RESUMO

Information from the Jamaican Perinatal Mortality Survey was used to identify features of mothers and their pregnancies that were independently associated with perinatal death. social, biological, environmental, life style and medical aspects of mothers and their pregnancies were collected on two inter-locking subsamples: (1) all births on the island of Jamaica in the 2 months of September and October 1986, the 'cohort months', and (2) all fetal deaths of weight 500g or more, together with all neonatal deaths, in the 12-month period from 1 September 1986 to 31 August 1987. Singleton survivors from the cohort months were compared with all perinatal deaths in the 12-month period using logistic regression. The first model omitted items concerning past obstetric history, but these were included in the second model. In total, 21 variables entered the first model and 24 the second. The only item that became non-significant when past obstetric history was included was maternal age. The final model compared 1017 perinatal deaths with 7672 survivors. It consisted of the following: union (marital) status (married being at lower risk, P<0.01), maternal employment status (housewives at lowest risk, P<0.001), number of adults in household (the more the higher the risk, P<0.05), the number of children aged <11 (the more the lower the risk, P<0.0001), use of toilet facilities (shared with other households increased risk, P<0.001), maternal height (tall women at reduced risk, P<0.001), mother's report that she was trying to get pregnant (P<0.001), maternal alcohol consumption (drinkers had lower risk, P<0.05), maternal syphilis (higher risk, P<0.0001), bleeding before 28 weeks or more (higher risk, P<0.0001), first diastolic blood pressure (80mm + at higher risk, P<0.0001), highest diastolic blood pressure (100mm + at increased risk, P<0.0001), highest proteinuria (++ or more at increased risk, P<0.0001, vaginal discharge/infection (untreated at increased risk, P<0.001), pre-eclampsia diagnosed in antenatal period (increased risk, P<0.01), maternal diabetes (increased risk, P<0.05), start of antenatal care (first trimester at reduced risk, P<0.01), iron taken (reduced risk, P<0.0001), type of perinatal care available in parish of residence (reduced risk if consultant obstetricians and paediatricians available at all times, P<0.0001), number of miscarriages and terminations (the more the higher the risk, P<0.0001), previous stillbirth (higher risk, P<0.0001), previous early neonatal death (higher risk, P<0.001), previous Caesarean section (higher risk, P<0.01). The implications for reduction in perinatal mortality rates are discussed (Summary)

Assuntos

RESUMO

The Jamaican Perinatal Mortality Survey compared all 2069 perinatal deaths occurring during the 12 months between 1 September 1986 and 31 August 1987 with 10086 survivors born in the 2 months of September and October 1986. The Wigglesworth classification identified 44 percent of the deaths as attributable to intrapartum asphyxia (IPA), and this grouping was largely confirmed by post-mortem examination where it had been carried out. About half of these babies weighed 2500g+ and death should have been largely preventable. Comparison of the 813 IPA singleton deaths with 9919 singleton survivors using logistic regression showed independent associations with maternal employment status, the number of children in the household, maternal height, whether or not the mother was trying to get pregnant, or had ever used an intrauterine contraceptive device. Medical conditions such as syphilis, untreated vaginal infection, bleeding < 28 weeks, bleeding 28+ weeks, highest diastolic and first blood pressures and eclamptic fits antenatally were all strongly associated. Mothers who commenced antenatal care in the first trimester were at reduced risk as were those who took iron during pregnancy. There were at substantial reductions in mortality in areas where better medical facilities were available. To this model, features of previous obstetric history were offered, but the only variables which entered were those relating to prior perinatal deaths and immediately preceding miscarriage and termination. Examination of specific features in the management of labour and delivery is a logical basis for the introduction of changes in practice. Caesarean section is unlikely to be apropriate but it is suggested that more active interventions in terms of use of forceps and/or vacuum extraction may be useful (Summary)

