Obstetric deaths in Trinidad.

We determined the causal pathways of pregnancy-related deaths over a 16-year period. Pregnancy-induced hypertension was the chief contributor to our high maternal mortality rate of 36.9 per 100 000 births. Anaesthetic-related deaths were due to a combination of Mendelson's syndrome and faulty intubation technique. An improvement in the health-management system to identify high-risk mothers who need intensive emergency care and the availability of experienced personnel for obstetric anaesthesia appear to be indispensable requirements for reducing and minimising adverse maternal outcome in Trinidad.     

Obstetric hazards of maternal obesity.

To test the hypothesis that obesity represents a risk factor in pregnancy, we conducted a prospective case-control study to determine whether or not there was any divergence in the obstetric outcome among 132 obese women from that in a control group of 136 non-obese patients. Obese mothers had an increased incidence of pregnancy-induced hypertension and gestational diabetes but there was no significant difference in the duration of pregnancy or in the frequency of low Apgar score at 1 minute. The favourable fetal outcome in obese parturients reflects an increased awareness of the possible medical and obstetric complications and an early recourse to abdominal delivery.     

Obstetric factors in cerebral palsy.

A study was carried out on the patient population of two cerebral palsy facilities serving Northeast New York State to evaluate obstetric factors which might be associated with the development of cerebral palsy. A combination of available medical records and a maternal questionnaire was used for analysis. Of 605 contracted, 158 mothers (26%) provided valid and detailed data, and the study was confined to these 158 patients. A positive association was found with increased reproductive loss, prematurity, and vaginal breech delivery. The need to develop and adopt a comprehensive uniform record system for the pregnant patient and her child is underscored. The limitations of a single factor retrospective study are acknowledged.     

Obstetric medication and neonatal behavior. Current controversies

This article reviews the work on the neonatal effects of low drug doses published in the last five years. At the same time, there will be a focus on new developments in perinatal pharmacology and on current controversies in this area. The article includes discussions about neurobehavioral outcome measures and statistics, as well as recommendations for future studies.     

Obstetric aspects of adolescent pregnancy and delivery.

An analysis of 31 years of adolescent pregnancies and deliveries at Novi Sad Medical Facility is presented. Obstetric complications are discussed. The psychological impact of adolescent pregnancy is examined.     

Obstetric cholestasis. A 14 year review.

A 14 year review of obstetric cholestasis in the Women's Centre, Winnipeg, revealed 42 cases (incidence one in 1,293 deliveries). The perinatal outcome in these 42 patients was compared to that in a group of control subjects and showed a significantly higher incidence of premature labor, low-birth-weight babies, and postpartum hemorrhage. There was no particular association of intrapartum fetal distress or intrauterine growth retardation with the cases of obstetric cholestasis.     

Obstetric critical care issues in prematurity.

Typically, obstetric critical care issues focus on the management of the patients whose pregnancies are complicated by severe preeclampsia and oliguria. Here, the focus is on the expectant management of the preterm pregnancy complicated by severe preeclampsia, HELLP syndrome, or eclampsia. Then, the emphasis shifts to tocolytic and severe preeclampsia-related pulmonary edema and its clinical management.     

Obstetric complications and perinatal outcome in triplet pregnancies.

The incidence of multiple pregnancies with more than two fetuses has significantly increased since the introduction of ovulation agents and assisted reproductive technologies. Over a 15-year period there were 35 triplet pregnancies beyond 24 weeks that delivered at the King Fahad Hospital, an incidence of 1 in 1,099 deliveries. Early diagnosis is important for improving the rate of fetal salvage in triplet pregnancy. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilised. A total of 91% of the pregnancies had at least one antenatal complication, pre-term labour being the most common (80%) followed by anaemia (43%). The average gestational age at delivery was 31.7 weeks (SD 4.2 weeks). A total of 94.3% of the patients were delivered by lower segment caesarean section. The mean birth weight of the neonates was 1,552 g (SD 510 g) and mean 5-min Apgar score was 7.6 (SD 0.8). The corrected perinatal mortality rate in the study was 152/1,000. Pregnancy outcome did not vary with birth order or mode of conception. Higher rate of pre-term births among triplet pregnancies make considerable demands on the neonatal intensive care unit. All methods of assisted reproduction should aim at prevention of multifetal pregnancies.