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PubMedDate not supplied

[The quality of the registry of perinatal deaths. Asturias, 1986-90].

The quality of official perinatal mortality statistics in a geographical and administratively well defined region (Asturias, Spain) is studied in a five years period (1986-90). The official figures were compared with those collected, retrospectively, from multiple hospital sources. Under-registration of perinatal death was 35% (45.5% of fetal death and 22.5% of early neonatal death, these occurred in the first 24 hours). Validity of mentioned statistics is discussed.

Fetal Death↗
PubMed1993

Cervical cancer in pregnancy: reporting on planned delay in therapy.

OBJECTIVE: To report our experience with invasive carcinoma of the cervix during pregnancy, assessing maternal morbidity due to treatment delay and reporting maternal and fetal outcome. METHODS: Twenty-seven patients with invasive cervical cancer, who were pregnant at the time of diagnosis or treatment, were identified from review of morbidity and mortality statistics between January 1, 1980 and December 31, 1991. All medical records were examined retrospectively. RESULTS: The incidence of cervical carcinoma in our population was 1.2 cases per 10,000 pregnancies. Most patients had stage I lesions. The predominant histologic cell type was squamous cell carcinoma, followed by adenosquamous carcinoma and adenocarcinoma. Eight patients with stage Ia or Ib cervical cancer postponed therapy to optimize fetal outcome, with a mean diagnosis-to-treatment interval of 144 days (range 53-212). Nineteen patients elected immediate treatment, with a mean diagnosis-to-treatment interval of 17 days (range 2-42). Fetal outcome was uniformly good for the delayed-treatment group. Nine fetal deaths and two neonatal deaths occurred in the immediate-treatment group. All patients who delayed therapy are free of disease after a median follow-up of 23 months. CONCLUSION: Deliberate delay of therapy to achieve fetal maturity appears to be a reasonable option for patients with stage I cervical cancer complicating pregnancy.

Adenocarcinoma↗
PubMed1980

Changing trends of neonatal and postneonatal deaths in very-low-birth-weight infants.

Advances in perinatal care have resulted in a decline in mortality of very-low-birth-weight infants (< 1.5 kilograms) and also in an extension of the mortality period. To determine the current relevance of neonatal mortality results as indicators of outcome, all deaths among 427 very-low-birth-weight infants admitted during 1975-1977 were documented. A total of 145 infants died; 90 of the deaths (62%) occurred during the early neonatal period (0 to 6 days), 35 (24%) in the late neonatal period (7 to 27 days), and 20 (14%) in the postneonatal period. Death in 17 of the 20 postneonatal losses was due to neonatal complications of prematurity, and 16 of the 20 deaths occurred during the initial hospitalization. The postponement of these deaths to the postneonatal period has important epidemiologic implications and indicates a need for a reconsideration of accepted reporting mechanisms for infants of very low birth weight.

Female↗
PubMed1981

Outcome for infants of very low birthweight: survey of world literature.

Reports from developed countries world wide describing the outcome for infants of very low birthweight (VLBW, less than or equal to 1500 g) born since 1946 show that, in general, mortality rates and the prevalence of major handicap in survivors were high until 1960. Since then the chances of healthy survival have trebled, whereas the handicap-rate has remained stable and relatively low at 6--8% of VLBW live births.

Australia↗
PubMedDate not supplied

Pattern of childhood cancer mortality in Mexico.

Public and governmental concern regarding increasing cancer mortality trends in children in Mexico led us to investigate the current situation of childhood cancer in this country, as well as to discuss the reasons for which no decline in total and childhood cancer mortality has been documented during the past decades. The data used for analysis of total cancer mortality and study of the trends in mortality of specific childhood cancer in Mexico were retrieved from official Mexican Cancer Mortality Statistics for the period of 1955-1995, as well as from the latest official death records of the Mexican National Institute of Statistics, Geography and Informatics. Actual mortality rates from all sites of cancer in Mexico show a tendency to increase in adults and in children over the last decades. The mortality rate due to all malignant neoplasms in the Mexican population increased significantly, from 28.1 per 100,000 inhabitants in 1955 to 52.6 per 100,000 inhabitants in 1995, whereas the rate of total mortality tended to decrease. The death rate among Mexican children under 15 years of age from all malignant neoplasms increased from 1980-1995 by 20.3%. Although these findings offer some support for the suggestion that socioeconomic factors and delayed diagnosis and treatment may be the major contributors to childhood cancer death rates in Mexico, other explanations cannot be excluded. Further and more detailed research into the nature of the influence of environmental exposures, geographical distribution-including rural vs. city life-and purely biological factors concerned with the cancer situation is warranted. Predictions indicate that the increase of both total and childhood cancer mortality will continue. The pattern in the epidemiology of childhood diseases is changing in view of better national health measures to control infectious diseases, diarrheas, and neonatal problems. All these measures would lead to an increase in the incidence of childhood cancer in children who previously died of other causes. Therefore, improved registry, early diagnosis, better knowledge of the epidemiologic pattern of childhood cancer, appropriate treatment, and greater resources are necessary to solve this emerging health problem in Mexico.

