Socio-demographic risk factors for perinatal mortality. A study of perinatal mortality in the French district of Seine-Saint-Denis.

Objectives: To investigate the impact of a set of socio-demographic risk factors commonly associated with perinatal mortality -- age, parity, marital status, educational attainment, occupation, and ethnic origin in the French district of Seine-Saint-Denis.

Methods: The study has a case-control design with prospective identification of cases. It includes all singleton non-malformed perinatal deaths which occurred between October 1, 1989 and September 30, 1992.

[Epidemiology of fetal deaths in the Seine-Saint-Denis perinatal survey].

Objective: To analyse the epidemiological characteristics of antepartum stillbirths.

Design: A population based cases-cohort study in a limited geographical area, the department of Seine-Saint-Denis, France. Prospective collection of cases and controls between the 1989-10-01 and 1992-09-30, and retrospective collection of data.

Determinants of meconium-stained amniotic fluid in term pregnancies.

This study examines ethnic variations in meconium-stained amniotic fluid in term pregnancies, taking into account the role of gestational age, maternal sociodemographic characteristics, and medical risk factors. The study population included black and white singleton live births (N = 14,419) between 37 and 42 weeks' gestation, delivered vaginally at the Medical University of South Carolina from 1982 through 1990. Chi-square and logistic regression analysis were used to examine the association between the independent variables and meconium-stained amniotic fluid (MSAF).

Hyaline membrane disease in black newborns: does fetal lung maturation occur earlier?

Debate has developed among several authors about possible accelerated maturation of black fetuses in comparison with whites. In Guadeloupe, French West Indies, where 85% of the population is of black African-American origin, it has been noted that the incidence of hyaline membrane disease (HMD) represents a significant drop beginning after the 32nd week of gestation. Over a 3-year period, 419 black low-birthweight singleton newborns were admitted in the University Hospital's Neonatal Department covering 70% of all births of the island.

Paternity patterns and risk of preeclampsia in the last pregnancy in multiparae.

Few authors have published investigations regarding a possible association between preeclampsia and changing paternity. This study employs an epidemiological approach to explore the relationship between severe preeclampsia and changes in paternity patterns among multigravidae in a Caribbean community (Guadeloupe, French West Indies). Multiparae who were diagnosed with preeclampsia or eclampsia with fetal complications (transfer of their infants in the Neonatal Department) and controls were examined (134 mothers' interviews).

[Pathology of travelers in the Antilles. Role of imported metropolitan pathology].

A preliminary and retrospective review--with a southern perspective--of some traveller's pathologies, mostly imported, and leading to hospital admission in Guadeloupe (FWI). End stage patients (cancer, AIDS..

Ethnic variation in postnatal assessments of gestational age: a reappraisal.

While the possibility of an ethnic bias in postnatal assessments of gestational age has been suggested by several investigators, others have reported that postnatal assessments do not provide biased estimates in non-White ethnic groups. In the light of this ongoing controversy, this study examines the validity of the Ballard postnatal assessment of gestational age by ethnicity, using a relatively large hospital data base that allows for the inspection of ethnic variations in the agreement between the Ballard assessment and last menstrual period (LMP). The results indicate that there is a greater over-estimation of the LMP interval by the Ballard method in Blacks compared with Whites and suggest that systematic differences exist by ethnicity of mother in the agreement between the Ballard postnatal assessment and the LMP interval.

Validity of postnatal assessments of gestational age in low birthweight infants from a Caribbean community.

The Dubowitz assessment of gestational maturity was compared with the best obstetric estimate of gestational age based on date of last menstrual period (LMP) or ultrasonography performed early in the pregnancy or both. This study involved 384 low birthweight infants admitted to the neonatal tertiary center in Guadeloupe, French West Indies, during the period 1986 through 1988. The Dubowitz assessment exceeded the best obstetric estimation by an average of nearly 5 days.

Validity of postnatal assessments of gestational age: a comparison of the method of Ballard et al. and early ultrasonography.

This study investigates the accuracy of the postnatal gestational age assessment method of Ballard et al. to predict very preterm, preterm, term, postterm, and small-for-gestational-age infants, with gestational age by early ultrasonography used as the gold standard. Sensitivity, specificity, and predictive value were examined for each gestational age category, with 4193 single live births occurring during the period from 1982 through 1989 with an ultrasonographic examination done by 20 weeks' gestation and a postnatal assessment at 28 to 44 weeks.

The Guadeloupean perinatal mortality audit: process, results, and implications.

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985.

Anamnestic pregnancy risk assessment.

Based on data obtained from the 1984-1985 Guadeloupean Perinatal Audit, a pregnancy risk scoring system was developed using maternal demographic, socioeconomic, obstetric history and risk characteristics recorded at the first prenatal visit. Various combinations of risk factors were identified for four distinct pregnancy outcomes (perinatal mortality, low birth weight, preterm delivery and intra-uterine growth retardation). The findings emphasize the importance of developing risk assessments for discrete pregnancy outcomes within specific populations.

[An example of research and actions related to perinatal mortality in Guadeloupe. Factors and profiles of sociodemographic risk].

Perinatal risk factors in Guadeloupe (French West Indies) have been analysed from a community-based case-control survey. Two hundred and sixty four perinatal deaths were involved along with 605 controls. Principal component factor analysis of individual risk characteristics was used to identify risk group profiles.

[An example of the effect of research on perinatal mortality in Guadeloupe (1984-1985). I. Objectives and methodology].

Research with a view to action being taken was carried out in Guadeloupe in 1984 and 1985 to try to find out the causes of the high level of perinatal mortality which persists on the island before suggesting to the public health authorities what action to take. All the cases of perinatal mortality (above 500 g in weight) were looked at and analysed carefully according to a protocol that had been prepared. The events preceding the perinatal death were described and also the antenatal and intranatal as well as immediate post-natal care given to the children.