Risk factors in mothers and newborn

One hundred and fifty mothers and their newborn babies were studied over a period of two years in villages around Hyderabad to collect vital data regarding their sociobiological factors, customs and beliefs and to observe the impact of maternal and child health services. A positive correlation was observed between the maternal hemoglobin weight and mid-arm circumference and infants weight; the birth weight rising with an increase in these values. Better results were observed in mothers who received antenatal care. The important risk factors emerging were primigravida, very young mothers, severe anemia (Hb<8 g/dl) malnutrition in mothers (wt<40 kg), lack of antenatal care, unhygienic practices during labour, non-availability of trained midwife and harmfuls uperstitions, taboos and customs prevailing in the area.     

Pyocolpos — a rare cause of neonatal sepsis

A newborn female infant presented with a lower abdominal mass and sepsis. Radiologic and ultrasonic studies established the diagnosis of pyocolpos. Surgical drainage was successfully carried out. Hydrocolpos is an uncommon anomaly resulting from imperforate hymen or atresia of the vagina. It usually presents in the first few weeks of life as an asymptomatic abdominal mass or with symptoms due to compression of adjacent structures by the enlarged vagina. Rarely, pyocolpos results from an infected hydrocolpos, usually associated with vaginal atresia rather than imperforate hymen. It may cause life-threatening sepsis; early diagnosis and prompt surgical drainage are therefore essential. The infant described demonstrates the diagnostic approach and the management of pyocolpos. Offprint requests to: O. Zamir     

Fetal growth: relationship with maternal anthropometery,hemoglobin and serum albumin status

Three hundred fortyone primiparous mothers in the age group of 20 to 28 yr were subjected to anthropometery (weight, height and head circumference), hemoglobin and serum albumin estimations. Their offsprings were weighed at birth and birth weight was studied in relation to these maternal variables. The means for birth weight increased with increase in maternal weight, height, head circumference, hemoglobin and serum albumin levels. The subgroups of maternal weight, height and hemoglobin explained almost equal per cent variation in birth weight. Subgroups of gestation explained maximum per cent variation in birth weight. High degree of correlation (p<0.001) persisted between birth weight and maternal weight, height, head circumference and hemoglobin levels even after controlling gestation. The partial correlation coefficient value(r) between birth weight and serum albumin levels fell down considerably when gestation was controlled (p<0.05). Orthogonal polynomial equations were derived between birth weight(y) and maternal variables using coefficients of determination (R²) value of suitable degree.     

Neonatal mortality pattern in rural based medical college hospital

The present study was undertaken to establish priorities in neonatal care and to find out neonatal mortality pattern in a rural based medical college hospital. One hundred and twentythree neonatal deaths out of 1461 live births constituted the study material. The neonatal mortality rate was 84.2/1000 live births. The mortality in preterm, full term and post term infants was 43.13,4.02,7.02 percent respectively (p<0.001). The mortality in relation to birth weight was 100 percent (<1000 g); 71.43 percent (1000–1499 g); 37.14 percent (1500–1999 g); 7.63 percent (2000–2499 g) and 2.94 percent (>2500 g). Almost 70 percent of all deaths were because of severe birth anoxia and septicemia (including meningitis) either alone or in combination.     

A study of perinatal mortality rate from rural based Medical College Hospital

The present study conducted in a rural medical college aimed at analysing the perinatal mortality and its determinants in a rural set up. Fiftyeight still births and sixty two early neonatal deaths among 1107 consecutive deliveries gave a perinatal mortality rate of 108.4 per 1000 deliveries. Fifty percent of the total deliveries were unbooked. The perinatal mortality was higher in unbooked cases (16.3%), twins (33.2%) and preterms (33.9%) as compared to that in booked cases (5.3%), singletons (9.6%) and term deliveries (6.7%). Sixty nine percent of the still births were due to causes like obstructed labour, toxemia of pregnancy, antepartum hemorrhage, hand prolapse, and cord prolapse where timely intervention would have reduced the perinatal mortality significantly. Early neonatal deaths were mainly associated with prematurity and were largely due to birth anoxia, intraventricular hemorrhage, aspiration and infections.     

Deliveries after cesarean birth in two Asian university hospitals

The task force of the consensus conference on cesarean birth of the National Institutes of Health, USA, has recommended substituting a trial of labor and vaginal delivery for elective repeat cesarean section in selected women. This paper assesses the benefits and risks associated with that recommendation using data from two Asian teaching hospitals, one in Jakarta, Indonesia and the other in Colombo, Sri Lanka. Data recorded on the Maternity Record Form designed by the International Fertility Research Program and the International Federation of Gynecology and Obstetrics were used for analysis. Consistent findings were derived from the two hospitals, in spite of the different medical care delivery systems in their countries. No significant increase in maternal and infant mortality and morbidity were associated with women having vaginal delivery subsequent to cesarean birth as compared to those with repeat cesarean section. Savings in medical cost were considerable in the former group.     

