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Background: While traditionally Maori perinatal mortality has been similar to that of other ethnic groups, rates of preterm birth, small for gestational age (SGA) and teenage pregnancy have remained high., Aims: To review current trends in preterm birth, SGA and teenage pregnancy for Maori during 1980-2001 and to highlight the major factors that have influenced Maori reproductive outcomes during this period., Methods: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001., Results: During 1980-1994, Maori women had the highest preterm birth rates of any ethnic group in New Zealand, but in relative terms, inequalities declined as a consequence of a non-significant 7% fall in rates being offset by a statistically significant 30% increase for the European/other ethnic group. Rates of SGA were also higher amongst Maori women but declined by 25% during the 1980-1994 period. In addition, Maori women experienced significant socioeconomic gradients in SGA, with risk for Maori women in the most deprived NZDep areas being double that of Maori living affluent areas. Paradoxically, while Maori women had high rates of teenage pregnancy, this did not confer additional risk for preterm birth or SGA during the 1996-2001 period., Conclusions: While high rates of teenage pregnancy amongst Maori women appear not to confer additional risk for preterm birth or SGA, the social consequences of early childbearing may well be significant. The persistence of elevated rates of preterm birth and large socioeconomic gradients in SGA amongst Maori suggest that broader social and policy interventions are necessary if Maori are to achieve optimal birth outcomes in the coming decades.

Background: Pacific women in New Zealand reside in areas of higher socioeconomic deprivation compared to women from other ethnic groups. Pacific women and their health are further disadvantaged because of genetic predisposition and sociocultural factors that cause ill-health. The correlations between pregnancy outcomes, risk factors and other health indices in Pacific women need evaluation., Aims: To examine trends in preterm birth, small for gestational age (SGA) and late fetal death for Pacific women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome., Methods: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001., Results: Pacific women had the lowest rates of preterm birth and SGA when compared to Maori and European women. In addition, preterm birth rates underwent a non-significant 4% decline and SGA rates a 30% decline during 1980-1994. Although there has been a 49% decline in late fetal deaths during 1980-1994, the rate remained higher for Pacific women than for Maori and European/other women., Conclusions: Despite residing in areas of high socioeconomic deprivation, which is associated with poor pregnancy outcomes for Maori and European/other women, Pacific women had better pregnancy outcomes, with lower preterm and SGA rates. The significant decline in rates of late fetal death during the past two decades is a cause for celebration; however, the rate remains higher for Pacific women than for other ethnic groups. Biological, cultural and social factors might explain the better pregnancy outcomes for Pacific women and these factors should be considered when developing future prevention programmes.

Background: In the early 1980s European/other women made up 80% of New Zealand's population and experienced rates of preterm birth that were lower than for other ethnic groups. Rates of small for gestational age (SGA) and late fetal death were intermediate between those of Maori and Pacific women., Aims: To examine trends in preterm birth, SGA and late fetal death for European/other women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome., Methods: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001., Results: During 1980-1994, rates of preterm birth rose by 30% for European/other women, in contrast to a non-significant decline of 7% for Maori women and 4% for Pacific women. Rates of SGA declined 19% for European/other women, compared to 25% for Maori and 30% for Pacific women. Preterm birth and SGA were positively associated with teenage pregnancy and increasing NZDep deprivation. During 1980-1994, rates of late fetal death declined by 49%, with declines being similar for all ethnic groups., Conclusions: The progressive rise in preterm birth during the past two decades is a cause of concern for European/other women, particularly as it appears confined to this ethnic group. While rates of SGA have declined, albeit at a slower rate than for other ethnic groups, the elevated risk amongst teenagers and those living in the more deprived NZDep areas suggests that greater gains are achievable if interventions are targeted towards these particular groups.

Background: New Zealand Government policy during the past decade has placed a high priority on closing socioeconomic and ethnic gaps in health outcome., Aim: To analyse New Zealand's trends in preterm and small for gestational age (SGA) births and late fetal deaths during 1980-2001 and to undertake ethnic specific analyses, resulting in risk factor profiles, for each ethnic group., Methods: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for the period 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and New Zealand Deprivation Index decile. Trend analysis was undertaken for 1980-1994 while multivariate logistic regression was used to explore risk factors for 1996-2001., Results: During 1980-1994, preterm birth rates were highest amongst Maori women. Preterm rates increased by 30% for European/other women, in contrast to non-significant declines of 7% for Maori women and 4% for Pacific women during this period. During the same period, rates of SGA were highest amongst Maori women. Rates of SGA declined by 30% for Pacific women, 25% for Maori women and 19% for European/other women during this period. Rates of late fetal death were highest amongst Pacific women during 1980-1994, but declined by 49% during this period, the rate of decline being similar for all ethnic groups., Conclusions: The marked differences in both trend data and risk factor profiles for women in New Zealand's largest ethnic groups would suggest that unless ethnicity is specifically taken into account in future policy and planning initiatives, the disparities seen in this analysis might well persist into future generations.