Adolescent↗
PubMed1991

In utero exposure to steroid contraceptives and survival during infancy.

A cohort study was conducted in Chiang Mai, northern Thailand, in 1,431 children of women who had used the injectable contraceptive Depo-Provera (The Upjohn Company, Kalamazoo, Michigan), 565 children of women who had used oral contraceptives during pregnancy, and a group of 2,307 control infants with no hormonal contraceptive exposures. In follow-up interviews, information was obtained on stillbirths and deaths. Cause of death was ascertained by interview, death certificate, or medical record, and underlying causes of death were ascribed by a panel. The children exposed in utero to Depo-Provera had higher neonatal and infant mortality rates (44.3 and 62.9 per 1,000 live births, respectively) than did the controls (19.8 and 29.1 per 1,000 live births). Mortality in infants exposed in utero to oral contraceptives was intermediate between that in the other two groups. Adjustment by logistic regression showed no significantly increased risk of mortality among infants exposed to oral contraceptives, but the odds ratio for death was significantly increased with Depo-Provera exposures due to accidental pregnancy (odds ratio (OR) = 1.8 (95% confidence interval (Cl) 1.1-3.0) for neonatal deaths; OR = 2.0 (95% Cl 1.3-3.2) for infant deaths). Adjustment for low birth weight reduced the risks, suggesting that low birth weight may act as an intermediate determinant of Depo-Provera-associated mortality. Among the accidental pregnancies with Depo-Provera, there was a relation between shorter injection-to-conception intervals, when maternal blood levels of the drug are high, and an increased risk of mortality. The odds ratios for neonatal mortality were 2.5 (95% Cl 1.1-5.7), 2.1 (95% Cl 1.0-4.6), and 0.9 (95% Cl 0.4-2.4) for injection-to-conception intervals of less than or equal to 4, 5-8, and greater than 9 weeks, respectively. Adjustment for low birth weight reduced these risks. Chi-square tests for trend were highly significant. Similar associations were also observed between Depo-Provera accidental pregnancies and risks of low birth weight. Thus, infants from accidental pregnancies that occur 1-2 months after a 150-mg Depo-Provera injection may be at increased risk for low birth weight and death. However, the attributable risk is low, because such pregnancies are uncommon.

Cause of Death↗
PubMed1989

The influence of in-utero transfer on perinatal mortality in a tertiary care centre.

From March 1, 1986 through February 28, 1989 inclusive there was a total of 8,319 births with a birth-weight of 500 g or more at Royal North Shore Hospital (RNS). Three hundred and sixty one births (4.3%) resulted from in-utero transfer of high risk pregnancies (IUT); the remainder were booked at RNS. There were 141 perinatal deaths of which 55 (39%) occurred in infants transferred in-utero. For the whole population delivered at RNS the perinatal mortality rate was 17.0/1,000 births (10.8/1,000 for booked patients versus 152.4/1,000 for IUT births), the stillbirth rate was 7.1/1,000 births (5.4/1,000 for booked patients versus 44.3/1,000 for IUT births) and the neonatal mortality rate was 9.9/1,000 livebirths (5.4/1,000 for booked patients versus 113.0/1,000 for IUT livebirths). These data show that crude perinatal mortality statistics from individual hospitals do not necessarily reflect their standard of care. Although the infants transferred in-utero comprised only 4.3% of the total population they constituted more than one third of the perinatal deaths at RNS. Their very high group specific mortality rates are related to their degree of prematurity and associated maternal and neonatal conditions.

Female↗
PubMed1975

Childhood mortality, family size and birth order in pre-industrial Europe.

