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The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non-anaemic women suffering from severe pre-eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre-eclampsia causes increased blood viscosity which predisposes to placental pathology and initiates a vicious circle.

Out of all the women who were delivered in Cardiff maternity units during 1965-74, 43 developed eclampsia, an incidence of 72/100 000 deliveries. The incidence in residents of Cardiff was 53/100 000 deliveries. None of the mothers with eclampsia died, but 10 of the 47 babies were lost, all but one having been born to women with antepartum eclampsia. The perinatal deaths were mainly associated with chronic placental insufficiency and preterm delivery. The extent to which the wide range of complex drug regimens used influenced perinatal outcome is not clear, although polypharmacy should be avoided. Because eclampsia is rare we advocate that its management should be planned and rehearsed and that a simple, standardised treatment regimen should be used. Failing placental function may be detected by monitoring fetal growth by ultrasound.

A regression analysis using a linked file of all Swiss births und perinatal deaths 1979–1981 showed a significant relation between birthweight and canton. Sex of infant and multiplicity of birth were significant, too. For live births, marital and socio-economic status of mother and father relate to birthweight. Logistic regressions brought out relationships between the risk of stillbirth and occupation of father, nationality and marital status of mother, apart from birthweight. For live births, only sex and (weakly) marital status and rank of the child were influencial after correction for birthweight. Une analyse multivaariee des donnees sur la mortalite perinatale descrites en (1) montre une relation significative entre poids de naissance et canton. D'autres analyses demontrent des relations entre l'etat civil de la mere, l'occupation du pere et le poids de naissance pour les enfants morts dans les premieres heures. Des regressions logistiques montrent des cofacteurs de la mortalite independantes du poids de naissance: occupation du pere, nationalite' et etat civile de la mere pour les nes-morts, etat civil de la mere et sexe pour les nouveaux-nes morts.

SummaryIn a series of 2000 patients, labour was induced routinely in 350 whose pregnancies were continuing at 41 weeks. Maturity had been confirmed by early ultrasound at about 18 weeks. Labour was induced with prostaglandin E2 vaginal pessaries, followed a day later by surgical rupture of the membranes for the 40 per cent of patients who were not in labour. The caesarean section rate in the 350 patients whose labours were induced routinely was 5·7 per cent and none of these was for failed induction. There were no perinatal deaths, no problems with respiratory distress of the newborn and no increase in the incidence of neonatal jaundice

The neuropathologic conditions in 120 perinatal deaths attributed to fetal or newborn asphyxia were examined. Central nervous system necrosis was present in 16 of these deaths. The approximate time of asphyxial insult was established by determining the duration of the process, based on the findings of neuronal necrosis, macrophage response, or an astrocyte response, in conjunction with clinical data. The time of the asphyxial insult for the 16 perinatal deaths was as follows: antepartum fetal asphyxia, two cases; antepartum-intrapartum fetal asphyxia, five cases; intrapartum fetal asphyxia, four cases; and neonatal asphyxia, five cases. These observations indicate that an asphyxial insult may occur in the antepartum period, in the prodromal period of preterm labor, in the intrapartum period, and in the neonatal period. Five to ten percent of the asphyxial insults in each reproductive time period were initially sublethal, allowing necrosis of the brain of the fetus or newborn to develop.

1. 1. A review of 6,860 cases of electively induced labors has been presented. 2. 2. The most effective method of inducing labor is simple amniotomy. 3. 3. Eighty-two and three-tenths per cent of the patients were in labor within 4 hours, and only 2.3 per cent had a latent period of over 24 hours. 4. 4. Pitocin stimulation was used in patients with prolonged latent periods or desultory labors with intrapartum fever. 5. 5. Serious though must be given to performance of cesarean section when the latent period is prolonged and infection is present, if labor cannot be stimulated within 24 to 36 hours. 6. 6. There was one maternal death related to induction. 7. 7. The principal fetal hazards were (a) prematurity, 3.1 per cent; (b) prolonged latent period, 5.0 per cent; (c) malpresentation, 0.9 per cent; (d) prolapsed cord, 0.3 per cent. 8. 8. There were 6,889 babies born. Of these, 37, or 0.6 per cent, were 9. stillborn, and 55, or 0.8 per cent, died neonatally. The perinatal mortality was 1.4 per cent. 10. 9. Thirty-nine of the perinatal deaths (0.6 per cent of the babies delivered) were directly related to the elective induction. 11. 10. A conservative attitude should be maintained by the specialist toward the elective induction of labor. The average general physician should allow labor to start spontaneously.

