASURES: Frequency of risk factors and relative risks of stillbirth, neonatal death and perinatal death by year of birth. RESULTS: There have been changes in the sociodemographic characteristics of mothers, their obstetric management and perinatal outcomes during the 1980s. Crude perinatal mortality rates have not increased, despite increases in the frequency of low birthweight, preterm births, mothers aged 35 years and over, and some other risk factors. After adjusting for risk factors, the risks of stillbirth, neonatal death and perinatal death were lower among singletons in 1987-1989 than in the 1981-1982 reference period. CONCLUSION: Advances in clinical management may be preventing increases in stillbirths, neonatal deaths and perinatal deaths in response to increased numbers of births with low birthweight, preterm delivery and some other risk factors in South Australia.     

Cardiovascular mortality in Peninsular Malaysia: 1950-1989.

Mortality statistics of Peninsular Malaysia for the period 1950-1989 have been studied in relation to cardiovascular diseases, with particular emphasis on coronary heart disease as an important cause of death. It was observed that among six major disease groups reviewed, cardiovascular diseases which occupied third place as a cause of death in 1950 emerged as the number one killer during the 1970s and has remained so since (with exception in 1980). In contrast, infectious diseases which ranked first in 1950 dropped to fourth position in 1980. Between 1960 and 1980, mortality due to cardiovascular diseases was higher in males than in females. This tendency became less apparent during 1985-1989. With reference to race, the incidence of cardiovascular deaths was highest in Indians followed by Chinese and Malays. Among the specific cardiovascular diseases, coronary heart and cerebrovascular diseases accounted for the main causes of mortality. Mortality due to coronary heart disease has increased by more than three fold over the last 40 years and is still rising. However, mortality incidence due to rheumatic heart disease and hypertension decreased during the same period. In 1965, mortality due to coronary heart disease was highest in the 55-59 age group. In recent years (1985 to 1989), it shifted to the older age group (i.e. 65-69). There was a tendency for higher mortality due to coronary heart disease in males compared to females. Indians had a higher mortality due to coronary heart disease than Chinese and Malays.     

Quality of obstetric care provided for Asian immigrants in Leicestershire

Between 1976 and 1981 some 939 perinatal deaths occurred to women living in Leicestershire, of which 128 (14%) were to Asian women. The qualifications of the general practitioners, the gestation at which women start antenatal care, and perinatal death were used as structural, process, and outcome measures for evaluating the services provided to Asian immigrants within this population. Perinatal deaths were divided into four groups: congenital malformation, macerated stillbirth, asphyxia in labour, and immaturity. Asian mothers had one and a half times the risk of perinatal mortality when social class, parity, height, legitimacy, and the general practitioner's qualifications were taken into account. Asian and non-Asian mothers with general practitioners who were not on the obstetric list had more than twice the risk of a perinatal death when a similar adjustment was made. Recommendations include priority allocation of community midwives to practitioners not on the obstetric list, the establishment of postgraduate courses for such doctors, and the continued evaluation of the effect of such proposals on perinatal mortality.     

Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men

OBJECTIVE. To investigate the long-term effects of multifactorial primary prevention of cardiovascular diseases (CVD). DESIGN. The 5-year randomized, controlled trial was performed between 1974 and 1980. The subjects and their risk factors were reevaluated in 1985. Posttrial mortality follow-up was continued up to December 31, 1989. SETTING. Institute of Occupational Health, Helsinki, Finland, and Second Department of Medicine, University of Helsinki. PARTICIPANTS. In all, 3490 business executives born during 1919 through 1934 participated in health checkups in the late 1960s. In 1974, 1222 of these men who were clinically healthy, but with CVD risk factors, were entered into the primary prevention trial; 612 were randomized to an intervention and 610 to a control group. INTERVENTIONS. During the 5-year trial, the subjects of the intervention group visited the investigators every fourth month. They were treated with intensive dietetic-hygienic measures and frequently with hypolipidemic (mainly clofibrate and/or probucol) and antihypertensive (mainly beta-blockers and/or diuretics) drugs. The control group was not treated by the investigators. MAIN OUTCOME MEASURES. Total mortality, cardiac mortality, mortality due to other causes. RESULTS. Total coronary heart disease risk was reduced by 46% in the intervention group as compared with the control group at end-trial. During 5 posttrial years, the risk factor and medication differences were largely leveled off between the groups. Between 1974 and 1989 the total number of deaths was 67 in the intervention group and 46 in the control group (relative risk [RR], 1.45; 95% confidence interval [CI], 1.01 to 2.08; P = .048); there were 34 and 14 cardiac deaths (RR, 2.42; 95% CI, 1.31 to 4.46; P = .001), two and four deaths due to other CVD (not significant), 13 and 21 deaths due to cancer (RR, 0.62; 95% CI, 0.31 to 1.22; P = .15), and 13 and one deaths due to violence (RR, 13.0; 95% CI, 1.70 to 98.7; P = .002), respectively. Multiple logistic regression analysis of treatments in the intervention group did not explain the 15-year excess cardiac mortality. CONCLUSION. These unexpected results may not question multifactorial prevention as such but do support the need for research on the selection and interaction(s) of methods used in the primary prevention of cardiovascular diseases.     

Cohort Mortality Study in Three Ceramic Factories in Jingdezhen in China

To investigate the health impacts of crystalline silica mixed dust and other potential occupational hazards on workers in ceramic factories, a cohort study of 4851 workers registered in the employment records in 3 ceramic factories in Jingdezhen city of China between 1972 and 1974 was identified. The cohort mortality was traced throughout 2003 with an accumulation of 128970.2 person-years, revealed 1542 deaths. Standardized mortality ratios （SMRs） were calculated for the main causes of death by using Chinese national mortality rates as reference. The mortality from all causes in three ceramic factories was 12.0‰ and the cumulative mortality was 31.8%. Malignant neoplasm, cardiovascular diseases, respiratory diseases, infectious diseases were the first four illnesses that threaten workers’ life, and they accounted for 73.2% of all deaths. The results of this study showed that the standardized mortality ratio for all subjects was 1.02, which is very close to that expected on the basis of the China national mortality rates. Statistically significant mortality excesses for respiratory disease （SMR=1.36）, pneumoconiosis （SMR=37.34）, infectious disease （SMR=5.70） and pul- monary tuberculosis （SMR=3.88） were observed. The mortality of 2938 dust-exposed workers was higher than that of 1913 non dust-exposed workers. Except for pneumoconiosis, the mortality from lung cancer, non-malignant respiratory diseases and pulmonary tuberculosis in dust-exposed workers were significantly increased as compared with that in non-exposed workers, and the relative risks （RRs） were 1.86 （1.16–2.99）, 2.50 （1.84–3.40）, 1.81 （1.34–2.45）. The exposure-response relationships between cumulative dust exposure level and mortality from all causes, colorectal cancer, lung cancer, respiratory diseases, and pulmonary tuberculosis were also identified. The findings indicated that silica mixed dust in ceramic factories has harmful impact on the workers’ health and life span in ceramic factory.     

