Reduced Apgar Scores Research Articles

The giving tree: impacts of deforestation on birth outcomes in Mexico

ABSTRACT Deforestation adversely impacts human health through mechanisms such as increased air pollution, shifts in disease vector distributions, and changes in local climate. Although the influence of deforestation on human health is recognized, its effects on infant health outcomes have been insufficiently studied. This paper examines the effects of deforestation on infant health by analysing birth certificate data from 2011 to 2021 across Mexican municipalities, combined with satellite-derived annual deforestation rates. We show that increased deforestation leads to decreased birth weight, higher rates of low birth weight (LBW), and reduced Apgar scores. Specifically, an increase of one standard deviation in deforestation results in a reduction of average birth weight by 19 grams, an increase in the probability of LBW by 0.43% points, and an increase in the probability of a low Apgar score by 4.7% points. These effects are consistently observed even after controlling for different definitions of forest cover, excluding data during the COVID-19 pandemic, and limiting the analysis to municipalities with at least 2% forest coverage. This study provides critical evidence that deforestation directly impairs newborn health in Mexico, highlighting a significant and underappreciated environmental cost with long-term implications for human capital.

Overt hypothyroidism in pregnancy and language development in offspring: is there an association?

PurposeOvert hypothyroidism during pregnancy is linked to various obstetric complications, such as premature birth and fetal death. While some studies have shown that maternal hypothyroidism can impact a child's Intelligence Quotient (IQ) and language development, findings are controversial. The aim of this study was to explore the connection between treated maternal hypothyroidism during pregnancy and offspring neurodevelopment, focusing on learning and language and examining related maternal obstetric complications.MethodsGroup 1 included 31 hypothyroid women with elevated thyroid stimulating hormone (TSH) (> 10 mU/L, > 10 µIU/mL) during pregnancy, and Group 2 had 21 euthyroid women with normal TSH levels (0.5–2.5 mU/L, 0.5–2.5 µIU/mL). Children underwent neuropsycological assessments using the Griffiths-II scale.ResultsPregnancy outcome showed an average gestational age at delivery of 38.2 weeks for hypothyroid women, compared to 40 weeks for controls, and average birth weight of 2855.6 g versus 3285 g for controls, with hypothyroid women having children with higher intrauterine growth restriction (IUGR) prevalence and more caesarean sections. The 1-min APGAR score was lower for the hypothyroid group's children, at 8.85 versus 9.52. Neuropsychological outcomes showed children of hypothyroid mothers scored lower in neurocognitive development, particularly in the learning and language subscale (subscale C), with a notable correlation between higher maternal TSH levels and lower subscale scores.ConclusionFetuses born to hypothyroid mothers appeared to be at higher risk of IUGR and reduced APGAR score at birth. Neurocognitive development seemed to affect language performance more than the developmental quotient. This alteration appeared to correlate with the severity of hypothyroidism and its duration.

Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Pregnant Women: A Systematic Review of Cohort Studies

AimsThe aim of this systematic review is to identify and appraise pharmacological options available for management of ADHD in pregnant women and adverse effects of ADHD medications on pregnancy and foetus (malformations or long-term effects).MethodsSystematic review of prospective or retrospective cohort studies, available on this topic till September 2021 after PubMed and MEDLINE search, carried out by 2 reviewers independently. The preliminary search was conducted in March 2021, though the reviewers carried out timely cross-referencing as required. All cohort studied except those with ambiguous methodology were included. The data were further extracted using Microsoft excel after Quality Assessment was completed using NewCastle Ottawa Scale. A narrative synthesis was undertaken as meta-analysis was not feasible owing to heterogeneity between studies included.ResultsEighteen Cohort studies were included (N = 28227 pregnant women with ADHD) of which 16 were deemed as good quality. Multiple confounders were identified.The review noted that use of stimulants/non-stimulants reduced symptoms and improved functionality in these expectant mothers. Findings from our review overall indicate low risk of developing malformations with ADHD medications, with only Methylphenidate (notably cardiac) and Modafinil showing slightly increased though statistically significant risk. We also noted slightly increased risk for reduced Apgar scores, abortions on maternal request, pre-eclampsia and preterm births. There was no conclusive association noted between neuro-developmental delay or future ADHD in baby/child.ConclusionA case-by-case approach needs to be adopted for every patient, looking at how ADHD affects daily functioning and balancing that against adverse pregnancy outcomes. Also, innovative practices like drug holidays, as required medications, drug free trial while planning pregnancy etc. will help practitioners streamline the treatment of this group of patients better. Issues like research being restricted to certain countries, small sample size, record-based analysis, issues in ascertaining adherence, confounding factors, ethical conundrums etc. were noted.