Based on parish registers, demographic histories of Crulai (France), Tourouvre-au-Perche (France), and Geneva (Swizertland) established the childhood mortality experienced by complete sibships during periods of at least half a century before the Fench revolution. These observations may be presented as frequenceis in incomplete five-dimensional contingency tables. The five dimensions are: survival (living or dead), completed sibship size, birth order, type of family (according to completeness of information about family), and epoch (period in which the family lived). This paper reanalyzes these published data, using hierarchical log-linear models to discern which interations among the five variables can justifiably be inferred from the data. The neonatal and infant mortality rates of firstborn are probably higher than those of later sibs (in Crulai and Tourouvre). But mortality by age 20 (in Geneva) is associated strongly with the epoch, type of family, and family size, and not significantly with birth order. The increase in mortality with completed family size is insufficient to select, in an evolutionary sense, for limited family size.

Adolescent↗
PubMed1991

Childhood morbidity and mortality in a large hospital over last four decades.

Pediatric statistics in a 50-year-old large hospital were analysed to find out any change in pediatric admission rate, morbidity and mortality and outcome of common disorders during the last four decades. Information was collected from four block years from each of the last four decades and compared. An increase of almost 250% in the total pediatric admissions as compared to an increase of 150% in total hospital admissions over last four decades suggest an increased awareness of maternal and child health by the community. The pediatric mortality excluding neonates has not shown a significant fall over the last four decades, being 14.6, 12.7 and 13.0% in 1955-1958, 1974-1977 and 1984-1987, respectively. Diarrheal disorders, pneumonia, tetanus and infections of central nervous system continue to remain the common causes of hospital admissions in children. The morbidity and mortality in these disorders, in general, have shown a significant decline though less appreciable in pyogenic meningitis, encephalitis and tetanus cases.

Brain Diseases↗
PubMed1990

Causes of death: an assessment of global patterns of mortality around 1985.

Cause-of-death statistics are available for virtually the entire population of the developed world (1.17 billion in 1985) and thus estimates of the mortality pattern in these countries can be made with some confidence, notwithstanding the artefacts which arise due to differences in diagnostic and certification practices between countries. In the developing countries, cause-of-death estimation is much more difficult due to the paucity of mortality statistics. Nonetheless, there are several sources of information on mortality, ranging from surveillance systems and small-scale community studies to complete vital registration, which can be exploited to estimate mortality patterns. Of the 50 million deaths which occur throughout the world each year, roughly 39 million (78%) occur in developing countries. For the developing countries as a whole, infectious and parasitic diseases are estimated to have accounted for almost one-half of all deaths in 1985. Diarrhoeal diseases, acute respiratory diseases (primarily pneumonia) and tuberculosis each claimed about 3-5 million deaths in the developing world in the mid-1980s, with a further 2.6 million due to measles and whooping cough. Perinatal conditions are estimated to have been responsible for a little over 3.2 million deaths in 1985 in developing countries, one-quarter of which were due to neonatal tetanus alone. Maternal causes claimed the lives of about 0.5 million women. At the same time, the chronic diseases are emerging as a leading cause of death in several regions of the developing world, particularly Latin America and East Asia. Circulatory and specific degenerative diseases are estimated to have caused about 6.5 million deaths in 1985. Chronic lung diseases and cancer are each thought to have claimed about 2.5 million lives in 1985. External causes also probably accounted for 2.0-2.5 million deaths.

Australia↗
PubMed1989

New approaches for epidemiologic studies of mortality statistics.

Finding and analyzing multiple causes of death-rather than single causes-has major epidemiologic advantages. Besides helping to reveal the magnitude of the causes or morbid conditions leading to death, it also demonstrates that deaths are usually the result of several simultaneous or sequential causes. This article reviews ways that multiple cause of death data have been analyzed in order to improve our knowledge of these causes and other relevant health factors.

Cause of Death↗
PubMedDate not supplied

Classification and analysis of fetal deaths in Massachusetts.

Fetal deaths, in contrast to infant deaths, have been subject to epidemiologic analysis infrequently. We characterized 574 Massachusetts resident fetal deaths from 1982 and assessed the accuracy of cause-of-death information available from vital records compared with that from corresponding fetal autopsies. The fetal death rate exceeded the neonatal mortality rate. Fetal mortality was higher among black, unmarried, and older mothers. Fetuses of multiple-gestation pregnancies had an unusually high risk of fetal death. Autopsy reports were obtained for 61% of fetal deaths. The underlying cause of death from the fetal death record differed from that on the autopsy report in 55% of cases. Systematic collection of population-based autopsy data is a useful approach for improving the quality and accuracy of mortality statistics on fetal deaths. Many stillbirths remain unexplained, however, and research is needed to identify pathological markers that might reduce the heterogeneity within the fetal deaths currently ascribed to unknown causes.

Adult↗
PubMed1985

[Retardation problems within the scope of prematurity].

