Obstetric Discharge Research Articles

Patient Sociodemographics and Comorbidities and Birth Hospital Characteristics Associated With Postpartum Emergency Department Care

Postpartum emergency department (ED) visits may indicate poor access to care and risk for maternal morbidity. To identify patient and hospital characteristics associated with postpartum ED visit rates. This retrospective cohort study used data from the 2014 to 2016 New York State Inpatient Database and State Emergency Department Database. All obstetric discharges from acute care hospitals in New York State from January 1, 2014, through November 15, 2016, were included. Obstetric discharges in the inpatient database were linked to subsequent ED visits by the same patient in the ED database. Data were analyzed from February 2020 to August 2022. Patient characteristics assessed included age, race, insurance, home zip code income quartile, Charlson Comorbidity Index score, and obstetric risk factors. Hospital characteristics assessed included safety net status, teaching status, and status as a hospital disproportionally serving racial and ethnic minority populations. The primary outcome was any ED visit within 42 days of obstetric discharge. Multilevel logistic regression with 2-level nested mixed effects was used to account for patient and hospital characteristics and hospital-level clustering. Of 608 559 obstetric discharges, 35 299 (5.8%) were associated with an ED visit within 42 days. The median (IQR) birth hospital postpartum ED visit rate was 6.3% (4.6%-8.7%). The mean (SD) age was 28.4 (9.1) years, 53 006 (8.7%) were Asian patients, 90 675 (14.9%) were Black patients, 101 812 (16.7%) were Hispanic patients, and 275 860 (45.3%) were White patients; 292 991 (48%) were insured by Medicaid, and 290 526 (47.7%) had private insurance. Asian patients had the lowest postpartum ED visit rates (2118 ED visits after 53 006 births by Asian patients [3.99%]), and Black patients had the highest postpartum ED visit rates (8306 ED visits after 90 675 births by Black patients [9.15%]). Odds of postpartum ED visits were greater for Black patients (odds ratio [OR], 1.31; 95% CI, 1.26-1.35; P < .001) and Hispanic patients (OR, 1.19; 95% CI, 1.15-1.24; P < .001) relative to White patients; those with Medicare (OR, 1.55; 95% CI, 1.39-1.72; P < .001), Medicaid (OR, 1.37; 95% CI, 1.34-1.41; P < .001), or self-pay insurance (OR, 1.50; 95% CI, 1.41-1.59; P < .001) relative to commercial insurance; births that occurred at safety net hospitals (OR, 1.43; 95% CI, 1.37-1.51; P < .001) and hospitals disproportionately serving racial and ethnic minority populations (OR, 1.14; 95% CI, 1.08-1.20; P < .001); and births that occurred at hospitals with fewer than 500 births per year (OR, 1.25; 95% CI, 1.14-1.39; P < .001) relative to those with more than 2000 annual births. Adjusted odds of postpartum ED visits were lower after birth at teaching hospitals (OR, 0.82; 95% CI, 0.74-0.91; P < .001) and metropolitan hospitals (OR, 0.74; 95% CI, 0.65-0.85; P < .001). This cohort study found that Black and Hispanic patients experienced higher adjusted odds of postpartum ED visits across all hospital types, particularly at safety net hospitals and those disproportionately serving racial and ethnic minority populations . These findings support the urgent need to mitigate structural racism underlying maternal health disparities.

Differentiated approach to the correction of short cervix in women with a history of anovulatory infertility according to the results of ultrasound elastography