417 IS ACCELERATED GROWTH VELOCITY A RISK FACTOR OF ADVERSE PERINATAL OUTCOME

Introduction: Large for gestational age and macrosomia are known risk factors of adverse perinatal outcome. Less is known on the association between accelerated growth velocity and placental insufficiency which results in such adverse outcomes as intrauterine death, reduced Apgar scores and cesarean section for fetal distress. Aim of the study: The aim of this study was to assess the incidence of accelerated growth velocity (AGV) and its relationship with adverse perinatal outcome. Methods: This is a retrospective cohort study. The study included singleton deliveries that had an ultrasound performed between 28-32 weeks of gestation and subsequently delivered at our maternity unit. We defined appropriate-for-gestational-age (AGA) as between the 10-90th centile, large-for-gestational-age (LGA) as above the 90th centile, by the Intergrowth chart. Accelerated growth velocity was defined as increase by at least 50 centiles between birthweight and estimated fetal weight on ultrasound at 28-32 weeks of gestation. Composite neonatal outcome, intrauterine fetal death and neonatal death were assessed in the following groups: LGA, LGA+AGV, AGA+AGV, AGA. Results: The final database of combined ultrasound and delivery records comprised of 2209 records (AGA n=1688, AGA+AGV n=86, LGA n=391, LGA+AGV n=44; 88.56%, 4.51%, 20.51%, 2.31% respectively). The highest risk of APO was in AGA neonates with AGV 26.74%, followed by LGA with AGV 18,18%. The lowest risk of APO was among LGA neonates 16.37%. Conclusions: The role of accelerated growth velocity needs further assessment. The highest risk of APO is among AGA neonates with AGV. This could be explained by the disproportion between fetal and placental size resulting in placental insufficiency.

The Relationship between Nuchal Cord and Adverse Obstetric and Neonatal Outcomes: Retrospective Cohort Study.

Objective: The twisting of the umbilical cord around the fetal neck is a common phenomenon in the delivery room, and despite the lack of univocal evidence of its negative impact on perinatal events, it causes anxiety and stress in patients. The aim of the study was to assess the prevalence of nuchal cord and its impact on adverse obstetric and neonatal outcomes. Methods: We conducted a retrospective cohort study. All patients who gave birth in the clinic within one year (n = 1467) were included in the study group. We compared the prevalence of nuchal cord in distinct subgroups of patients. In the next stage, we estimated the chance of specific perinatal outcomes and compared the neonatal outcomes between groups with and without nuchal cord. Results: Nuchal cord was present in 24% of labors. It was twice as common among patients giving birth vaginally (32.14%) than among patients giving birth by a caesarean section (16.78%, p < 0.001). Nuchal cord was also more frequent in births with meconium-stained amniotic fluid (33.88% vs. 23.34%, p = 0.009). In the group of patients with nuchal cord, we observed a slight increase in the risk of a non-reassuring fetal heart rate trace (OR = 1.55, CI 95% 1.02–2.36) as an indication of the completion of labor by caesarean delivery. We did not note an increase in the risk of completing natural childbirth by vacuum extraction. In the group of nuchal cord patients, there was a higher chance of a serious or moderate neonatal condition in the first minute of life (Apgar 0–7 points) (OR = 2.00, 95% CI = 1.14–3.49). Conclusions: Nuchal cord increases the risk of a caesarean delivery due to a non-reassuring fetal heart rate trace. Nuchal cord increases the chance of a reduced Apgar score (0–7 points) in the first minute of life. The observed relationships do not translate to neonatal arterial blood gas testing.