Assuntos

RESUMO

All perinatal deaths occurring over a 12-month period on the island of Jamaica were classified using the Wigglesworth schema. In all, there were 584 antepartum fetal deaths (incidence 10.7 per 1000 total births). Comparison of the 558 singleton deaths with 9919 singleton survivors revealed, using logistic regression, strong associations with union (marital) status, maternal employment status, the composition of the household, the sole use of a toilet by the household, the parish of residence, whether the mother was trying to get pregnant and the mother's age (the older the mother the higher the risk). Independent of these factors were strong statistically significant relationship with syphilis, diabetes, maternal anaemia, third-trimester bleeding, highest diastolic blood pressure of 90mm or more and highest proteinuria of ++ or more. Mothers who had taken prophylactic iron were at substantially lower risk compared with those who had not. We conclude that appropriated identification and treatment of syphilis, diabetes, anaemia and hypertension give the best chance of reduction of the high antepartum fetal death rate on the island (Summary)

Assuntos

RESUMO

The Jamaican Perinatal Mortality survey was designed to identify the true perinatal mortality rate, and assess the factors which could contribute towards a reduction in perinatal mortality on the island. All births in a 2-month period (n=10527) were compared with all perinatal deaths occurring over a 12-month period (n=2069). Over half the deaths (n=1058) received a detailed post-mortem examination. Use of the Wigglesworth classification identifies the major component of perinatal death in this country to be associated with intrapartum asphyxia (44 percent of deaths). Deaths due to congenital malformations and miscellaneous causes contribute relatively little (<10 percent) to the overall mortality rate. Over a quarter of deaths apparently occur before the onset of labour, a a fifth are prematurely liveborn but die of causes related to immaturity (Summary)

Assuntos

Assuntos

RESUMO

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51 percent of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70 percent to the rest of the time period when the post-mortem rate was only 40 percent. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 percent of deaths overall and 59 percent of deaths of infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20 percent of deaths. Sixty percent of the infants in this group weighted less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care. (AU)

Assuntos

RESUMO

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were found in 96 (8.6 percent) of 1112 perinatal and neonatal deaths coming to necropsy and in 28 (2.6 percent) of 1085 not so examined. The central nervous system was most commonly affected, followed by the renal, gastrointestinal, and cardiovascular systems in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malformations syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, their importance will increase when deaths from other causes, such as birth asphyxia, decline. The type of malformation currently fatal in a particular population is relevant when planning diagnostic and surgical services for neonates and infants. It is also important to any discussions about provision of prenatal diagnostic services. (AU)

Assuntos

RESUMO

Socioeconomic factors relating to all maternal deaths identified during the 12 months of the Jamaican Perinatal Morbidity and Mortality Survey were compared with a control population of over 10,000 women. The maternal mortality rate was 11.5 per 10,000 livebirths. Initial analyses showed (a) a negative trend in risk of maternal death with increasing maternal education level, (b) that mothers who lived in households with direct pumped water and/or flush toilets enjoyed a reduced risk, (c) mothers who were themselves the major wage earner and (d) those living in households where the major wage earner was a farmer were at increased risk of maternal death. A previous analysis showed that the mothers age, her parity and variables indicating access to medical care were important. Logistic regression showed that only maternal age and toilet facilities were independently associated with maternal mortality (AU)

Assuntos

RESUMO

During the Jamaican Perinatal Mortality and Morbidity Survey, details of 62 maternal deaths occurring in the 12 month period September 1987 to August 1988 were compared with a control population of 95 percent of all births on the island in September and October 1987. The incidence (11.5 per 10,000 livebirths) had not fallen since a study 5 years previously. The mothers who died showed the expected trends with advanced maternal age and high parity. The major cause of maternal mortality was hypertension, (3.5 per 10,000 livebirths) followed by haemorrhage and infection. There was little evidence that these mothers had delayed their first attendance for antenatal care but they were more likely to have reduced access to basic facilities such as health centres and public transport. The risk of maternal death varied with grade of hospital facilities available, particularly for hypertension-related deaths, being lowest in areas with access to a specialist hospital and highest in areas where there were no obstetricians available (AU)

Assuntos

RESUMO

Information on the area of maternal residence of 1856 singleton perinatal deaths occurring during a 12 month period (September 1986 - August 1987) were compared with those of 9933 singleton births born during a two month period (September-October 1986) and surviving the first week of life (The Jamaican Perinatal Morbidity and Mortality Survey). The overall mortality ratio of deaths to estimated survivors was 35.7 per 1000. When the area of residence was categorised according to the type of facilities available, there was a clear trend - births to mothers resident in areas with specialist hospital facilities available, had a mortality ratio of 32.0 per 1000, substantially less than those areas with some obstetric and paediatric facilities (rate 39.2 per 1000) or those with only a cottage hospital and no obstetricians (35.8 per 1000). Categorisation of the deaths using the Wigglesworth classification showed significant variation with intrapartum anoxia. This could not be explained by differences in birthweight, or demographic features of the population. It is concluded that access to a specialist hospital results in a significant reduction in mortality associated with intrapartum asphyxia, but not with other types of perinatal death (AU)