Today, the problem of miscarriage around the world is especially relevant on the background of increasing infertility. One of its causes is isthmic-cervical insufficiency and the «short cervix» syndrome, which is increasingly claimed in modern literature. The objective: was determination of cervical elastography parameters in women with a history of "short cervix" syndrome and anovulatory infertility and selection of the method of correction depending on the type of elastogram. Materials and methods. The main group included 25 women with singleton pregnancies that occurred after treatment of anovulatory infertility by in vitro fertilization (IVF), who were diagnosed with a short cervix according to transvaginal cervicometry during the first prenatal screening. The control group consisted of 20 healthy pregnant women. Results. Analyzing the results of ultrasound elastography of the cervix, it was found that in the main group mixed type of elastogram was observed in 14 (56.00%) patients, mild type in 11 (44.00%), while in women of the control group all cervical tissue was dense, indicating a rigid type of elastogram. When determining the coefficient of deformation, a significant difference in the area of interest (area of the inner eye and cervical canal) between the two groups was noted. Patients with a mixed type of cervical elastogram underwent prophylactic mechanical correction of cervical changes by applying an obstetric discharge pessary, and pregnant women with a mild type of cervical elastogram - cervical cerclage was applied with mercylen tape. The majority of pregnant women in the main group had a timely delivery (92.00%), only two (8.00%) patients had a premature birth within 34-36 weeks +6 days of gestation (one woman with different correction methods). Conclusions. Іn women with short cervix, who became pregnant after treatment of anovulatory infertility with IVF, there is a significant decrease in cervical tissue density, which should be considered as a prognostic criterion for isthmic-cervical insufficiency, and therefore miscarriage requires mechanical correction by applying a prophylactic suture to the cervix or the installation of an obstetric pessary, depending on the type of elastogram of the cervix.

The effectiveness of correction methods for isthmic-cervical insufficiency: cohort study results

AIM: To assess the pregnancy outcomes in patients with isthmic-cervical insufficiency (ICN) and the effectiveness of modern methods of correction, namely cervical cerclage, obstetric discharge pessary, and progesterone preparations.&#x0D; MATERIALS AND METHODS: The retrospective analysis included 184 females with ICN, who were divided into three groups based on ICN correction methods: 1st group consisted of 82 (44.6%) females who were corrected by cervical cerclage; 2nd group with 67 (36.4%) females by obstetric pessary; and 3rd group with 35 (19.0%) females by progesterone therapy with ICN sign appearance.&#x0D; RESULTS: According to the obtained data, every second patient (53.3%) in our study had risk factors for ICN development due to the mechanical expansion of the cervical canal in cervical anamnesis. In most cases, ICN was diagnosed in 20 weeks and more, and the median period of correction was 21 [2022] weeks in 1st group, 24 [2226] weeks in 2nd group, and 22 [2022] weeks in 3rd group (p 0.001). The overall incidence of preterm birth (PTB) in 1st group was 48.8%, whereas 40.3% in 2nd group and 60% in 3rd group. The share of timely births accounted for 41.5% in 1st group, whereas 53.7% in 2nd group and 11.4% in 3rd group.&#x0D; CONCLUSION: Correction of ICN with cervical cerclage and obstetric pessary showed similar effectiveness and allowed prolonged pregnancy to more favorable terms. The correction group with only progesterone preparations noted a high frequency of premature pregnancy termination since this group initially included females with a higher risk of PTB and adverse factors for further prolonged pregnancy.

Methods of efferent therapy in prolongation of pregnancy in the isthmic-cervical insufficiency (two clinical observations)

The report presents two clinical observations of pregnancy outcome in patients with isthmic-cervical insufficiency of functional (first observation) and functional-organic (second observation) origin. In both cases, previously treated cervical erosion by laser (in the second observation – carried out excision of the cervix). In secundiparous women in the present pregnancy were noted recurrent urogenital (first observation) and genital (second observation) infection with a threatened miscarriage and the need for re-hospitalizations. Complex therapy with the introduction of obstetric discharge pessarium was not effective enough, there were manifestations of the inflammatory response of the body, isthmic-cervical insufficiency progressed, up to prolapse of the fetal bladder into the cervical canal (first observation). When entering the perinatal center, the treatment of pregnant women included methods of low-volume membrane plasmapheresis and photomodification of blood with ultraviolet and laser rays (alternated). In both cases, it was possible to stop the manifestations of inflammatory response, to improve the condition of the cervical canal, to prolong pregnancy to the term of normal childbirth. In the first observation, the birth occurred naturally, in the second case cesarean section was performed due to organic changes in the cervix. Childbirth, the postpartum period in women proceeded normally. Children were born healthy, full-term, develop normally, receive breastfeeding.

Identification of vulnerability within a child and family health service.

Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother-baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson's Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12-16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, and 74.6% of vulnerable newborns were offered a home visit. Children identified as vulnerable were more likely to have a home visit than those who were not (z for 95% CI=1.96; P<0.1). Conclusions Although the high reported prevalence of identified risk needs to be confirmed in further studies, identifying vulnerability allowed the offer of home visiting to be directed towards those most likely to benefit. What is known about the topic? Of the Australian child population, 10-20% are vulnerable to adverse health, developmental and wellbeing outcomes. Vulnerable infants are at a greater risk of becoming vulnerable children, adolescents and adults over the life course. Biological and psychosocial risk factors for vulnerability are well described. Families with the greatest need are often the least likely to access or receive support, and have lower utilisation of preventative health services despite evidence that support in the first few years of life can significantly improve long-term outcomes. What does this paper add? This paper provides a detailed description of vulnerabilities in a cohort of newborns and demonstrates that it is possible to assign risk of vulnerability within existing child and family health services using tools that identify biological and psychosocial risk factors. Identification of vulnerability risk allows prioritisation of services to those with the greatest need. What are the implications for practitioners? It is possible to identify vulnerability risk within child and family health services. This allows those families at risk of future adverse health, developmental and wellbeing outcomes to be prioritised to receive health services and supports.

Analysis of the summary content in obstetric discharge reports in a reference maternity hospital. An opportunity to rethink the strategy of continuity in maternal and neonatal care

Analysis of the summary content in obstetric discharge reports in a reference maternity hospital. An opportunity to rethink the strategy of continuity in maternal and neonatal care

Pandemic (H1N1) 2009 in Neonates, Japan

To the Editor: In 2009 in Japan, a medical response to pandemic (H1N1) 2009 infection in neonates was proposed by the Japan Pediatric Society (JPS) (1). Few such cases have been reported (2–7). Because the effects of pandemic (H1N1) 2009 in neonates are unknown, the JPS Committee of Neonatal Medicine conducted a nationwide survey during 2009. Surveys were mailed to neonatal care units in 522 facilities certified by JPS as teaching hospitals, which included almost all tertiary neonatal intensive care units in Japan. The survey asked whether during April 2009–March 2010 any neonates had been born to mothers with pandemic (H1N1) 2009 onset from 7 days before delivery until obstetric discharge and whether pandemic (H1N1) 2009 developed in any neonates <28 days of age before hospital discharge. The study was approved by the Bioethics Committee and Board of Directors of JPS. Of the 522 facilities, 327 (62.6%) responded. During the period in question, 52,774 neonates had been hospitalized for any cause except routine care. Pandemic (H1N1) 2009 infection of the mother was reported by 47 (16.1%) facilities. From the 37 of these facilities, detailed information was available for ≈42 mothers with pandemic (H1N1) 2009 infection who gave birth to 43 neonates (29 full-term and 14 preterm births). Of these 42 mothers, a diagnosis of influenza A was made by rapid influenza diagnostic kit for 33 (78.6%) and for pandemic (H1N1) 2009 by reverse transcription PCR (RT-PCR) for 5 (11.9%). Only 1 case of pandemic (H1N1) 2009 in a mother was reported in May 2009, when influenza subtype H3 was dominant in Japan. This infection was confirmed by RT-PCR, and the mother was included in the study. During the study period, except April and May 2009, almost all influenza A infections were caused by pandemic (H1N1) 2009 virus. Delivery on the day after symptom onset was most frequent (14 [32.6%] births), followed by delivery on the same day as symptom onset (8 [18.6%] births). A similar trend was observed for preterm births. Of the 42 mothers, 40 (95.2%) received antiviral medications. Mixed feeding of breast and formula milk was most common, and 8 neonates were breast-fed only. Among the 43 neonates, pandemic (H1N1) 2009 infection developed in only 1 (male, gestational age 37 weeks, birthweight 2,665 g). His mother had high fever, and pandemic (H1N1) 2009 was diagnosed by RT-PCR; she received oseltamivir and delivered her son 2 days after illness onset. The neonate became lethargic at 4 days of age, and pandemic (H1N1) 2009 infection was confirmed by a rapid-antigen detection kit. The neonate received oseltamivir and recovered the next day. He received oseltamivir for 5 days and was discharged at 12 days of age with no subsequent medical problems. Because onset occurred 4 days after birth, the possibility of horizontal infection from the mother cannot be excluded. Except for this 1 neonate, prophylactic antiviral drugs were not given to the other 42 neonates, none of whom became infected. With respect to nosocomial pandemic (H1N1) 2009 infection in hospital wards caring for neonates, no cases of onset within 28 days after birth were reported. However, pandemic (H1N1) 2009 infection before discharge but after 28 days of age was reported for 6 neonates. These diagnoses were made by rapid diagnostic kit, specific RT-PCR, or both. Of these 6 neonates, 1 was born at 29 weeks of gestation and had a low birthweight (1,026 g); symptom onset at 32 days of age; and complications of respiratory distress, pneumothorax, and systemic inflammatory response syndrome. Oseltamivir was given to 5 of these 6 neonates, none had adverse effects and all 6 recovered. Pandemic (H1N1) 2009 infection may have caused preterm labor. According to our findings, the virus does not seem to be transmitted during breast-feeding, and antiviral drugs, if given to the mothers, may not always be needed by neonates. However, because of the limitations of this observational study, these findings need further support. Dulyachai et al. confirmed vertical transmission of pandemic (H1N1) 2009 virus at 31 weeks of gestation (5). Jajoo and Gupta reported a 32-week-old preterm patient with pandemic (H1N1) 2009 who died of pneumonia and multiorgan failure (6). Maternal pandemic (H1N1) 2009 infection associated with preterm labor may adversely affect the fetus or neonate (2,3,5,6). Our results show that pandemic (H1N1) 2009 virus infection in mothers seldom occurred in their neonates, i.e., vertical transmission was rare. This finding is consistent with the fact that few such cases have been reported (8,9). On the basis of the results of this survey, JPS published Guideline for Management of Influenza (including Pandemic [H1N1] 2009) in Neonates during the Early Postnatal Period in 2010–2011 Season (10).