Repercussões perinatais do Oligoidrâmnio na gestação de alto risco

Objetivo: Analisar os resultados perinatais da oligoidramnia em gestações de alto risco. Método: Estudo epidemiológico, observacional, retrospectivo, com abordagem quantitativa, realizado a partir de dados secundários de 3.448 gestantes de alto risco. Desse total, 44 gestantes tinham como intercorrência clí­nica a oligoidramnia. Os dados foram coletados no perí­odo de novembro de 2016 a outubro de 2017. A variável independente foi o oligoidrâmnio. As variáveis desfechos foram: prematuridade, baixo peso ao nascer, Apgar, óbitos fetais e neonatais e tipo de parto. Resultados: O Oligoidrâmnio apresentou associação estatí­stica significativa com o parto pré-termo (p=0,05), o BPN (p&lt;0,001), o Apgar reduzido no 1° minuto (p=0,03) e a morte infantil (p=0,01). Conclusão: As oligoidramnia na gestação de alto risco associa-se a resultados perinatais desfavoráveis como prematuridade, BPN, Apgar reduzido no 1º e 5º minuto e morte infantil, evidenciando a necessidade de cuidados especializados í gestante, por meio de pré-natal especializado e de qualidade.

Associations between metabolic acidosis at birth and reduced Apgar scores within the normal range (7-10): A Swedish cohort study of term non-malformed infants.

Risks of neonatal and long-term neurological outcomes are influenced by metabolic acidosis at birth and by reduced Apgar scores, even within the normal range (7-10). To analyse associations between metabolic acidosis at birth and risks of reduced Apgar scores within the normal range. In a Swedish cohort of term non-malformed infants born between 2008 and 2013, we included 81861 infants with information from cord blood gas analyses and Apgar score values of 7-10 at 1, 5, and 10minutes. Poisson log-linear regression analyses were used to examine associations between metabolic acidosis at birth (defined as pH <7.05 or <7.10 and base deficit ≥12) and Apgar scores of 7, 8, and 9. Adjusted risk ratio (RR) and 95% confidence intervals (C). were calculated. Compared with infants without metabolic acidosis, the adjusted RR of an Apgar score of 9 at 5minutes was 3.14 (95% CI 2.57, 3.84) in infants with metabolic acidosis (pH <7.05 as cut-off), and 10.13 (95% CI 7.63, 13.45) and 7.60 (95% CI 3.54, 16.33) for Apgar scores of 8 and 7, respectively. Corresponding RRs of Apgar scores at 10minutes were also substantially increased. The magnitude of RDs varied, but was consistently increased. Both reduced Apgar scores and metabolic acidosis (pH <7.10) influenced neonatal morbidity. Metabolic acidosis is associated with increased risks of reduced Apgar scores within the normal range. Due to international variations in the assessment of Apgar score, our findings need to be confirmed in other populations.

Apgar Score Components at 5Minutes: Risks and Prediction of Neonatal Mortality.