Demography and causes of death among the Huli in the Tari Basin

Monthly demographic surveillance by local reporters was continuous in the Tari Basin from 1971 until 1995 and cause of death was determined primarily by verbal autopsy. In 1982 the de jure population was 26,500, 15% aged less than 5 years. Crude birth rate was 34/1000/annum in 1980-1984; from 1977 to 1983 crude mortality rate was 15/1000/annum and life expectancy at birth 50 years. Infant mortality fell from 160 in the 1920s to 72/1000 livebirths in the 1970s, the greatest decline occurring between 1952 and 1971 when antibiotics became widely available. Respiratory disease (particularly chronic lung disease in adults) accounted for 39% of all deaths, and pneumonia for 50% and 33% of infant and toddler deaths respectively. Very few deaths from pigbel have occurred since the introduction of pigbel vaccine. Initially childhood mortality from diarrhoea declined following introduction of an oral rehydration program but subsequently rose when medical attention was no longer sought and children were inadequately treated at home. The higher mortality in the lower-lying Iumu area was attributed to malaria. Since the opening of the Highlands Highway in 1981, there has been a dramatic increase in short-term movement of both men and women in and out of Tari resulting in increased incidence of sexually transmitted diseases and viral infections such as measles. If restored, the Tari Research Unit could continue to play a key role in assisting the Department of Health in making decisions on appropriate interventions to improve the quality of life of Papua New Guineans.     

西宁地区围产儿死亡原因临床病理分析

通过我院1988年元月—1992年元月围产儿死亡原因的临床及病理分析,探讨西宁地区(海拔2260米)围产儿死亡的发生原因及特点。本组围产儿死亡率18.9‰、尸检58例,尸检率77.3％。围产儿死亡原因中死胎、死产原因均以宫内缺氧为首;胎儿畸形为第二位;新生儿死亡仍以宫内缺氧延续所致重度新生儿窒息为主,其次为宫内感染,肺部疾患和早产儿肺透明膜病。分析提示,死亡原因的正确分析,有赖于细致、系统的死胎、死婴尸检,并密切结合产科临床及不可缺少的胎盘检查。     

An audit of perinatal mortality

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 outcome, 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 the 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%), birth asphyxia (22.2%) and sepsis (13.5%). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended.     

广州市白云区2008～2012年居民传染病死因分析

目的 分析白云区2008～2012年患传染病的居民的死亡原因.方法 应用死亡率、标化死亡率、死因构成及死因顺位等统计学指标,对2008～2012年白云区居民死因资料进行分析.结果 2008～2012年白云区居民传染病死亡数为227人,年平均死亡率为2.04/10万,传染病死亡率男性高于女性.传染病主要死因是病毒性肝炎、肺结核和艾滋病.前三位死因占总死亡数的94.27％.职业以无业或待业居第一位.结论 病毒性肝炎、肺结核、艾滋病是导致白云区居民死亡的最严重传染病,应加强防控.     

SURGICAL TREATMENT OF CONGENITAL VENTRICULAR SEPTAL DEFECT A 21 YEAR EXPERIENCE IN l,187 PATIENTS

From June 1959 to December 1980 1,187 con- secutive cases underwent vantricular septal de- fect (VSD) closure in our department. The operative mortality was 4.8'70 (VSD with pulmo- nary hypertension 13.1To, VSD without pulrrion- ary hypertension l.8To). 80To of early deaths in the series were due to postoperative complica- tions. 572 have been followed up from 6 months t0 19 yeariS (mean, 3.5 years). The late results are divided int0 3 groups: good (84.2To), fair (11.3To) and poor (4.3To). We analyzed the causes of early and late poor results .vhich were largely related to VSD with pulmonary hypertension and postoperative complications with the major technical factors. The operative technic of repairing membraneous VSD through a right atrial incision and treatment of VSD with pulmonary hypertension are discussed, with proper patient selection in the latter ca- tegory stressed. Improvements in equipment and surgical technic are necessary.     

71例围产儿死亡原因分析

目的：分析围产儿死亡原因,以提高围产期保健质量,降低围产儿死亡率。方法：按照围产期Ⅰ标准,对我院1992～2001年间71例住院围产儿死亡病例进行回顾性分析。结果：围产儿死亡率为11．10%,死亡原因排在前3位的是：脐带因素、畸形和早产,占同期围产儿死亡原因的49．29％;流动人口围产儿死亡率明显高于常住人口。结论：加强区域围产期保健网的作用,加强对流动人口的管理,及时发现并治疗高危妊娠是降低围产儿死亡的主要措施。