Creating an Obstetric Preadmission and Discharge Clinic: Saving Time, Saving Money and Increasing Satisfaction

Creating an Obstetric Preadmission and Discharge Clinic: Saving Time, Saving Money and Increasing Satisfaction

Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up

This study was undertaken to evaluate the advantages and disadvantages of a program of early obstetric-pediatric discharge (24 hours postpartum) with domiciliary follow-up, compared with the traditional postpartum hospital stay (more than 48 hours), according to the criteria described by reviewers of the subject. A randomized controlled trial of early obstetric discharge for healthy mothers and term infants, with postpartum randomization, with no prenatal preparation and with observational and clinical follow-up was performed. The participants were mothers with healthy, term neonates (37-42 weeks) weighing more than 2500 g and produced via vaginal delivery and with a verified normal evolution before discharge. The sample consisted of 430 cases (213 cases with early discharge, and 217 control cases) in which the following variables were evaluated: existence of complications in the mother and/or child that required rehospitalization or a medical consultation, existence of maternal problems of fatigue or anxiety/depression after the birth, continuity of lactation and its problems, satisfaction of the mother and family, and relative costs. After demonstrating the homogeneity of the groups, no significant differences were found in the rates of maternal rehospitalization (1.9% in the early discharge group vs 2.3% in the control group, relative risk 0.81, 95% CI 0.21-3.03) or in the rates of rehospitalization of the neonates (1.4% in the early discharge group vs 2.3% in the control group, relative risk 0.16, 95% CI 0.15-2.56). No increases were observed in maternal or neonatal disease, puerperal fatigue, or maternal anxiety/depression. A prolongation of maternal lactation to 3 months was observed in the early discharge group (P=.016 <.05 Fisher exact test). When the cost of early discharge is compared with that of traditional discharge with a minimum of 48 hours hospital stay, we find a saving of 18% to 20%. The level of maternal satisfaction with early discharge is better than 90%.

Quality of health services and early postpartum discharge: results from a sample of non-English-speaking women.

Few studies have explored the knowledge, perceptions and satisfaction of ethnic women in relation to early obstetric discharge. The aim of this study was to form a profile of Vietnamese mothers who opt for early postpartum discharge, and to identify factors associated with those decisions. Focus group discussions, in-depth interviews and survey questionnaires were utilized to collect information from a sample of 160 mothers. Sixty mothers (38%) opted for early discharge (< 48 h). Factors strongly associated with early discharge were poor comprehension of English (OR=6.58, 95% CI=1.81, 24.02), very low level of education (OR=3.10, 95% CI=1.55, 6.20) and first time mother (OR=2.70, 95% CI=1.15, 4.27). The in-depth interviews identified further factors driving early discharge, including fear and anxiety when having to approach staff for assistance, and perceptions of disempowerment within culturally unfamiliar hospital surroundings. The findings in this study ought to alert administrators and clinicians to possible negative drivers for the choice of early postpartum discharge by Vietnamese mothers.