The Apgar score consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and colour. Although the Apgar score has been used for 60years, the specific contribution of the Apgar score components with respect to risks and prediction of neonatal mortality remains unknown. Likewise, the value of reduced scores (including less than five Apgar score components) has rarely been investigated. In a population-based cohort study of 148765 liveborn singleton infants in Sweden 2008-2013, we investigated components of Apgar score at 5min with respect to relative risks and prediction (using ROC curves, sensitivity, and positive predictive values) of neonatal mortality. Reduced values (0-1) of heart rate, respiratory effort, and colour were independently associated with increased relative risks of neonatal mortality. For the full Apgar score, the sensitivity and positive predictive values of neonatal mortality (cut-off ≤3) were by gestational age: ≤31weeks: 56.1% and 49.2%; 32-36weeks: 25.0% and 18.2%; and ≥37weeks: 35.2% and 9.3%, respectively. When only heart rate and respiratory effort were considered (range 0-4; cut-off ≤2), corresponding values were 66.7% and 34.9%; 37.5% and 13.0%; and 46.3% and 7.6%, respectively. A reduced Apgar score has generally the same predictability of neonatal mortality as the full Apgar score. The full Apgar score or reduced scores may be better predictors of neonatal mortality in very preterm infants (≤31weeks) than in infants with longer gestations.

Differential effects of antiepileptic drugs on neonatal outcomes

Offspring of women with epilepsy (WWE) on AEDs are at increased risks for major congenital malformations and reduced cognition. They may be at risk for other adverse neonatal outcomes. Women with epilepsy on carbamazepine (CBZ), lamotrigine (LTG), phenytoin (PHT), or valproate (VPA) monotherapy were enrolled in a prospective, observational, multicenter study of the neurodevelopmental effects of AEDs. The odds ratio for small for gestational age (SGA) was higher for VPA vs. PHT, VPA vs. LTG, and CBZ vs. PHT. Microcephaly rates were elevated to 12% for all newborns and at 12months old, but normalized by age 24months. Reduced Apgar scores occurred more frequently in the VPA and PHT groups at 1min, but scores were near normal in all groups at 5min. This study demonstrates increased risks for being born SGA in the VPA and CBZ groups, and transiently reduced Apgar scores in the VPA and PHT groups. Differential risks among the AEDs can help inform decisions about AED selection for women during childbearing years.

Pronóstico perinatal de los fetos con circular de cordón en relación con la vía del parto. Revisión de la literatura

Introducción: un supuesto incremento en el riesgo de resultados perinatales negativos en fetos expuestos a circular de cordón a cuello lleva con frecuencia a la realización de la operación cesárea, sin embargo, no es claro que la circular de cordón esté realmente asociada con la frecuencia de malos resultados fetales o neonatales. El objetivo del artículo es hacer una revisión de las publicaciones sobre el resultado perinatal asociado con la circular de cordón a cuello y la vía del parto que reviste mayor seguridad.Materiales y métodos: se realizó una búsqueda bibliográfica en las bases de datos electrónicas PubMed, Ovid, SciELO y LILACS, así como de revistas indexadas y sociedades médicas reconocidas:The American College of Obstetricians and Gynecologists, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, The American Journal of Obstetrics and Gynecology y the Medical Journal Armed Forces India.Resultados: se revisaron 520 títulos, de los cuales cumplían con nuestros criterios de selección 40 revisiones, correspondientes a diseños de tipo transversal, de cohorte, casos y controles, y revisiones sistemáticas. Los estudios muestran que no se presentan diferencias significativas entre pacientes con y sin circular única de cordón respecto al retardo de crecimiento intrauterino (RCIU), disminución en el valor de Apgar al nacer o mortalidad perinatal como parámetros de evidencia de resultados adversos perinatales. Además, las tasas de cesáreas en pacientes con circular de cordón única están alrededor de un 9% frente a un 13% en pacientes sin circular.Conclusión: la evidencia disponible en la actualidad no soporta de manera consistente la asociación entre la presencia de circular de cordón fetal y resultados perinatales adversos mayores, al compararlos con fetos sin circular de cordón. Existe algún riesgo en situaciones especiales como las múltiples vueltas de cordón y la circular ajustada al cuello. No hay evidencia que soporte la realización de cesárea ante la presencia de circular única en nuca fetal.

