The relationship of fetal birth injuries to obstetric difficulties

Abstract

I N THE two years 1935 to 1936 on the Obstetrical Service of the Toronto General Hospital there were 1,710 births, and of these 77 were stillbirths and 41 neonatal deaths, a combined rate of 6.9 per cent. Any patient who is six months or more advanced in pregnancy is admitted to the obstetric wards, and our figures include some babies weighing less than 2 pounds. An analysis of stillbirths and neonatal deaths, totaling 118 cases, included 15 macerated fetuses (several premature) ; 14 deformities, incompatible with life; 34 prematures, under four pounds; 1 case of pemphigus ; 1 case of icterus gravis ; 5 placenta previa ; 3 accidental hemorrhage ; and 1 craniotomy on a dead baby. For these 74 fetal deaths, the method of delivery could not be held responsible, with the possible exception of the 5 cases of placenta previa. Of the remaining 44 cases for which the method of delivery may be held responsible, there were 19 normal deliveries, including 1 bronchopneumonia of mother, 1 heart disease of mother, 4 eclamptic toxemia% and 4 prematures over 4 pounds and under 6 pounds. Also 13 forceps deliveries (3 intracranial hemorrhages), in 3 eclamptic toxemias, 1 brow, 1 face, 3 persistent occipitoposterior, and 5 for delay in second stage. Among 6 versions, there were 4 intracranial hemorrhages; in 3 breech deliveries, 1 intracranial hemorrhage, and 3 cesarean sections were done, 2 before labor commenced, and 1 after three hours labor. Of the 19 normal deliveries, 10 were complicated as enumerated. Of the remaining 9, 2 had intracranial hemorrhage (autopsy, labors 37 and 24 hours) ; 3 causes unknown (no autopsy), and 4 causes unknown (autopsy). Of the 11 cases of intracranial hemorrhage (6 autopsy and 5 clinical diagnosis), there were 4 versions (2 for tra.nsverse presentation), 3 forceps (1 high, 1 mid, 1 low), 1 breech, 1 cesarean section, and 2 normal deliveries. A review of the clinical histories of these fetal deaths appeared to emphasize some facts worthy of consideration. The problem of fetal birth injuries is intimately connected with that of maternal mortality, and it is unfortunate that the methods to lower the incidence of one may not have the same effect on the other. The