Medical students on their obstetrics and gynaecology attachment were randomly assigned to attend hospital (n = 24) or general practice (n = 18) obstetric clinics once weekly for 4 weeks. The students completed self-assessment questionnaires at the beginning and end of the attachment. There was a significant improvement in the level of knowledge and skills required for antenatal care, care in labour and postnatal care by the end of the attachment, with no difference between hospital or general practice groups. There was a significant increase in the level of interest in the future practice of obstetrics only in the general practice group. However, this difference could be explained by the greater number of students in the general practice group who were by chance in the 'no or don't know' category at the start of their attachment. We conclude that general practice based clinical teaching of obstetrics can be a suitable alternative to hospital-based clinical teaching for undergraduate medical students.

Objective: To develop a statistically derived but clinically usable antenatal risk scoring system., Methods: Data from 20,985 pregnancies were statistically analyzed to identify significant risk factors. Logistic regression analysis was then used to produce a final scoring system, which was subsequently tested for validity on a separate population of 3120 pregnancies., Results: Twenty-seven significant antenatal variables were included in the final scoring system. Application of the system in early pregnancy resulted in a predictive accuracy of 0.73; at the onset of labor, predictive accuracy was 0.91. At the time of labor, 87% of poor outcomes were accurately identified by allocation of only 16% of the women to the high-risk group., Conclusions: It was possible to develop a risk scoring system with a predictive accuracy higher than any previously reported statistically derived score. Summation of the logistic coefficients provides a score that by comparison with a chosen threshold identifies a high-risk pregnancy. In this way, despite the complexity of statistical analysis, all clinicians can quickly apply this scoring system.

A retrospective case-control study was designed to assess risk factors for neonatal infection. Nonprivate patients (8,215) who delivered in a period from January 1, 1983 to June 30, 1988 were studied. Ninety three cases of conjunctivitis (incidence 2.4/1,000), 104 cases of pneumonia (incidence 2.8/1,000), and 50 cases of sepsis (incidence 1.3/1,000) were identified. Group B streptococcus was cultured from septic neonates in 46%. Calculated Odds ratio's indicated prematurity/low birth-weight (OR 6.9) and antepartum fetal tachycardia (OR 6.3) as important risk factors for pneumonia/sepsis. Prematurity/low birth-weight (OR 3.0) and an abnormal presentation in the birth canal (OR 2.8) were identified as risk factors for conjunctivitis. After testing all the risk factors found by univariate analysis in a logistic regression model tachycardia (chi 2 35.21, p less than 0.001) remained an independent predictor for neonatal pneumonia/sepsis and abnormal vaginal presentation (chi 2 7.58, p 0.006) for conjunctivitis.

Simultaneous observations of the movements of opposite sides of the human fetal trunk were made by an ultrasonic device. Rhythmical excursions that were in time but out of phase were recorded from the lateral chest walls. These movements are considered to be the result of changes in the shape of the chest and are consistent with breathing movements. Large excursions of the antior abdominal wall compared to the chest movements suggest that the diaphragm shares in the breathing movement.

A new low-frequency Doppler shift signal associated with fetal breathing has been observed. This signal is out of phase with the previously described signal from the inferior vena cava and originates from the umbilical vein.

One hundred and ninety eight stillbirth deliveries occurred in three major obstetric departments of Auckland hospitals between July, 1983 and June, 1986. Post mortem examinations were performed in 74.7% of cases. The overall stillbirth rate was 5.92 per 1000 total births and the major causes of death were fetal abnormality, fetal anoxia and unexplained fetal death. Of normally formed stillbirths, about 60% occurred in uncomplicated pregnancies. Intracranial haemorrhage was common amongst Pacific Island patients while abruptio placentae occurred more commonly in caucasians. The study suggests that stillbirths occur more commonly in small for dates infants at earlier gestations, but this trend has disappeared by term. Cord problems were rare and occurred mainly in babies over 2500 g, and the absence of post mortem evidence of anoxia in the majority of these babies may suggest that the cord complications occurred as a post mortem phenomenon. Cardiotocographs were recorded 24 hours prior to death in 16 patients. The risk of stillbirth during each subsequent week of pregnancy is calculated and it is found that this risk increases sharply after 42 weeks gestation.

Fifty-five consecutive adolescents, aged sixteen years or under at delivery, were cared for at a special antenatal clinic by one nurse and doctor and educated about pregnancy, health and reproduction. A philosophy of self-care and respect was engendered in these adolescents by the nurse and doctor. The effects of such care on the pregnancy and outcome were compared with a group of 55 consecutive patients (of similar age and background) cared for by the general clinic immediately prior to the introduction of the special care clinic. Urinary tract infection, anaemia, premature labour, fetal distress, operative delivery, primary postpartum haemorrhage, low birth weight infants, infant admission rate to neonatal unit and artificial feeding, were all significantly less common in the special clinic patients who also rarely missed outpatient appointments.