Schulterdystokie – Risikofaktoren und Hinweiszeichen

Shoulder dystocia represents a severe obstetric emergency with the risk of injury to the newborn even in cases with adequate reactions by the obstetrician. Therefore, the potential benefit of early diagnosis is obvious. Using the cases of 53 newborns out of 14,193 births within 11 years we have analysed the association between a BIP-thoracic diameter difference greater 14 mm and the obstetric manoeuvres for foetal birth. With classic foetal ultrasound biometry, most of the birth weights near or beyond term were underestimated. In the group with a BIP-thoracic diameter difference greater than 14 mm, all the obstetric manoeuvres with internal rotation of the baby were found as well as all cases of foetal acidosis and reduced Apgar scores, whereas the other babies were born after McRoberts manoeuvre alone. The medium birth weight was not different between the two groups. Therefore, the obstetric procedures as well as the foetal outcome are dependent on foetal biometry. Multiparae do have greater risks for complicated shoulder dystocia compared with primiparae. A BIP-thoracic diameter difference of greater than 14 mm is able to predict probable difficult courses of birth. This means that, from our point of view, ultrasonography close before delivery is an obligate necessity.

Infant serotonin transporter (SLC6A4) promoter genotype is associated with adverse neonatal outcomes after prenatal exposure to serotonin reuptake inhibitor medications

Reduced Apgar scores and birth weight, increased risk of respiratory distress, jitteriness and increased tone have been reported in up to 30% of neonates with prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressant medications. In adults, effects of these medications may be related to the genotype for the serotonin transporter (SLC6A4) promoter. In this study we investigated whether SLC6A4 genotype influences the risk for adverse outcomes in neonates with prenatal SRI exposure. Neonatal outcomes including Apgar scores, birth weight, gestational age at birth, symptoms of poor neonatal adaptation and genotype for SLC6A4 were determined in 37 prenatally SRI exposed neonates and compared with 47 non-exposed neonates. Reduced 5 min Apgar scores were observed in exposed neonates and this was moderated by the ss genotype (P<0.001). Birth weight was lower in exposed ls neonates (P=0.008). Risk for respiratory symptoms (respiratory distress and rapid breathing) was higher in exposed neonates with the ll genotype compared to non-exposed neonates (P<0.05) and risk for neuromotor symptoms increased in exposed ss neonates (P<0.026). These relationships remained when controlling for maternal mood during pregnancy, length of gestational medication exposure and gestational age at birth and cesarean section rate. Prenatal SRI exposure was associated with adverse neonatal outcomes and these effects were moderated by infant SLC6A4 genotype. Relationships between polymorphisms and specific outcomes varied during the neonatal period, suggesting that beyond apparent gene-medication interactions, multiple mechanisms contribute to adverse neonatal outcomes following prenatal SRI exposure.

Correlating head-to-body delivery intervals with neonatal depression in vaginal births that result in permanent brachial plexus injury

Objective: The purpose of this study was to evaluate which variables predict neonatal depression in vaginal deliveries that result in permanent brachial plexus injury. Study Design: With the use of a data set of litigated vaginal deliveries (n = 103 deliveries) from 1978 through 1999 that resulted in permanent brachial plexus injury, detailed delivery and neonatal and pediatric information was obtained by chart review. Neonatal depression was defined as a 5-minute Apgar score of <7. Data that were extrapolated from neonates with low Apgar scores at 5 minutes were compared with neonates with Apgar scores of ≥7 with the use of the Fisher exact test, χ2 test, or one-way analysis of variance; a two-tailed probability value of <.05 was considered significant. Results: Nine of 89 neonates (10%) had low 5-minute Apgar scores. Head-to-body delivery intervals (available for 36 deliveries) were significantly longer in neonates with 5-minute Apgar scores of <7 vs ≥7 (294 ± 68 seconds vs 147 ± 82 seconds, P <.001). Differences in other clinical variables (ie, maternal weight, gestational age, diabetes mellitus, parity, birth weight, and sex) were not significant. None of the infants in this data set, which includes those infants with neonatal depression) died or had long-term asphyxia-related sequelae in the form of speech impediments, seizures, cerebral palsy, coma, or organ dysfunction. Conclusion: The head-to-body delivery interval was the only significant factor in the prediction of 5-minute Apgar score of <7 in a data set of deliveries that resulted in permanent brachial plexus injury. Despite extended times (≤6 minutes) on the perineum that resulted in a higher reduced Apgar score rate, there was no asphyxia-related morbidity. (Am J Obstet Gynecol 2002;187:839-42.)