Assuntos

RESUMO

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were in 96 (8.6 percent) of 1112 perinatal and neonatal deaths coming to necropsy and in 25 (2.35 percent) of 1085 other deaths. The central nervous system was not most commonly affected, followed by the renal, gastro-intestinal and cardiovascular system in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malfomation syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, its importance will increase as there is a fall in deaths related to perinatal asphyxia, currently the major cause of perinatal mortality in Jamaica. Although many malformations are currently untreatable, it is important to take account of gastro-intestinal defects when planning surgical services for the newborn, since these are the most easily remediable (AU)

Assuntos

RESUMO

Data from the Jamaican Perinatal Morbidity and Mortality Survey, 1986-1987, were analysed in order to examine the frequency of pathological markers of asphyxia and birth trauma amongst fresh stillbirths and neonatal deaths in babies coming to necropsy. A total number of 1112 necropsies were performed. There were 295 normally formed fresh stillbirths and 463 neonatal deaths, 264 of whom died on the last day of life. One hundred and seventy (57.6 percent) fresh stillbirths showed signs of asphyxia and 64 (21.7 percent) had evidence of birth trauma. Signs of asphyxia were common in all the birth weight groups in 1st day neonatal deaths, being least common in the 0-999g group (19.6 percent) and most common in those weighing 2500-3499g (48.7 percent). Birth trauma was most common in infants with birth weights of over 2500g. It is of great concern that a large proportion of mature fresh stillbirths and neonatal deaths in Jamaica show pathological evidence of intrapartum asphyxia or birth trauma at necropsy. The problems underlying these deaths and the methods of preventing them need urgent attention. (AU)

Assuntos

RESUMO

A large population-based study of all stillbirths and neonatal deaths occuring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified from an estimated population of 54,400 total births giving a perinatal death rate of 38.0 per 1000 total births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many deaths as possible. In the event, 51 percent of perinatal deaths received such a postmortem examination, for the most part by 3 specially trained pathologists working in the capital. Postmortem rate was affected by sex, multiplicity of the infant, month of death and area of delivery. Deaths were classified using Wigglesworth scheme. The distribution categories was similar in the months when the postmortem rate was 70 percent to the rest of the time period when the post-mortem rate was only 40 percent. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 percent of deaths. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care (AU)

Assuntos

RESUMO

Socioeconomic factors relating to all maternal deaths during the 12 months of the Jamaican Perinatal and Mortality Survey were compared with a control population of over 10,000 women. The maternal mortality rate was 11.5 per 10,000 livebirths. Initial analyses revealed (a) that the risk of maternal death declined with increasing maternal education level, (b) that mothers who lived in households with direct pumped water and/or flush toilets enjoyed a reduced risk; (c) mother who were themselves the major wage earner and (d) those living in households where the major wage earner and source of income was an agricultural worker or farmer were at increased risk of maternal death. A previous analysis showed that the mother's age, her parity and variables indicating acess to medical care were important. Logistic regression showed that only maternal age and toilet fascilities were independently associated with maternal mortality. (AU)

Assuntos

RESUMO

A large population-based study of all stillbirths and neonatal deaths occuring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified from an estimated population of 54,400 total births giving a perinatal death rate of 38.0 per 1000 total births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many deaths as possible. In the event, 51 por ciento of perinatal deaths received such a postmortem examination, for the most part by 3 specially trained pathologists working in the capital. Postmortem rate was affected by sex, multiplicity of the infant, month of death and area of delivery. Deaths were classified using Wigglesworth scheme. The distribution categories was similar in the months when the postmortem rate was 70 por ciento to the rest of the time period when the post-mortem rate was only 40 por ciento . The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 por ciento of deaths. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.