In recent years, perinatal medicine has become one of the most rapidly growing clinical disciplines. New developments in any subspecialty demand attention from pathologists concerned with that area, hence, the arrival of this book is timely. Developmental Pathology of the Neonate is a synthesis of postmortem observations from thousands of perinatal deaths studied at the Research Center for Biological Development of the Fetus and Newborn and at the Port Royal Maternity Hospital in Paris. There is a strong emphasis on clinicopathologic correlation throughout the book. The text is divided into 24 chapters in which each important organ system is represented. Separate chapters deal with hemolytic disease of the newborn, nonimmunologic hydrops fetalis, the untoward effects of umbilical catheterization, and placental pathology. Cytobacteriologic examination of the placenta and membranes is recommended for more rapid diagnosis of neonatal infection. The placenta is also useful for tissue and biochemical diagnosis of storage disorders

All 315 perinatal deaths in Nassau County in 1973 were reviewed by a panel of obstetric and pediatric perinotolegists. Preventability, based on the presence or absence of factors which would have materially lessened the risk of death, was delineated for each perinatal death. Perinatal death rates (PDR) and preventable perinatal death rates (PPDR) were developed for each hospital. All deaths were attributed to the hospital of birth. Size of obstetric service was defined as the total number of births per hospital. The mean PDR was 20.3 with a range of 12.0-50.3/1000 live births; the mean PPDR was 4.9 with a ranoe of 2.0-10.1/1000 live births. There was a significant inverse correlation between the size of a hospital's obstetric service and its PDR (p < 0.02). There was no sianificant correlation between the size of a hospital's obstetric service and its PPDR. These findings suggest that a hospital's obstetric service size should be considered in conjunction with mortality data (PDR) and an assessment of quality of care (PPDR) when regionalizing perinatal services.

We have reviewed 934 perinatal deaths from 1976 through 1983 among 28,000 inborn births in an urban perinatal center hospital. During perinatal mortality review the principal cause of death was assigned by one individual (JBP) into 7 fetal and 7 neonatal major diagnostic groupings; autopsy information contributed to assignment in 80%. Perinatal asphyxia accounted for approximately 50% of the neonatal deaths; over time there tended to be a redistribution with increased contribution from the 500-750g group. Congenital anomalies decreased from 11.7% to 9.1% while infection tripled from 8.3% to 25%. The most impressive change was the decrease in immaturity as the principal cause from 21% to 4.5%; this change may represent an artifact of having more information available for the review process. For 33% of fetal deaths cause was undetermined. The next common cause was placental abruption, 18.5% overall, with no real change over time; in contrast maternal disease and Rh disease decreased from 12% to 10% respectively to 2.3% for each group. The wt specific distribution of perinatal mortality, except for >2500g, has been progressively towards the

The perinatal mortality rate has declined dramatically in the United States during the last three decades. Prematurity accounts for 70% to 80% of all perinatal deaths that are not caused by severe congenital malformations, 1 yet the rate of prematurity has not declined in the last 30 years. Thus, the decline in perinatal mortality is attributable to improved neonatal care, which has been achieved only at great cost. The estimated cost of term and premature neonatal care in the United States in 1980 was $460 million. If all neonates treated in neonatal intensive care units had instead been delivered as healthy term babies, the estimated cost for all neonatal care would have been only $50 million. 2 The additional cost of subsequent neurological morbidity in premature newborns who survive is difficult to assess. Further reduction of the perinatal death rate and the cost of neonatal care and of subsequent morbidity

