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The effect of modern intensive monitoring in obstetrics on infant mortality and the incidence of hypoxia and acidosis.

UNLABELLED: We consider intensive monitoring to be fetal monitoring during labor and in the newborn period of all births using the most efficient methods. During the last ten years we have sequentially used the following techniques: Amnioscopy, blood analysis, estrogen determinations in urine, external and internal cardiotokography and internal pressure determinations, gas analyses of umbilical blood. amniotic fluid analyses (phospholipids), ultrasound (B-apparatus) and HCS determinations. All clinics dealing with risk pregnancies should have these techniques available. Total perinatal mortality decreased to below 2% after introduction of cardiotokography. During the last year it decreased to 0.89%. Premature mortality shows the same decrease and is 50% of total mortality. The frequency of premature deliveries remained unchanged at 6.2%. Both improved intensive monitoring and neonatal reanimation and intensive care contributed to the reduction of perinatal mortality. Continuous heart rate recordings make it possible to uncover hypoxic and acidotic states in time and this is of particular value for the premature infant. The incidence of acidosis (pH less than 7.10) was 2.03% before monitoring was introduced and fell to 0.45% this year when intensive monitoring became the rule. No pH lower than 7.0 was found this year. It is thus not sufficient to monitor only cases at risk, since in about 50% of infants born with acidosis no alarming symptoms were found that would have indicated the need for intensive monitoring. CONCLUSION: Infant mortality should be reduced to less than 1% if the diagnostic tools available are applied. Below this nonviable infants limit further improvement. Perinatal hypoxia and acidosis (below pH 7.10) should also be lower than 0.5% but at least lower than 1%.

Acidosis

A new technique to estimate infant mortality with an application for El Salvador and Colombia.

The paper presents new estimates of infant mortality for Colombia and El Salvador for the years 1950--1970. These estimates are obtained by using a technique which improves on Brass's method in that it suppresses the assumption of constant mortality and introduces instead assumptions about linear and nonlinear changes in mortality risks affecting various cohorts of individuals.

Birth Rate

The effects of sex, birthweight, birth order and maternal age on infant mortality in a Nigerian community.

Corrected registration returns in a rural area of Nigeria show that the average infant mortality rate during one five year period was 88.2 per 1000 per annum. The rate was 89.4 per 1000 for females, which did not differ significantly from that of 87.0 per 1000 for males. There were significant variations in the rates by maternal age and by birth order. Forty-two per cent of the infant deaths were of low birth-weight, the mortality rate among this group being approximately six times as high as for those with greater weights.

Birth Order

Fertility and perinatal and infant mortality in the Jewish population of Beersheba and the Negev, 1972.

There were 4,569 Jewish births in the Negev (southern Israel) in 1972, the first year of birth registration by the Unit for Evaluation and Planning of Kupat Holim and the Ben-Gurion University center for Health Sciences. The crude birth rate was 28.8 per 1,000 population, with 130.7 live births per 1,000 women aged 15 to 44 years. Total fertility was 3.9 per woman, varying from 3.4 in the kibbutzim and 3.5 in Beersheba to 5.2 in the moshavim (collective settlements) and 3.7 to 6.3 in the development towns. Late fetal and perinatal death rates were 9.4 and 19.0/1,000, and the neonatal and infant mortality rates, 11.0 and 18.1/1,000 respectively. The proportion of males was 0.51, the twinning rate was 9.5/1,000 women delivered, and 1.1% of babies were illegitimate. Low birth weight (less than 2.5 kg) was recorded in 6.9% of births. Fifty-three percent of births were to immigrant mothers from North Africa; the remainder were divided equally among mothers born in Israel, the Asian Near East, and Western countries. The Asian immigrant group was at high risk for infant death, with a rate of 3.64/1,000 as compared with 14.8, 14.2 and 5.8 recorded for the offspring of mothers born in Israel, North Africa and Western countries, respectively. Patterns of mortality in relation to maternal age, birth order and education were similar to those reported for developed countries.

Adult