Early obstetric discharge: does it make a difference to health outcomes?

Clinicians in several countries have expressed concerns about possible adverse effects of shortening obstetric length of stay. A population-based survey of 1366 mothers who gave birth in Victoria, Australia, in 1993 was used to investigate social and obstetric characteristics of mothers discharged home 'early', and to assess whether shorter stays were associated with adverse health outcomes, or a lesser degree of satisfaction, or both. Women's views and experiences of length of hospital stay were gathered via a statewide postal survey of women who gave birth in a 2-week period; 62.5% (n = 1336) responded. Assessment of the relationship between length of stay (1-2 days vs. > or = 5 days, and 3-4 days vs. > or = 5 days) and four main outcome measures (infant feeding at 6 weeks, period prevalence of feeding problems, maternal confidence and depression) showed no association between these variables and length of stay after adjusting for other obstetric and social factors in separate regression analyses. For stays of 3-4 days, the adjusted odds ratio (OR) for formula feeding at 6 weeks was 1.35 [95% confidence interval (CI) 0.9-1.9]; for feeding problems OR = 0.87 [0.7-1.2]; for lacking confidence OR = 0.81 [0.6-1.2]; and for depression OR = 0.96 [0.7-1.4]. Large randomised trials of early obstetric discharge are required to resolve continuing uncertainties about the safety, and possible benefits of shorter hospital stays.

Early obstetric discharge: does it make a difference to health outcomes?

Early obstetric discharge: does it make a difference to health outcomes?

Reasons To Stay, Reasons To Go: Results of an Australian Population‐Based Survey

Background: Debate about early obstetric discharge is occurring simultaneously in several different countries. An Australian population‐based survey of recent mothers investigated women's views about shorter postnatal stays and assessed the impact of early discharge on important maternal health outcomes. Method: Women's views and experiences of length of hospital stay were gathered by means of a statewide postal survey of all women who gave birth in Victoria, Australia, during two weeks in 1993. Questionnaires were mailed to women 6 to 7 months after the birth; 62.5 percent (n = 1336) responded. Results: Most of the sample (64%) stayed in hospital for 5 or more days after the birth, 26.6 percent left on day 3 or 4, and 9.4 percent on day 1 or 2. Compared with women who stayed for 5 or more days, women who left in the first 48 hours were more likely to be multiparous; to have attended public models of care (public hospital clinic, shared care, public general practitioner, birth center); not to have private health insurance; to have experienced a lower level of obstetric intervention; and to have a very low income. Twenty‐one percent of women who left within 48 hours, and 26 percent of those who left on day 3 or 4 described their stay as too short. Women who left on day 3 or 4, or within 48 hours, were not more likely to experience any of the adverse outcomes investigated in the study: breastfeeding problems, low confidence about caring for the baby, or depression 6 to 7 months after birth. Women who left on day 3 or 4 had slightly lower rates of breastfeeding at 3 and 6 months than women staying for longer or shorter periods. Conclusion: Concerns about possible adverse outcomes resulting from shorter postnatal stays were not borne out by the study findings. Large and carefully designed randomized trials are needed to resolve continuing uncertainties about the safety and possible benefits of shorter hospital stays. (BIRTH 24:3, September 1997)

Reasons to stay, reasons to go: results of an Australian population-based survey.