Detailed postmortum examinations including chronosomal studies were performed on 100 unselected babies delivered in the Greater Vancouver Regional Hospital District during a one year period. Multiple congenital anomalies (MCA) were noted in 23 cases. Of these, a recognizable pattern of genetic malformation was identified in 18 cases and a chromosomal abnormality in 3 other cases. Chromosomal cultures grew in 8/59 cases of intrauterine deaths, 7/24 intrapartum deaths and 14/17 early neonatal deaths. The risk of recurrence was high (2-25%) in 11/23 of those MCA cases. Amniocentesis for prenatal diagnoses is available to monitor subsequent high risk pregnancies. Attention is drawn to the significant (20%) mount of recognizable heritable disease in cases of stillbirths and perinatal deaths.

During 1980 to 1984, 279 deaths occurred among 15,306 births in a regional perinatal unit. Survival to discharge corrected for lethal malformations was 81% or better in infants with a birth weight above 749 gm. Congenital malformations (23.2%), infections (21.3%), asphyxia (19.8%), and hyaline membrane disease (11%) caused most perinatal deaths.

Chromosome studies by fibroblast culture of autopsy material were attempted on 762 perinatal deaths seen over a 4-yr period. Results were obtained from 593 (77.8%) cases; the main reasons for failure were maceration and infection. Results from macerated foetuses can usually only be obtained by culture of the placental amnion, but even this does not always produce results. Twenty-eight (4.7%) major chromosome abnormalities were detected, the most common being trisomy 18. Clinical studies of these infants suggest that trisomy 18 is underdiagnosed as the malformations may be so severe as to obscure the diagnosis. Over the same period, chromosome results from 153 other autopsies made up of 27 late (spontaneous) abortions and 126 children aged more than 28 days, were obtained and 13 (8.5%) were found to have major chromosome abnormalities. Chromosome study was introduced as a routine procedure at the Adelaide Children's Hospital in May 1975. Results obtained to date from 290 successful studies have revealed that 15 (5.2%) had a major chromosome abnormality. The data are analysed according to age and cause of death. It is concluded that chromosome study should become an integral part of all perinatal autopsies, and, whenever possible, of other paediatric autopsies as well.

Extract Perinatal deaths are common among piglets in New Zealand. They tend to occur in epidemics, they are independent of the type of soil or of feeding practices, and are most common in the litters of young sows and of those recently introduced into the piggery. Affected sows may show signs of sickness and inappetence before farrowing, and the piglets are usually born dead (delivered in intact foctal membranes) or they may be weak and die within 24 hours of birth. A sow that has once delivered dead piglets rarely, if ever, does so at later farrows.

This 308 page hardcover summary of a conference costs $8.50. At 2¾¢ per page (typewritten print!) it is at best a poor buy. The book presents current as well as potential techniques for monitoring mutagenesis and teratogenesis, topics of particular interest in this era of environmental, ecologic disaster. Unfortunately, in the words of one of the contributors, the volume is "heavy on theory and light on accomplishment" (page 246). The following general methods are discussed in an exhausting, tedious, and inarticulate manner. Prenatal methods, employing detailed anatomic examination of all fetal deaths as well as amniotic fluid analyses are not logistically practical in an era when viable perinatal deaths are seldom autopsied or carefully examined. Monitoring for major and minor malformations using both retrospective (death certificate) and prospective techniques also appears to be logistically impractical and unrewarding. Again, the most telling criticism comes from one of the contributors (page 103)

The purpose of this communication is to record the occurrence of hyaline membrane disease of the lung in Thailand. A review of the autopsy records for 1959 at the Chulalongkorn Medical School in Bangkok disclosed 9 cases of hyaline membrane disease among 58 postmortem examinations conducted on infants who died during the perinatal period. The most recent year, 1959, for which autopsy records were available was selected for study. A total of 65 perinatal deaths was tabulated in the autopsy records of this year. Each of these cases was reviewed, and lung sections were restudied. Material from 7 cases was not available for review, and they were therefore excluded from consideration. Of the remaining 58 cases, 9, or about 15%, showed the classical changes of hyaline membrane disease. All of these 9 infants were alive at birth, succumbing in from 7 to 37 hours after delivery. The birth weight ranged