Doppler flow velocity waveforms of the umbilical arteries correlate with intravillous blood volume

OBJECTIVE: My purpose was to measure the volume of the fetoplacental vessel tree and to relate findings to Doppler flow patterns of the umbilical arteries. STUDY DESIGN: One hundred sixty placentas were examined by means of standardized random block placental histomorphometry after delivery and the results were compared with antenatal Doppler findings. RESULTS: There was a high correlation ( r = –0.703) between the intravillous blood volume obtained from measurements of intermediate and terminal villi and the Doppler flow velocity waveforms detected within the last week before delivery. Moreover, the reduced size of a vessel tree less than 85 mL is highly predictive of perinatal complications, such as fetal growth restriction, low umbilical artery pH values after birth, reduced Apgar scores, and cesarean section for fetal distress. CONCLUSION: These data suggest that reduced end-diastolic flow velocities in the umbilical arteries are associated with elevated fetoplacental impedance owing to reduced vascularization of intermediate and terminal villi. (Am J Obstet Gynecol 1998;179:540-3.)

Classification of growth hormone idiopathic insufficiency: Clinical features and efficacy of therapy with growth hormone

In 3,226 patients with idiopathic growth hormone (GH) deficiency included in the KIGS study, a comparative analysis of epidemiological factors and the effectiveness of treatment with recombinant GH depending on the presence or absence of birth trauma was performed. The relative frequency of gluteal presentation, instrumental AIDS in childbirth, reduced Apgar score, neonatal hypoglycemia and occurrence of microfallos was higher in the group with birth trauma, which was manifested later by more severe hypopituitarism and earlier manifestations of the disease. Both groups had almost the same reaction to GH therapy. A similar study was conducted in a group of children with GH deficiency in combination with empty Turkish saddle syndrome, septooptic dysplasia, cleft palate, neurosecretory dysfunction and secretion of biologically inactive GH. The comparative analysis was carried out with a group of children with idiopathic insufficiency of GH. Despite the differences in the clinical picture between the groups, the effectiveness of treatment of GH was the same. The study confirms the concept of multifactorial etiology of idiopathic gr insufficiency. Comparison with other groups of congenital insufficiency of GH indicates that complications in the perinatal period may occur secondary to hypopituitarism.

Measurements of fetal head compression pressure during bearing down and their relationship to the condition of the newborn.

Fetal head compression pressure (FHCP) and its clinical importance has been investigated in a group of 46 spontaneous births. Measurement of FHCP was facilitated using a compression transducer positioned between the fetal head and the wall of the birth canal. This method not only constitutes a means of quantitating the forces acting directly on the fetal head, but also provides information about the intracranial pressure generated during delivery. The latter extrapolation is based on the principle of applanation. The technique provides an objective and reliable estimate of intracranial strain and therefore a means of comparing the forces generated under different delivery modes. The condition of the same neonates at birth was assessed using umbilical artery pH, Apgar score, neurobehavioral testing and fundoscopic examination. The mean amplitude of FHCP in the different deliveries ranged from 38 to 390 mmHg (5-52 kPa) with an overall mean of 157.9 mmHg (21.1 kPa). The study indicated that the appearance of retinal hemorrhages in the newborn cannot be explained by exposure of the fetal head to abnormally high compression during birth. Other explanations must be sought for infants with a neurobehavioral deficit, reduced Apgar score, or umbilical artery acidosis at birth. It is concluded that a relatively short period of high FHCP has no obvious consequences for fetal well-being, at least within the limits described in the present report.

