The causes of fetal and neonatal mortality

Abstract

1.1. The study is concerned with a report of 1,000 fetal deaths occurring among 25,823 deliveries at New York Hospital and the Sloane Hospital for Women. On the basis of live births, the gross fetal mortality rate was 4.03 per cent. If only the viable infants are included, the rate is 3.66 per cent.2.2. Asphyxia is the most common cause of fetal death.3.3. There is a higher fetal death rate in the Negro.4.4. Multiparas and primiparas show essentially the same fetal death rate.5.5. The greatest net gain of living over dead children occurs among women between 20 and 24 years of age. After the age of 30 the woman delivers a proportionately greater number of dead babies than she did before that age.6.6. In labors that exceed thirty hours, the fetal mortality rate doubles.7.7. Spontaneous deliveries show the lowest fetal death rate. High forceps show the highest.8.8. On the basis of the material studied, a reduction of the fetal death rate suggests the following: 8.1.(a) Labors that exceed thirty hours in duration should receive the benefit of consultation, unless delivery is imminent.8.2.(b) Interference should be avoided unless absolutely justifiable; the best results are obtained in spontaneous deliveries.8.3.(c) Pelvic conformation should be studied roentgenologically if there is doubt. Both see and feel the cephalopelvic relationship.8.4.(d) The mechanism of delivery should be adapted to the architecture of the pelvis in operative deliveries.8.5.(e) In dystocia, avoid interference if progress is being made even though the progress is slow, but do not unnecessarily delay delivery if progress has come to a standstill.8.6.(f) The asphyxiated baby should be treated before delivery. Avoid hurry in delivering these babies.8.7.(g) The fetal heart should be auscultated frequently for one-half hour after membranes rupture.8.8.(h) Examine patient after the membranes rupture if the presenting part was high prior to their rupture.8.9.(i) Examine for tight cord around neck when there is no other obvious cause for asphyxia.8.10.(j) Use sedatives sparingly when labor is going to be prolonged. Use them freely in cases of precipitate labors.8.11.(k) Use pituitrin with great care if at all before parturition.8.12.(l) Save premature babies by adequate pediatric organization. The first twenty-four hours are the most important.8.13.(m) Research in the causes of labor, the causes and early detection of uterine inertia, the causes of premature rupture of membranes, means of predetermining the size of the fetus, the physiology of fetal respiration, the mechanics of molding and birth injuries, and the physiology of the premature infant will all aid materially in further reducing the infantile mortality rate.