Among 804 short-weight infants (birth weight less than 2500 g) born at the Department of Obstetrics and Gynaecology, Medical School, Friedrich-Schiller University, Jena, from 1. 1. 1978 to 31. 12. 1981, one-third were small for gestational age babies. These hypotrophic infants showed, in relation to premature infants (appropriate for gestational age) a higher prenatal and intranatal mortality (statistically not significant). A frequent severe foetal distress mainly on the background of chronic or subacute placental insufficiency implied a higher rate of obstetrical operations by the hypotrophic infants. This was particularly evident by the incidence of caesarean sections (24.7% : 15.2% respectively). The premature hypotrophic infants had the highest caesarean section incidence, amounting to 30.3%. Postnatal adaptation proved more favourable with the small for gestational age babies than with the premature group. There was in fact a statistically significantly lower rate of asphyxiated infants detectable by means of APGAR-score less than or equal to 7 five minutes after labour and a lower neonatal and late mortality in spite of "acidotic morbidity", which was statistically significantly higher in the group of small for date infants (p less than 0.05). We consider as possible cause a higher average duration of gestation with approximately average birth weights. The difference in the clinical behaviour between the premature-hypotrophic and hypotrophic infants were smaller than between the premature-eutrophic and hypotrophic infants. This contradictory behaviour before, during and after labour requires the specialist to be capable of meeting the diagnostic and therapeutical requirements in every respect.

Acid-Base Equilibrium↗
PubMed1985

Changes in infant mortality rates among whites, coloureds and urban blacks in the RSA over the period 1970-1983.

Using national mortality statistics, we found that infant mortality rates (IMRs) declined among whites and coloureds in the RSA over the period 1970-1983, the decrease in coloured IMR being from 134,8 to 50,7/1 000 and that in white IMR from 21,6 to 12,6/1 000. The decrease in the IMR among coloureds was mainly due to the decline in post-neonatal mortality rates (PNMRs). Since post-neonatal deaths are generally due to gastro-enteritis, pneumonia, malnutrition and measles, the decline in mortality is probably due to a decrease in these causes. The decrease in early neonatal mortality made only a small contribution to the decline in the IMR among coloureds. In the case of whites the decrease in the IMR was largely due to the decline in the early neonatal mortality rate (ENMR); these deaths usually result from low birth weight, the respiratory distress syndrome, asphyxia and infections. The decline in the PNMR played a minor role. National IMRs for blacks are not reported annually, but IMRs can be calculated for the two census years 1970 and 1980 for blacks in 34 'selected' (urban) magisterial districts, and were 124,4 and 85,9/1 000 respectively. A valid IMR for 'rural' Transkei from a well-conducted epidemiological study was 130/1 000 in 1980. The components of the IMRs for blacks can only be determined for certain urban areas with large black populations such as Soweto (adjacent to Johannesburg), where the IMR fell from 81,4/1 000 in 1970 to 25,5/1 000 in 1983. The decline in the IMR was due to decreases in both the ENMR and the PNMR.(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗
PubMed1983

[Child mortality in the Hauts de Seine district].

The authors present the results of the analysis of mortality statistics among the children who were born in 1977 in the French department of Hauts-de-Seine. The data were obtained from 8th day of life health certificates, from information given by the registry office and from hospital records. The results establish the department in an excellent position: child mortality rate: 7.34%, early neonatal mortality: 2.81%, late neonatal mortality 1.45% and post-neonatal mortality: 3.08%. The causes for child mortality are analysed and suggestions concerning possible improvements are made.

Female↗
PubMed1981

Perinatal outcome in Western Australia, 1968 to 1976. Perinatal mortality and birthweight.

Trends in perinatal mortality and low birth-weight in Western Australia were analysed by means of a linked file of perinatal death and birth registration papers for the years 1968 to 1975. Stillbirth rates fell only slightly, and there was no improvement in low birthweight stillbirth rates. There was increased ascertainment of low birthweight stillbirths after 1968 when the definition changed. Neonatal mortality fell markedly after 1971, much of the fall being due to a shift in the birthweight distribution towards heavier babies, particularly in males. The proportion of babies with birthweights of less than 2500 g fell from nearly 6% to 5.3%. The impact of changes in the obstetric care of premature labour were minimal up to 1975, with rural (away from specialist care) low birthweights rates differing only slightly from metropolitan rates. Social and demographic differences probably account for the major differences in stillbirth rates between areas. Neonatal mortality rates in low birthweight babies showed a definite advantage for babies living close to neonatal intensive care facilities. However, decisions to expand neonatal intensive care facilities to rural areas need to take into account other adverse perinatal risk factors.

Australia↗