Debate about early obstetric discharge is occurring simultaneously in several different countries. An Australian population-based survey of recent mothers investigated women's views about shorter postnatal stays and assessed the impact of early discharge on important maternal health outcomes. Women's views and experiences of length of hospital stay were gathered by means of a statewide postal survey of all women who gave birth in Victoria, Australia, during two weeks in 1993. Questionnaires were mailed to women 6 to 7 months after the birth; 62.5 percent (n = 1336) responded. Most of the sample (64%) stayed in hospital for 5 or more days after the birth, 26.6 percent left on day 3 or 4, and 9.4 percent on day 1 or 2. Compared with women who stayed for 5 or more days, women who left in the first 48 hours were more likely to be multiparous; to have attended public models of care (public hospital clinic, shared care, public general practitioner, birth center); not to have private health insurance; to have experienced a lower level of obstetric intervention; and to have a very low income. Twenty-one percent of women who left within 48 hours, and 26 percent of those who left on day 3 or 4 described their stay as too short. Women who left on day 3 or 4, or within 48 hours, were not more likely to experience any of the adverse outcomes investigated in the study: breastfeeding problems, low confidence about caring for the baby, or depression 6 to 7 months after birth. Women who left on day 3 or 4 had slightly lower rates of breastfeeding at 3 and 6 months than women staying for longer or shorter periods. Concerns about possible adverse outcomes resulting from shorter postnatal stays were not borne out by the study findings. Large and carefully designed randomized trials are needed to resolve continuing uncertainties about the safety and possible benefits of shorter hospital stays.

Financial Impacts of Early Neonatal and Obstetric Discharge. † 1544

The effect of early neonatal and obstetric discharge was studied using hospital admissions and discharge data in Wisconsin for the period 1989-94. Data for 412,268 neonatal and 360,362 obstetric admissions were analyzed using a stochastic model of discharge patterns and multiple regression techniques. The average length of stay (ALOS) decreased significantly (p <.001) from 2.97 days in 89 to 2.22 days in 94 for newborns, and from 2.61 to 2.07 for mothers. The readmission rates (within 14 days for newborns) decreased significantly (p <.001) from 5.67 to 1.78 while for mothers it increased significantly (p <.01) steadily from.76 to.89 during the same period. The total charges per newborn (charges at birth +expected readmission charges(calculated as readmission rate times the charges during readmission))increased significantly (p <.001)from $1011.24 in`89to 1350.83 in '94 for newborns and from $1570 to $ 2530 for mothers after adjusting for inflation. Quarterly averages of expected readmission charges for urban and rural counties were regressed on ALOS, readmission rates for three major categories, and socio-economic variables. In urban counties, the coefficient of ALOS was found to be negative and highly significant (p-value of.0005). Our analysis indicates that extending ALOS by one additional day is optimal (for minimizing the expected charge of birth) and leads to a saving of$161.68 for each newborn. Readmission charges increase by $966 for jaundice(DRG 391), $2545.62 for newborn with major problems (DRG 389), $4405 for premature infants classified as normal at birth (DRG 388). For obstetric readmissions, the additional charges are $1938.70 for puerperal infection(ICD-9-CL 670) and $2689.50 for complications of surgical wounds(ICD-9-CL 6741-43).

The impact of early obstetric discharge on newborn health care

The impetus for shorter hospital stay of mother and newborn infant after delivery is based on economic constraints and parental preference. Earlier published studies did not demonstrate any increase in morbidity rate with shorter stay, but these studies were limited by methodologic flaws and biases that limited the validity and generalizability of the conclusions. More recent studies showed that readmission rates increased with shorter stay and that the severity of illness of readmitted infants may have increased. In addition, the interpretation of current newborn screening tests may not be applicable when performed prior to early discharge. In light of recent changes in neonatal hospital length of stay, a careful review and update of current guidelines and practices for newborn care are required.

Risk factors associated with low Apgar scores in a low-income population.

The purpose of this study was to identify risk factors associated with Apgar scores of less than 7 in newborns scored at 5 minutes after birth. All newborns were delivered at Grady Memorial Hospital, Atlanta, Georgia, which primarily serves a low-income population. The data were obtained from the obstetric discharge records for 1985-89. In this case-control study, 939 newborns with Apgar scores of less than 7 were compared with 2817 newborns with Apgar scores of 7 or higher. Low birthweight (< 2500 g) and short gestational age (< 37 weeks) were each significantly associated with low Apgar scores. Race was not a significant risk factor for low Apgar scores in this low socio-economic population. It is also demonstrated that maternal risk factors (pregnancy-induced hypertension, prolonged rupture of membranes), method of delivery (caesarean, repeat caesarean, vaginal birth after caesarean section) and male sex were significantly associated with Apgar scores of less than 7. As a result of the risks that were found to be associated with method of delivery, further study of the risks associated with caesarean delivery and of the relative advantage of a caesarean delivery versus vaginal delivery after a previous caesarean section is advocated.