Acute renal insufficiency: Physiopathology and treatment, with presentation of cases occurring on an obstetric service

Abstract

1.1. Maternal mortality rates are now so low that, for conservation of life, the fetus rather than the mother has become the primary concern of the obstetrician.2.2. More deaths occur in the first month of life than during all other periods in the pediatric age group up to 15 years.3.3. Of 150,000 fetal deaths each year, one-half are still births and one-half are neonatal deaths.4.4. Ninety per cent of this fetal loss is attributed to prenatal and natal causes.5.5. Pediatricians have requested and have been assigned the responsibility for the care of the newborn but they can function only as salvage officers whose results are limited by conditions already in effect.6.6. Infants under 1,500 grams comprise only 1.4 per cent of deliveries, but 36.9 per cent of fetal and neonatal deaths are in this group. Over half of these infants die within 24 hours of delivery. Since the combined mortality rate in this weight group is 78 per cent, the only prospective method for reduction of fetal loss is the prevention of prematurity.7.7. The infants who weigh between 1,500 and 2,500 grams comprise only 6.8 per cent of deliveries, but account for 29 per cent of the deaths. The combined stillbirth and neonatal mortality rate in this weight group has been reduced to 15 per cent and can probably be lowered further.8.8. Ninety-three per cent of deliveries are at term but they account for only 33.6 per cent of fetal deaths.9.9. Forty-seven per cent of stillbirths result from anoxia associated with premature separation of the placenta, placenta previa, or cord complications. An additional 10.4 per cent result from trauma. In 17.5 per cent stillbirth results from the fetal factors of congenital anomaly or erythroblastosis. In 16.8 per cent, the cause, other than prematurity alone, remains unknown.10.10. In contrast to stillbirths, only 10.5 per cent of neonatal deaths are directly due to anoxia. About 19.1 per cent are due to trauma, chiefly intracranial hemorrhage discovered at autopsy. The remainder of neonatal deaths are explainable by congenital anomalies (20.4 per cent), infection (5.9 per cent), erythroblastosis or maternal diabetes (10.5 per cent), hyaline atelectasis (14.5 per cent), and prematurity or unknown (19.1 per cent).11.11. In infants over 2,000 grams delivered by cesarean section the mortality rate is eight times that for those delivered by the vaginal route, and we are convinced that cesarean section should rarely be done in the primary interest of the fetus.12.12. Toxemia of pregnancy is related to fetal and neonatal mortality only to the degree that it increases the absolute number of premature deliveries.