EXCESSIVE PERINATAL MORTALITY IN A SMALL TOWN ASSOCIATED WITH EVIDENCE OF TOXOPLASMOSIS

Abstract

The small town of Barton on Humber in North Lincolnshire district England experienced a stillbirth rate of 59.6 for the years 1956 1957 and 1958. During the same 3 year period the neighboring town of Brigg had a stillbirth rate of 9.0 and the surrounding rural district had a rate of 28.1. The differences in numbers of stillbirths occurring in these districts were statistically significant. This discussion describes the investigations made to determine the cause of the excess of stillbirths experienced in Barton on Humber. As it was already apparent by the end of 1957 that the excessive mortality in Barton was unlikely to be due to chance a preliminary survey was begun. The county medical officer of health arranged for the midwives to complete a questionnaire focusing on all stillbirths and early neonatal deaths occurring in the 3 county districts. From the questionnaires it soon became evident that the fetus was either malformed or macerated in almost 2/3 of all stillbirths in the area suggesting that the factors responsible must be nonobstetric and that an inquiry must consider possible genetic and environmental influences if it was to be successful. 19 women who were residents of Barton on Humber and had stillborn babies during 1956 1957 and 1958 were identified and traced. For each of these women 2 control mothers of live babies born in the same months were selected. A questionnaire was designed to obtain information regarding past obstetric history consanguinity between parents occupation of father details of work outside the home illnesses during pregnancy dental treatment anesthetics x rays medical treatment recreational habits contact with animals and details of the pregnancy under review. In only 3 of the 19 stillbirths is it possible to state the cause with any certainty. In 1 case the fetal heart stopped after the mother was injured in a fall at the 27th week of pregnancy. In another patient the transverse lie of the fetus was due to a large fibromyoma which filled the placenta and to which a low lying placenta was adherent. In a 3rd case there was a placent previa and the cord encircled the babys neck. The most notable difference between the 2 groups of mothers was in respect of toxoplasma dye test titres. As stillbirth may be caused by toxoplasmosis either primarily as a result of the infection or secondarily as a result of obstetric difficulty due to hydrocephaly or malpresentation the finding of a significant excess of toxoplasma dye test titres of mothers of stillbirths supported by a relatively high incidence of hydrocephaly suggests that toxoplasmosis may have caused a proportion of these stillbirths. There was a significantly higher incidence of cytoplasm modifying antibody to Toxoplasma gondii in the women whose babies had been stillborn when compared with the other mothers.