RESUMO

Debate has developed among several authors about possible accelerated maturation of black fetuses in comparison with whites. In Guadeloupe, French West Indies, where 85% of the population is of black African-American origin, it has been noted that the incidence of hyaline membrane disease (HMD) represents a significant drop beginning after the 32nd week of gestation. Over a 3-year period, 419 black low-birthweight singleton newborns were admitted in the University Hospital's Neonatal Department covering 70% of all births of the island. The incidence of HMD was 50% among very low birthweight (< 1500 g) and 8.3% among moderate low birthweight (> or = 1500 g; P < 0.001). The incidence of HMD was 48.8% among the very preterm (< 32 weeks) and 7.8% (26/331) among the moderate preterm (> or = 32 weeks; P < 0.001). These differences were similar for appropriate for gestational age and small for gestational age infants. Significant differences remained after controlling for several maternal risk factors. These results suggest that the 32nd week of gestation represents a significant drop in the risk for respiratory distress syndrome in black premature compared with that reported in literature on European infants (34th week) and therefore may implicate different obstetrical decisions in the management of critical pregnancies in this population.

Assuntos

RESUMO

Few authors have published investigations regarding a possible association between preeclampsia and changing paternity. This study employs an epidemiological approach to explore the relationship between severe preeclampsia and changes in paternity patterns among multigravidae in a Caribbean community (Guadeloupe, French West Indies). Multiparae who were diagnosed with preeclampsia or eclampsia with fetal complications (transfer of their infants in the Neonatal Department) and controls were examined (134 mothers' interviews). Information concerning paternity for the index and previous pregnancies was collected from three groups: women with pregnancy-induced hypertension (PIH); women with chronic hypertension (CH); and a control group consisting of women without hypertension during pregnancy. In 21/34 (61.7%) of PIH mothers, the father of the current pregnancy was different than that of the former, compared to 4/40 (10%) among CH and 10/60 (16.6%) in the controls (P < 0.0001). Moreover, considering three and four consecutive pregnancies, there was a significant trend (P < 0.005 and P < 0.02) for an increase in PIH with having a different father in each successive pregnancy. Patterns of changing paternity were significantly correlated with pregnancy-induced hypertension in multiparae but not with chronic hypertension and controls.

Assuntos

RESUMO

A preliminary and retrospective review--with a southern perspective--of some traveller's pathologies, mostly imported, and leading to hospital admission in Guadeloupe (FWI). End stage patients (cancer, AIDS...) frequently travel for a last, "compassional" trip. Ischemic heart disease is the leading pathology imported from the mother country (France). As well as in diabetes or psychiatric illness, destabilization frequently occurs as a consequence of travel (jet lag). Compulsive tennis plus dehydration cause the very common stone passage of nephrolithiasis. Concern is growing for heroin withdrawal syndrome or cocaine (crack)-abuse, and for supply for rare and expensive anticancer, antigraft rejection or antinfective (AIDS) agents. Much more familiar to us are photodermatitis, larva migrans, dengue, or ciguaterra, locally acquired. On the other hand some pathologies are quite "exotic" to us: Kaposi sarcoma, Lyme, or Behçet disease, familial mediterranean fever, brucellosis.

Assuntos

RESUMO

The Dubowitz assessment of gestational maturity was compared with the best obstetric estimate of gestational age based on date of last menstrual period (LMP) or ultrasonography performed early in the pregnancy or both. This study involved 384 low birthweight infants admitted to the neonatal tertiary center in Guadeloupe, French West Indies, during the period 1986 through 1988. The Dubowitz assessment exceeded the best obstetric estimation by an average of nearly 5 days. This overestimation by the Dubowitz method was observed at every gestational age and was greatest at gestational ages of less than 35 weeks. The physical characteristics of the postnatal assessment were in closer agreement with the best obstetric estimate than the neurological characteristics. These findings concur with other investigations that indicate that the Dubowitz postnatal assessment of gestational age overestimates the gestational age interval from date of LMP in low birthweight and preterm infants.

PIP: Physicians used data on 384 low birth weight neonates born between January 1986 and December 1988, who were in the neonatal intensive care unit at Pointe-a-Pitre Hospital in Guadeloupe, to compare the Dubowitz assessment of gestational age with the best obstetric estimate of gestational age. They needed a valid estimate of gestational age to quickly differentiate premature newborns from small-for-dates newborns. The hospital had limited technical and human resources, so it needed to determine which infants were at greater risk. The Dubowitz assessment resulted in a mean gestational age about 5 days longer than the obstetric estimate. There was almost a 2 week difference in mean gestational age between the neurological component and the physical component of the Dubowitz assessment (35 weeks, 4 days vs. 33 weeks, 5 days). The 2 estimates agreed completely in just 25% of cases. They disagreed by at least 2 weeks in 18% of the cases and by at least 3 weeks in 8% of cases. The analysis indicated that the Dubowitz assessment consistently overestimated gestational age in both low birth weight and premature infants and that the mean difference increased as gestational ages fell. The Dubowitz assessment even had this effect when the researchers separated the newborns into those whose gestational age was based just on last menstrual period (LMP) and those whose gestational age was based just on last (LMP) confirmed by ultrasound at a gestational age 20 weeks. The neurological component significantly overestimated both the combined Dubowitz and obstetric values for premature infants, while the physical component tended to agree.

Assuntos

RESUMO

Based on data obtained from the 1984-1985 Guadeloupean Perinatal Audit, a pregnancy risk scoring system was developed using maternal demographic, socioeconomic, obstetric history and risk characteristics recorded at the first prenatal visit. Various combinations of risk factors were identified for four distinct pregnancy outcomes (perinatal mortality, low birth weight, preterm delivery and intra-uterine growth retardation). The findings emphasize the importance of developing risk assessments for discrete pregnancy outcomes within specific populations.

Assuntos

RESUMO

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985. Nearly one-half of the perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than one-half of the perinatal deaths were considered to be avoidable. Over the course of the audit, perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

PIP: In 1983, the authors implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. The authors investigated all 320 perinatal deaths in Guadeloupe during 1984-85. Nearly 1/2 of all perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than 1/2 of the perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

Assuntos

RESUMO

Perinatal risk factors in Guadeloupe (French West Indies) have been analysed from a community-based case-control survey. Two hundred and sixty four perinatal deaths were involved along with 605 controls. Principal component factor analysis of individual risk characteristics was used to identify risk group profiles. These risk profiles were: "single women of low socio-economical status" (17% of the variability), "traditional Caribbean housewives" (14%), "single adolescents" (7%), and "immigrant women" (10%). Only the three first were significantly associated with a poor outcome for the current pregnancy. This approach may be fruitful in planning for public health interventions to prevent perinatal risk. Also, risk profile concepts may be well-accepted by physicians and care providers, in routine practice, for screening of individual at-risk patients.

Assuntos

RESUMO

Research with a view to action being taken was carried out in Guadeloupe in 1984 and 1985 to try to find out the causes of the high level of perinatal mortality which persists on the island before suggesting to the public health authorities what action to take. All the cases of perinatal mortality (above 500 g in weight) were looked at and analysed carefully according to a protocol that had been prepared. The events preceding the perinatal death were described and also the antenatal and intranatal as well as immediate post-natal care given to the children. A control case was studied for each case that had been registered and the same questionnaire was filled in. The present work shows the methodology used to carry out the enquiry and how it was organized with the collaboration of all the actors in the public health department as well as the doctors and the health authorities authorities.

Assuntos