Estrogen screening in evaluation of fetal outcome and infant's development.

In an unselected obstetric population of 869 women serial determinations of estriol in serum and urine were performed from the 28th week of pregnancy until delivery. Clinical management was based on ultrasound and nonstress/contraction stress tests only. Data on the development of the infants were available after 1 year in 759 cases (89%) and after 2 years in 661 cases (78%). Serum free estriol (E3) screening during weeks 28-34 of pregnancy revealed a significantly increased risk for reduced Apgar scores, growth retardation and postnatal complications in pregnancies with decreased levels (p less than 0.001). The development of the children was disturbed by a higher incidence of childhood diseases, retardation in speech and bowel and bladder control. The urinary estrogen determinations (UE) during this period of pregnancy showed only a vague connection with birth weight and Apgar scores (p less than 0.05) and no connection to the infant's development. Serial determinations of E3 after the 35th week of pregnancy increased the significance for all parameters tested. If the estrogen concentration was determined in the last 2 weeks before delivery, 50% of the SGA and 60% of the endangered cases could be diagnosed. After reduced E3 serial levels neurological sequelae, reduced body weight, retarded speech and late development of bowel and bladder control were significantly more frequent at age two than after normal E3 levels. The differences obtained by serial UE determinations were less evident. Considering cost-benefit-calculations, an E3 screening of every pregnant woman cannot recommended. In pregnancies at risk serial E3 determinations allow better prognostication of fetal well-being. In the case of reduced E3 values maximum post partum care should be made available for all newborns. Special support should be given to the early infant's development after reduced E3 values have been observed.

Preterm breech delivery. Early and late complications.

One hundred and ten singleton breech infants with a birth-weight less than 2 500 g have been delivered at Huddinge University Hospital during the years 1972-78. The cesarean section rate was 30.1 per cent. Vaginal and abdominal deliveries were compared with regard to perinatal mortality and asphyxial morbidity at birth. All infants born with reduced Apgar scores or traumatic birth injuries have been followed up. During a 6-year period 3 children born with low Apgar scores were found to have persistent sequelae. Two of these were considered to relate to the delivery. We conclude that cesarean section is of benefit for infants weighing 1 000-1 500 g. However, it is doubtful if abdominal delivery is of benefit for the fetus weighing 1 500-2 500 g. A high congenital anomaly rate (13.6 per cent) was found.

The Role of Acidosis at Birth in the Development of Hyaline Membrane Disease

To test the hypothesis that intarpartum acidosis has a role in the etiology of hyaline membrane disease (HMD), blood was collected from the umbilical artery (UA) at birth from 110 premature infants and analyzed for hydrogen ion concentration ([H+]), PCO2, standard bicarbonate, and lactic acid. The infants were followed until a definite diagnosis was made of HMD (33 infants), type II respiratory distress syndrome (16 infants) or the absence of respiratory distress (61 infants). In general, infants with HMD were more premature and had lower Apgar scores than nondistressed infants; however, there were no significant differences between the two groups in any acid-base measurement. Only in those patients of 32 to 37 weeks' gestational age was it possible to detect a significant increase in UA [H+] in infants with HMD compared to those without respiratory distress. There was evidence that the reduced Apgar score of infants with HMD may be due to immaturity and abnormal pulmonary function secondary to lung disease. It is concluded that acidosis at birth is not a factor in the development of HMD except possibly in more mature infants.

Antenatal Fetal Heart Rate Monitoring

Summary: The value of antenatal fetal heart rate monitoring has been studied in 110 patients. When the fetal heart rate pattern was normal, the fetal outcome was satisfactory. When abnormalities of the fetal heart rate were present there was an increased incidence of fetal distress in labour, and reduced Apgar scores at 1 and 5 minutes. The place of fetal heart rate monitoring in antenatal care is discussed.