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At least 19 recordsLinked to original sources
PubMed1977

Specialized perinatal care: impact on perinatal mortality.

A neonatal intensive care unit was established at one hospital in 1972 when the neonatal mortality was 7.6 and the perinatal mortality 20.9 per 1000 deliveries. In 1973, with full operation of that unit and partial introduction of a high-risk pregnancy unit for fetal monitoring, the rates decreased to 6.4 and 14.9, respectively. With full operation of both units the rates decreased further, to 3.4 and 9.0 in 1974 and 3.8 and 8.9 in 1975. The frequency of cesarean section was 10.1% in 1972-73 and 11.6% in 1974-75. It is concluded that the centralization of obstetric and neonatal care, together with the development of qualified medical and nursing teams, had a major impact in reducing perinatal mortality, and that the frequency of cesarean section was not affected by the introduction of fetal monitoring, although the indications for this precedure became more specific.

Birth Weight↗
PubMed1976

Legislation relevant to perinatal care.

The legislative process is one route to follow in the attempt to change and improve perinatal care. Payment by the State Crippled Children's Service for medical care of certain costly high-risk neonatal conditions, only to qualified specialists and in centers meeting acceptable standards has had a snowball effect on upgrading neonatal care in this state. Not only has a large network of neonatal care centers and infant transport systems been developed, but there has been a rush especially on the part of nurses, to get special training in neonatal care. This has included not only the care of the sick neonate, but a look at newborn evaluation and resuscitation in the delivery and newborn areas. It is expected that this same center development and education and training process will now be extended to obstetrical care, as there is renewed interest in special care for high-risk mothers because of Assembly Bill 1326. The new hospital perinatal regulations mandate improvement of care in community hospitals where the majority of deliveries take place. The emphasis is on a larger and better educated staff, more concern with patients rights, and provision of a more humanistic family centered care as well as continual evaluation of maternal and neonatal outcome. The greatest limitation has been lack of Health Department staff to provide adequate consultation and surveillance of these services for compliance with the new laws. There has been an approximate 10 per cent reduction in the number of hospitals with maternity services- from 416 in 1968 to 369 today. While much of this consolidation may have been due to the fall in birth rate, these regulations have also contributed to the process. Most important of all, these laws have kept perinatal care constantly in the consciousness of California health care providers and consumers.

California↗
PubMed1975

The need for regional planning of perinatal care.

Regionalisation is urgently needed to provide the best possible maternal, fetal and newborn care. In practice this means organising perinatal care of three specified levels and referring the high-risk problems to the regional centre, preferably before labour and delivery. The programme requires careful planning and constant teamwork.

Child Health Services↗
PubMed1979

Perinatal care and cost effectiveness: changes in health expenditures and birth outcome following the establishment of a nurse-midwife program.

Estimates of infant health status and expenditures for perinatal care are presented for periods of time before and after implementation of a nurse-midwife program in rural Georgia. As the program developed, the infant mortality rate of the four counties served by the program showed a decrease. Similarly, the target population (pregnant women of low to moderate income who had no private physician) experienced decreases in the rate of neonatal mortality, low birthweight, and short gestational age. Estimated expenditures for perinatal care in the four counties decreased as well. These results are examined from the perspective of the National Health Planning and Resources Development Act of 1974 and the utility of using an epidemiologic approach for estimating the output of health services in terms of health status is emphasized.

Cost-Benefit Analysis↗
PubMed1979

The impact of regionalization programs on patterns of perinatal care.

A questionnaire developed to assess changes in patterns of perinatal care related to regionalization programs was sent to all 505 members of The American College of Obstetricians and Gynecologists in the state of Massachusetts. Respondents reported changes in facilities, services, educational experience, and referral and transfer patterns. The implications of these changes are discussed.

Child Health Services↗
PubMed1977

[The differentiated perinatal care for high-risk pregnancies (author's transl)].

The grounds for a change in the organisation of perinatal care in CSSR were the for years stagnating perinatal mortality and high of the perinatal morbidity. Since the modern diagnostics and effective therapy of the high-risk pregnancies represent considerable demands upon the instrumental and personnel equipment, a system of a differentiated ambulatory and institutional care for pregnant women and newborn has been worked out, that will ensure the maximal care to those who need it. The differentiated care for woman in the course of pregnancy and labour and for the newborns in the first weeks of life is divided into three degrees: basic for all, increased for risk cases and specialized for selected complications. The selection of risk cases is performed by means of simple screening methods, a further selection of the most serious cases by means of special diagnostic methods. The system of differentiated care has been worked out and checked in one of the Prague's districs with 200,000 of inhabitants under the guidance of the Institute for the Care of Mother and Child, Prague-Podolí. Now it is being introduced in all districts of the country.

Ambulatory Care↗
PubMed1978

The quality of perinatal care in small rural hospitals.