Value of cervical encirclage in the treatment of midtrimester abortion

Cervical encirclage (McDonald's operation) was performed on 64 patients from 1974 to 1978 as a primary treatment of cervical incompetence. Diagnosis of incompetent cervix was made by history alone in 21 cases, by history and vaginal examination in 41 and by hysterosalpingogram alone in only two cases. Before suture, these 64 patients had had 246 pregnancies with successful pregnancy in 62, a success rate of 25.2%. If first trimester abortions were excluded, successful outcome had occurred in only 31.6%. Following suture reinforcement, the same patients achieved 64 conceptions with 45 successful pregnancies, a success rate of 70.3%. Cervical encirclage is useful and attractive because of its simplicity, bloodlessness and easy reproducibility during the same pregnancy.     

提高孕产期保健质量是降低贫困地区壮族妇女孕产妇死亡的有力措施

目的 :提高贫困地区壮族农村住院分娩率 ,加强产时保健 ,提高贫困地区壮族农村产科质量 ,降低产后出血死亡率。在广西 30个老少边山穷地区 ,以项目和“母亲安全工程”为载体 ,在经济条件困难 ,基础设施落后 ,围产保健服务管理滞后的情况下 ,积极贯彻落实《母婴保健法》,依法规范围产保健服务管理 ,多方筹措资金 ,加强产科软、硬件建设 ,以项目工作为龙头 ,以科研为先导 ,积极推广适宜技术。以健康促进为目的 ,大力开展健康教育和生殖保健活动 ,使围产保健工作取得了较好成绩。30个贫困地区壮族农村近半数以上乡卫生院产科建设已达自治区标准 ,基本能满足贫困地区农民住院分娩的需求 ,并带动广西妇幼卫生工作的发展     

Body build from birth to adulthood and risk of asthma

BACKGROUND: Few reports aimed at the study of adulthood obesity and asthma have taken into account the effects of size at birth and obesity in adolescence. This paper examines the combined effect of size at birth and obesity in both adolescence and adulthood on the risk of asthma at age 31 years. METHODS: The study was derived from a prospectively population-based Finnish birth cohort born in 1966, for which data were collected in pregnancy and at various ages. Adulthood doctor-diagnosed asthma with current symptoms and results of skin prick tests were obtained in 1997. The analysis was limited to 4719 subjects with complete information on asthma and atopy and anthropometric measures at various ages. RESULTS: Ponderal index at birth had a U-shaped association with adult atopy, OR 1.30 (95% CI: 1.11-1.52) for the lowest tertile and OR 1.33 (95% CI: 1.13-1.55) for the highest tertile, as compared to the middle tertile. The association was independent of obesity later in life. Those obese (BMI > or = 95th percentile) in adolescence (OR 2.09, 95% CI: 1.23-3.57) and in adulthood (OR 1.99, 95% CI: 1.14-3.47) had a higher occurrence of adult asthma than those with BMI < 85th percentile. Both estimates were reduced after mutual adjustment. CONCLUSIONS: Size at birth has a long-lasting effect on atopy in adulthood, which is independent of weight in adolescence and adulthood. Those who were obese in adolescence and adulthood tended to have a higher risk of asthma in adulthood. These findings underline the importance of considering the life course of obesity in the analyses of asthma and atopy.     

Need for recovery after work predicts sickness absence: a 2-year prospective cohort study in truck drivers

BACKGROUND: Incomplete recovery from work-related fatigue after work (i.e., sustained activation) is assumed to mediate the relation between the exposure to stressful working conditions and the development of health problems. The need for recovery after work scale reflects the extent to which workers have difficulties to recover adequately from work-related fatigue after a working day. OBJECTIVES: The aim of this study was to establish if need for recovery after work in truck drivers (1). predicts future sickness absence (>14 working days) and (2). mediates the prospective relation between stressful working conditions (low control, high job demands) and sickness absence. METHODS: Self-administered questionnaires, providing information about need for recovery after work, sickness absence, job control, and job demands (psychological, physical, and supervisor job demands), were sent to a random sample of 2000 drivers in 1998. Of the 1123 responders, 820 returned a completed questionnaire 2 years later (response 72%). This study was restricted to the 526 participants who still worked at follow-up as a truck driver at the same company. RESULTS: High baseline need for recovery after work was associated with an increased risk for subsequent sickness absence (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.13-4.24) after adjustment for age, previous sickness absence, marital status, educational level, and company size. Additional adjustment for baseline stressful working conditions led to a marginally reduction of the excess risk for sickness absence. CONCLUSIONS: High need for recovery after work increases the risk of subsequent sickness absence that is not explained by relevant (non-) work-related factors. However, the results did not testify that need for recovery after work mediates between the exposure to stressful working conditions, and the subsequent occurrence of sickness absence. Practically, the results indicate that monitoring recovery complaints in truck drivers may assist practitioners to take efficient preventive measures at the appropriate time.