Assuntos

RESUMO

Data from the Jamaican Perinatal Morbidity and Mortality Survey, 1986-1987, were analysed in order to examine the frequency of pathological markers of asphyxia and birth trauma amongst fresh stillbirths and neonatal deaths in babies coming to necropsy. A total number of 1112 necropsies were performed. There were 295 normally formed fresh stillbirths and 463 neonatal deaths, 264 of whom died on the last day of life. One hundred and seventy (57.6 por ciento ) fresh stillbirths showed signs of asphyxia and 64 (21.7 por ciento ) had evidence of birth trauma. Signs of asphyxia were common in all the birth weight groups in 1st day neonatal deaths, being least common in the 0-999g group (19.6 por ciento ) and most common in those weighing 2500-3499g (48.7 por ciento ). Birth trauma was most common in infants with birth weights of over 2500g. It is of great concern that a large proportion of mature fresh stillbirths and neonatal deaths in Jamaica show pathological evidence of intrapartum asphyxia or birth trauma at necropsy. The problems underlying these deaths and the methods of preventing them need urgent attention.

Assuntos

RESUMO

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were in 96 (8.6 por ciento ) of 1112 perinatal and neonatal deaths coming to necropsy and in 25 (2.35 por ciento ) of 1085 other deaths. The central nervous system was not most commonly affected, followed by the renal, gastro-intestinal and cardiovascular system in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malfomation syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, its importance will increase as there is a fall in deaths related to perinatal asphyxia, currently the major cause of perinatal mortality in Jamaica. Although many malformations are currently untreatable, it is important to take account of gastro-intestinal defects when planning surgical services for the newborn, since these are the most easily remediable.

Assuntos

RESUMO

Information on the area of maternal residence of 1856 singleton perinatal deaths occurring during a 12 month period (September 1986 - August 1987) were compared with those of 9933 singleton births born during a two month period (September-October 1986) and surviving the first week of life (The Jamaican Perinatal Morbidity and Mortality Survey). The overall mortality ratio of deaths to estimated survivors was 35.7 per 1000. When the area of residence was categorised according to the type of facilities available, there was a clear trend - births to mothers resident in areas with specialist hospital facilities available, had a mortality ratio of 32.0 per 1000, substantially less than those areas with some obstetric and paediatric facilities (rate 39.2 per 1000) or those with only a cottage hospital and no obstetricians (35.8 per 1000). Categorisation of the deaths using the Wigglesworth classification showed significant variation with intrapartum anoxia. This could not be explained by differences in birthweight, or demographic features of the population. It is concluded that access to a specialist hospital results in a significant reduction in mortality associated with intrapartum asphyxia, but not with other types of perinatal death.

Assuntos

RESUMO

During the Jamaian Perinatal Mortality and Morbidity Survey, details of 62 maternal deaths occurring in the 12 month period September 1987 to August 1988 were compared with a control population of 95 por ciento of all births on the island in September and October 1987. The incidence (11.5 per 10,000 livebirths) had not fallen since a study 5 years previously. The mothers who died showed the expected trends with advanced maternal age and high parity. The major cause of maternal mortality was hypertension, (3.5 per 10,000 livebirths) followed by haemorrhage and infection. There was little evidence that these mothers had delayed their first attendance for antenatal care but they were more likely to have reduced access to basic facilities such as health centres and public transport. The risk of maternal death varied with grade of hospital facilities available, particularly for hypertension-related deaths, being lowest in areas with access to a specialist hospital and highest in areas where there were no obstetricians available.

Assuntos

RESUMO

Socioeconomic factors relating to all maternal deaths identified during the 12 months of the Jamaican Perinatal Morbidity and Mortality Survey were compared with a control population of over 10,000 women. The maternal mortality rate was 11.5 per 10,000 livebirths. Initial analyses showed (a) a negative trend in risk of maternal death with increasing maternal education level, (b) that mothers who lived in households with direct pumped water and/or flush toilets enjoyed a reduced risk, (c) mothers who were themselves the major wage earner and (d) those living in households where the major wage earner was a farmer were at increased risk of maternal death. A previous analysis showed that the mothers age, her parity and variables indicating access to medical care were important. Logistic regression showed that only maternal age and toilet facilities were independently associated with maternal mortality.

Assuntos