The Scottish perinatal mortality survey.

Abstract

1103reduces the second, and evidently has little effect on the third: thus there is no major penalty to the heart in terms of oxygen uptake for the increased flow that is generated. With the exception of other vasodilators most agents capable of augmenting cardiac output do so at greater metabolic cost.As with most clinical studies, some compromises were made in design to safeguard the overriding interests of the patients. We were anxious to establish the most appropriate treatment for each patient with little delay and were therefore unable to return to control conditions after each infusion rate to distinguish drug effect from possible spontaneous improvement. We thought it justifiable, however, to interrupt treatment once after the 40 ,tg/min dose regimen in eight of our 11 patients to show that the haemodynamic variables returned to the pretreatment values; only mean arterial pressure remained appreciably different from control readings in most patients. We chose to use pulmonary artery end-diastolic pressure as a measure of left ventricular filling pressure to avoid repeatedly wedging the Swan-Ganz catheter, since frequent changes in position or balloon inflation carry small risks. Though the measurement tends to underestimate true left atrial pressure in the presence of heart failure,15 the correlation between the two indices is close and changes are faithfully reflected.Salbutamol has little effect on "backward failure" as shown by the increased pulmonary artery end-diastolic pressure in our patients and therefore cannot be recommended for the treatment of pulmonary oedema in acute myocardial infarction.It is not useful if an increase in blood pressure is believed to be essential. Our results suggest, however, that salbutamol is a useful and safe method of increasing cardiac output in those patients with myocardial infarction in whom poor perfusion is the most important haemodynamic disturbance. Circulation, 1978, 58, 466. 7Walinsky, P, et al, American3Journal of Cardiology, 1974, 33, 37. 8 Franciosa, J A, et al, Lancet, 1972

Perinatal Mortality at the Armed Forces Hospital, Riyadh, Saudi Arabia: Five-Year Review of 22,203 Births

“…This rate is higher than that reported by others 3,11,15,16,26,35 but similar to that reported in Scotland for Avon and the Mersey region. 2,36,37 The high rate in the present study may be explained by the high incidence of consanguineous marriages among Saudis. Of the patients attending antenatal clinics of the Armed Forces Hospital, 25% were married to their first cousin.…”

“…Causes of death were classified according to a modified version of the Aberdeen classification. 2,3,34 The causes of death were listed according to the fetal or maternal condition that was most likely to be directly involved in the fetal death. Prematurity was defined as gestation below 37 weeks whereas infants over 42 weeks were considered postmature.…”

“…Large national perinatal mortality surveys conducted in Western countries have had a major influence in outlining problem areas and stimulating efforts toward reducing perinatal loss. [1][2][3] The definition of fetal death differs among various public health authorities, however, and this makes international comparison difficult. [4][5][6][7][8][9][10][11][12][13][14][15] Sociological and biological differences between countries and regions within countries further depreciate perinatal mortality figures as indicators of the adequacy of maternity services.…”

Perinatal Mortality at King Khalid University Hospital, Riyadh

“…In spite of the drawback, developed countries have used large national surveys to outline areas of deficiency and take corrective measures toward reducing perinatal loss. 12 Many reports about health and perinatal care in Saudi Arabia have appeared in the literature, [13][14][15][16] but as we discovered, 5 the definitions of perinatal mortality vary from report to report and from author to author, occasionally resulting in different figures from the same institution. 17,18 While there is a need for collecting and disseminating perinatal statistics at national, regional, and local hospital levels, there is an urgent need to apply standard definitions such as those recommended by WH0 [6][7][8] and FIG0.…”

Confidential paediatric inquiry into neonatal deaths in Wessex, 1981 and 1982.

“…Wessex has one of the lowest neonatal death rates in the United Kingdom, but, nevertheless, this study suggests that improvements could still be made.8 For example, the death rate from lethal or severe malformations, currently 2-2/1000 live births, is already lower than that in Belfast (4-1)2 and in Avon (3 6).4 If screening of ax fetoprotein concentrations was universally provided and the specificity of the test improved, however, the death rate could be reduced to below [1][2][3][4][5][6][7][8] if affected mothers underwent therapeutic legal termination.…”