Iowa birth and mortality statistics were reviewed to ascertain the outcome of perinatal care provided in hospitals with different-sized obstetric services. Although the data do not resolve the issue of the minimum number of deliveries necessary to ensure quality perinatal services, they do suggest that hospitals with small maternity services (fewer than 500 deliveries per year) can achieve acceptable perinatal outcomes when appropriate high-risk screening and prenatal referral occur.

Adolescent↗
PubMed1979

[The organisation of perinatal care in a rural area. An enquiry into the Limousin Region (author's transl)].

Improvement in mortality and perinatal morbidity in rural areas is the result of: The appointment of qualified obstetricians. The provision of modern methods of obstetrical monitoring. The fact that "'avoidable" mortality and morbidity persist in these same rural districts is related to: Premature deliveries and the difficulties of transporting the premature babies. The survival of "country deliveries". We propose three solutions to improve perinatal care in these regions: Transformation of rural maternity units which are under-equipped into Centres where pregnancy can be monitored properly. Avoidance of transfer of the newborn by making it easier to transport the mother to Centres that have a good obstetric and paediatric unit. Provision of a real liaison between the unit that has the obstetrician and paediatrician in it and the district rural maternity services.

Female↗
PubMed1976

Patterns of antenatal care, perinatal mortality, and birth-weight in three consultant obstetric units.

Patterns of antenatal care in three selected consultant units in Britain have been analysed. The study shows that antenatal care operates differently in the three hospitals. Pregnancies resulting in perinatal deaths may not always receive appropriate obstetric care. Patients appear to be at an advantage if they receive consultant-unit care at some stage of their pregnancy.

Ambulatory Care↗
PubMed1975

The quality of perinatal care received by patients in the Greater Harare area during 1973.

The perinatal deaths which occurred during 1973 in the Harare perinatal service were analysed in relation to their obstetric associations. Seventy-one per cent of all the deaths were associated with just five obstetric complications, namely asphyxia in laubour, preterm delivery, minor antepartum haemorrhage, unexplained intra-uterine death and disproportion. It is suggested that asphyxial deaths occurring labour will only be eliminated when continous cardiotocographic monitoring becomes standard practice for all patients. Until then, selected cardiotocography will remain as the main diagnostic aid. Its value will be improved by reviewing the principles of selection. The potential exists to eliminate preterm delivery by the use of beta-adrenergic stimulant drugs. It is suggested that the rational application of this potential would reduce perinatal mortality from preterm delivery. The unexplained intra-uterine deaths and those associated with a minor antepartum haemorrhage presented major problems of understanding and therefore management. These are discussed. Deaths associated with disproportion occurred in 0,10% of booked patients and 3,22% of unbooked patients. The management of the booked patient is satisfactory, and improvement in perinatal mortality will only be achieved by decreasing the number of unbooked patients.

Asphyxia Neonatorum↗
PubMed1976

Regionalization of perinatal care for the United States.

A scheme of regionalization is proposed in which a regional perinatal system within a defined geographic area permits access of the high risk mother-fetus and infant to the appropriate level of technology for improved perinatal outcome.

Child Health Services↗
PubMed1977

Advances in perinatal care: 1970--1980.

Although recognition of the neonate as an entity deserving special consideration was slow at first, the rise of perinatology to the rank of subspecialty has occurred swiftly over the last 25 years. Considerable improvements in both the quantity and quality of perinatal survival have resulted. The more significant recent advances in selected areas (hemolytic diseases, hyperbilirubinemia, maternal diabetes, hyaline membrane disease, nutrition of the tiny premature neonate, infections, monitoring and mother-child interaction) are discussed, and speculations are made about the next five years.

Erythroblastosis, Fetal↗
PubMed1976

Remaining sequelae with modern perinatal care.

The incidence of major sequelae-cerebral palsy (CP), psychomotor retardation (PMR), sensorineural hearing defect, and acquired hydrocephalus--has been studied retrospectively in a nonselected population of 6,5000 3-year-old children born in 1969 and 1970 at one Swedish hospital and treated uniformly according to the principles of modern perinatology. The total incidence of these four types of handicaps was 3.5 per 1,000 when children with congenital malformation syndromes, chromosomal aberrations, verified congenital viral infections, or toxoplasmosis were excluded. The incidence of CP was 1.2 per 1,000. Extreme immaturity, traumatic delivery, postnatal asphyxia, and hyperbilirubinemia were found to be relatively small factors as causes of sequelae in this population. Babies showing various degrees of intrauterine malnutrition were found to be the major remaining group at risk for PMR and/or CP, two thirds of children with these handicaps being recruited from the 16% of newborns with birthweights more than 1 SD below normal in relation to gestational age. The most important further gains can probably be made by earlier intrauterine diagnosis of these cases, induced termination of pregnancy in selected cases, and further studies on the perinatal treatment and adaptation of these infants.

Birth Weight↗