A New South Wales Population-based Study of Stillbirths Weighing 2,500 g or More

Summary: This paper describes factors associated with singleton stillbirths weighing 2,500 g or more, born in 1987 and reported to the NSW Midwives' Data Collection (MDC), a statewide perinatal data collection system. A total of 136 singleton stillbirths in this weight range were notified to the MDC, representing one-quarter of all singleton stillbirths in NSW. MDC records on these stillbirths were linked with perinatal death registrations for 125 of the 136. The death registrations indicated that fetal death occurred during labour in 20 cases, prior to the onset of labour in 98, and at an unknown time in the remaining 7 cases. Placental complications, including haemorrhage and functional abnormalities of the placenta, were the most frequent group of conditions associated with the stillbirths, being recorded as the underlying cause of death in 42 (34%) of the 125 cases. Cord complications (such as cord compression or cord around the neck) were given as the underlying cause of death in 30 cases (24%). The death certificate diagnosis was confirmed by autopsy in only 27 of the 125 cases (22%), although autopsies may have been done on a further 45 cases (36%). An adequate explanation of the cause appeared to be lacking for many of the fetal deaths. This highlights the importance of a thorough and systematic investigation of stillbirths. A list of standard investigations to be carried out following a stillbirth is proposed.     

Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac

A randomised, controlled study was undertaken to assess the postoperative pain and side effects experienced by patients undergoing day case diagnostic laparoscopy and laparoscopic sterilisation, and to evaluate the effectiveness in these patients of peroperative diclofenac. Patients undergoing laparoscopic sterilisation had significantly higher pain scores at one hour postoperatively, and at discharge, than patients undergoing diagnostic laparoscopy (p less than 0.01) but there were no significant differences in pain scores 24 hours after discharge. The incidence of postoperative side effects following discharge from hospital was high, but there were no significant differences between the groups. Diclofenac had no significant effect in either group on the severity of postoperative pain, or the incidence of postoperative side effects.     

The effect of atracurium or fazadinium on intra-ocular pressure. A comparative study during induction of general anaesthesia

The effect of atracurium 0.6 mg/kg (group A; n = 11) and fazadinium 1 mg/kg (group F; n = 11) on intraocular pressure (IOP) was investigated in 22 patients during induction of anaesthesia with thiopentone 4 mg/kg and fentanyl 0.015 mg/kg. IOP was significantly reduced (p less than 0.01) in all patients following induction of anaesthesia. Intubation produced a rise in IOP in all patients but this was not statistically significant and remained below pre-induction values. The changes were similar in each group. Both of these neuromuscular blockers appear suitable relaxants to use for intraocular surgery.     

Congenital paraplegia following maternal hypotension

Congenital paraplegia, with partial improvement over the first months of life, occurred in a female neonate born at 35 weeks' gestation, whose mother had suffered hypotension and hypoxaemia due to anaphylaxis 12 weeks earlier. Our patient subsequently had an acute encephalopathy during a respiratory illness with later developmental delay. We speculate that the baby's paraplegia resulted from spinal-cord ischaemia in utero. The aim of this report is to describe the spinal presentation.     

CHEMISTRY SET POISONING

A prospective survey of chemistry set poisoning (CSP) was undertaken using the monthly postal enquiry report system of the British Paediatric Surveillance Unit (BPSU). Fourteen cases were reported, with one fatality and uneventful full recovery in the other 13. The packaging of the chemicals was unsatisfactory in all cases: it was not child resistant and had no proper closures. Risk factors were lack of supervision 64.3%, emotional factors 28.6%, genuine accident 7% and unidentified 7%. An additional retrospective survey of CSP reported to the National Poisons Information Service centres over the same period added a further 19 cases of CSP, making a total of 33 cases, 14 (42%) being due to copper sulphate and four (12%) to cobalt chloride, respectively. This survey showed CSP to be a significant problem, with an incidence of 0.3 cases per 100,000 children. Six recommendations were made concerning child-resistant containers, toxic hazard warnings, size and content of the lettering, health education programmes targeted at the most vulnerable groups, and lastly, a legal restriction on the chemicals that can be included in these sets, so that the most toxic are excluded.     

Low Birth-weight in NSW, 1987: a Population-based Study

Summary: The New South Wales perinatal data collection was used to examine the association between low birth-weight and some of its potential risk factors. The study population comprised all recorded singleton births to residents of NSW in 1987. Low birth-weight infants were categorized as either small for gestational age (SGA) or preterm (less than 37 weeks). Risk factors were analyzed separately for these categories. The risk factors examined were primarily demographic or reproductive history variables. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors. The factors associated with SGA birth were mainly demographic (maternal age, parity, marital status, socioeconomic status, and ethnic group) while those associated with preterm birth had more reproductive history variables (maternal age, parity, marital status, prior spontaneous abortion, prior induced abortion, prior stillbirth or neonatal death, sex of infant). A first antenatal visit after 12 weeks had a statistically significant but small effect on both SGA and preterm birth.