Respiratory distress syndrome (RDS) is a major contributor to neonatal mortality worldwide. However, little information is available regarding rates of RDS-specific mortality in low-income countries, and technologies for RDS treatment are used inconsistently in different health care settings. Our objective was to better understand the interventions that have decreased the rates of RDS-specific mortality in high-income countries over the past 60 years. We then estimated the effects on RDS-specific mortality in low-resource settings. Of the sequential introduction of technologies and therapies for RDS, widespread use of oxygen and continuous positive airway pressure were associated with the time periods that demonstrated the greatest decline in RDS-specific mortality. We argue that these 2 interventions applied widely in low-resource settings, with appropriate supportive infrastructure and general newborn care, will have the greatest impact on decreasing neonatal mortality. This historical perspective can inform policy-makers for the prioritization of scarce resources to improve survival rates for newborns worldwide.

A substantial reduction in pre-eclampsia/eclampsia-related mortality could be made in low-income countries by widespread hypertension and proteinuria screening and early delivery of women with severe disease. Magnesium sulfate may reduce mortality, but should not be the cornerstone of maternal mortality reduction programs.

P regnancy can trigger the first episode of depression in a women or a recurrence of depression in those women with a prior history of the disorder. The prevalence of depression during pregnancy is estimated at 8% to 51%. The wide range in cited prevalence can be due to variations in the criteria used to diagnose depression and the timing and types of assessments used for evaluation of the disorder. This study evaluated the time to onset, duration, and risk factors for major and minor depression in pregnant women.The women were recruited from the Centers for Prenatal Care of the Public Health Service District in Mantova, Italy from September 2005 to August 2006. At each monthly visit, the study participants completed the Primary Care Evaluation of Mental Disorders (PRIME-MD) for screening of depressive disorders and the Hospital Anxiety and Depression Scale (HADS) for evaluation of the severity of anxious and depressive symptoms. The patients also completed a brief questionnaire for sociodemographic data. The PRIME-MD evaluates the presence of 9 depressive symptoms occurring in the previous 2 weeks. The HADS is a 14-item self-administered test that evaluates anxiety and depression in a nonpsychiatric population; it generates 2 subscale scores, that is, an anxiety and a depression score. Comparisons were made among women with minor or major depression and those without depression.Of 193 women who visited the center during the study period, 154 completed the study; their mean age was 30.8 ± 4.4 years, and the mean number of assessments completed during pregnancy was 6.2 ± 0.5. Nineteen (12.3%) and 28 (18.1%) women had major and minor depression, respectively, and 107 had no depressive symptoms. Those without depressive symptoms served as the control group. The 3 groups of women were similar in age, education, and family status although a larger number of women in the depression groups (26.3% in major depression group and 32.1% in minor depression group) were housewives compared with the controls (6.5%). Women with major depression had more frequent conflict with a husband or partner than women in the control group [odds ratio (OR), 7.8; 95% confidence interval (CI), 1.0-62.7]. No differences were found among the groups in the rates of family and job problems, presence of family support, and unwanted pregnancy. Major depression had a later onset (5.6 ± 2.8 mo vs. 2.3 ± 1.7 mo, respectively; P = 0.09) and longer duration (3.5 ± 2.2 mo and 1.6 ± 0.7 mo, respectively; P = 0.03), compared with minor depression. Among those with depression, 6 mothers with major depression and 2 with minor depression were still depressed at the final evaluation before delivery. No depressed women were treated with antidepressants or other psychotropic drugs, and only 2 women with major depression received psychologic support. Compared with nondepressed women, predictive factors at the beginning of pregnancy for the development of major depression were a history of a previous depressive episode (OR, 9.5; CI,) and conflict with a husband or...

OBJECTIVE To examine the outcomes of neonates born by elective repeat cesarean delivery compared with vaginal birth after cesarean (VBAC) in women with one prior cesarean delivery and to evaluate the cost differences between elective repeat cesarean and VBAC. METHODS We conducted a retrospective cohort study of 672 women with one prior cesarean delivery and a singleton pregnancy at or after 37 weeks of gestation. Women were grouped according to their intention to have an elective repeat cesarean or a VBAC (successful or failed). The primary outcome was neonatal intensive care unit (NICU) admission and measures of respiratory morbidity. RESULTS Neonates born by cesarean delivery had higher NICU admission rates compared with the VBAC group (9.3% compared with 4.9%, P=.025) and higher rates of oxygen supplementation for delivery room resuscitation (41.5% compared with 23.2%, P<.01) and after NICU admission (5.8% compared with 2.4%, P<.028). Neonates born by VBAC required the least delivery room resuscitation with oxygen, whereas neonates delivered after failed VBAC required the greatest degree of delivery room resuscitation. The costs of elective repeat cesarean were significantly greater than VBAC. However, failed VBAC accounted for the most expensive total birth experience (delivery and NICU use). CONCLUSION In comparison with vaginal birth after cesarean, neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay.

OBJECTIVE Fetal lung maturity often is used as the sole criterion that late preterm infants are ready for postnatal life. We therefore tested the hypothesis that fetal lung maturity testing does not predict the absence of morbidity in late preterm infants. STUDY DESIGN We performed a retrospective cohort study to examine 152 infants who were born in the late preterm (34 0/7 to 36 6/7 weeks) and early term (37 0/7 to 38 6/7 weeks) periods after mature fetal lung indices and compared them with 262 infants who were born at ≥39 weeks’ gestation and who were matched by mode of delivery. RESULTS Despite documented fetal lung maturity, infants who were born at <39 weeks had significantly higher rates of neonatal morbidities compared with infants who were born at ≥39 weeks’ gestation. After adjustment for significant covariates, we found that infants who were born at <39 weeks’ gestation had an increased risk of composite adverse outcome (odds ratio, 3.66; 95% confidence interval, 1.48–9.09; P < .01). CONCLUSION Fetal lung maturity testing is insufficient to determine an infant’s readiness for postnatal life.