Abstract: One hundred three pregnant women hospitalized following blunt trauma had injuries classified as: major (20%); minor (17%); or insignificant (63%). Maternal mortality related only to the severity of maternal injuries: 24% of women who sustained major injuries died. Pregnancy ended unsuccessfully in 18% of all women with known pregnancy outcome. The incidence of unsuccessful pregnancy was 61% following major injuries and 27% following minor injuries. Insignificant maternal injuries did not affect pregnancy outcome. Fetal survival did not relate to gestational age per se. Pregnancy uniformly ended unsuccessfully in the presence of maternal death, placental injury, uterine injury, and direct fetal injury, and occurred in 80% of women admitted in hemorrhagic shock. An understanding of the ways that the anatomic and physiologic changes of pregnancy alter the nature and frequency of maternal injuries and that maternal response to injury is altered is essential. The best chance for fetal survival is to assure maternal survival.

Abstract: The present study describes the evolution over a 5-year period of an ultrasonic routine screening programme of a pregnant population with participation of approximately 90 % of the pregnant women. One obvious result obtained in the screening programme is the pronounced improvement of early detection of twins, the incidence now approaching 95 % with the mean gestational age for the detection being 20 (median 19) weeks. Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm (before week 37) from 33 % to 10 %. The perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme.The power of an early measurement of the fetal biparietal diameter (BPD) to predict the date of confinement was high. Of 848 pregnant women with an early BPD measurement (96.5 % were measured before the 21st gestational week), 95 % were delivered spontaneously within 12 days according to the estimates from the BPD, only 1.5 % being deli...

Abstract: Eighty normal human brains varying from 22 weeks' gestation to 1 month postnatal life were graded according to convolutional development and compared with the microscopical development of kidneys and the gestational age as given by the mother. Excellent correlation was obtained between the gross appearance of the brain and the microscopical appearance of the kidney. The history of the mother mostly, but not always agreed with the anatomical appearance, which was considered a reliable guide to the gestational age of the infant.

Abstract: Forty-seven healthy neonates were fed by nasogastric tube 10 to 20 ml/kg of 5-gm/dl glucose in water containing 024 mg/dl of phenol red as a marker The proportion of test meal remaining in the stomach 30 minutes after feeding was measured Gestational ages ranged from 34 to 44 weeks and birth weights ranged from 1,300 to 4,680 gm Thirteen of 29 term neonates were appropriate for gestational age (AGA), six were small for gestational age (SGA), and nine were large for gestational age (LGA) Of the 18 preterm neonates, 6 were AGA and 12 were SGA Each baby was studied three times: at 4 to 12 hours after birth, before any other feeding, at 22 to 36 hours, and at 46 to 60 hours Preterm AGA babies retained more than term AGA neonates at both 4 to 12 hours and 22 to 36 hours Preterm SGA neonates retained more than their term peers at 4 to 12 hours only In both term and preterm neonates, 30 minute gastric retention decreased significantly from the 4- to 12-hour period to the 22- to 36-hour period, but it was similar at 22 to 36 hours and 46 to 60 hours At no time were there significant differences in retention between AGA, SGA, and LGA babies-except at 22 to 36 hours when preterm SGA neonates retained less than their AGA peers Thus 30-minute gastric retention was affected mainly by gestational maturity and postnatal age rather than by the quality of intrauterine growth

Abstract: The times of the first stool and the first void were recorded for 500 infants. The population studied was defined in terms of gestational age, maternal premedication, and mode of delivery. The results are presented in tabular form by time segments with term, preterm, and postterm infants treated separately.

Abstract: A total of 53 babies, 37 to 44 weeks' gestational age with a history of fetal distress in labour, and severe neurological abnormalities in the early newborn period, were followed up for between 2 and 5 years. Their progress was compared with an equal number of normal babies matched for gestational age, birthweight, sex, and social class, but without a history of fetal distress or delay in establishing spontaneous respiration at birth. In the set of babies with a history of fetal distress no perinatal condition was identified that could predict with certainty the type of neurological status in the newborn period, or the occurrence of neurological abnormality in later childhood. Follow-up disclosed a considerable improvement in function in most of the apparently brain-injured babies. It is suggested that such babies exhibiting apathy initially but subsequently hyperexcitability and extensor hypertonia carry the worst prognosis.

Abstract: Summary: The study analyzed several errors incorporated in widely used fetal growth standards. Such standards contain measurements from many infants who died as neonates. The present study found many of these nonsurvivors to be growth retarded so new standards were developed which contain only measurements from survivors. The study also found that weights and other body measurements of prematurely born neonates cluster at intervals consistent with maternal vaginal bleeding at monthly intervals in early pregnancy. Such bleeding is ofter mistaken for the last menstrual period. To avoid this error, the probability plot method was used to separate the clusters of measurements at each gestational age. The cluster with the lowest values at each gestational age was used as the data base for the new growth standards. Standard deviations from most mean values in the new growth standards are much smaller than are such deviations in the older standards. Speculation: At present there seems to be no completely valid method available to determine normal fetal growth using measurements from neonates because there is no assurance that prematurely born neonates are normally grown. Ultrasound and other modalities may eventually solve this problem by providing accurate, sequential in utero measurements of normal fetuses.

Abstract: Obstetric, neonatal, and psychosocial outcomes were compared for 82 matched adolescents who had been pregnant, been delivered of an infant, and received health care in three sites in Rochester, New York. There were no major differences in obstetric and neonatal outcome of adolescents and their babies according to health site. Differences in outcome were expected in the psychosocial area where a specialized maternity project (Rochester Adolescent Maternity Project [RAMP]) offered more services. On follow-up two years later, school attendance and reliance on full or partial assistance were similar. Repeated pregnancy and postpartum use of contraception favored RAMP.

Abstract: A retrospective study of 12 461 single births confirmed an association between maternal oxytocin infusion and neonatal jaundice. The effect of oxytocin on jaundice was independent of gestational age at birth, sex, race, epidural anaesthesia, method of delivery, and birth weight, each of which was significantly associated with neonatal jaundice. The effect of oxytocin was, however, small, producing a calculated mean increase in peak plasma bilirubin concentration of 8.6 mumol/1 (0.5 mg/100 ml); this excess was independent of sex and less than the effect of the baby being born one week earlier.

Abstract: Congenital anomalies caused 3.43 perinatal deaths/1000 births, as reported in a large prospective study. At all gestational ages the mortality rates progressively increased when gravidas smoked more than 10 cigarettes/day. An excessive death rate was also found in males, in offspring of mothers over 39 years of age, and in women of low socioeconomic status. Placentas associated with the malformed infants had an increased frequency of single umbilical arteries and abnormal insertions of fetal membranes and umbilical cords into the placenta.

Abstract: Maternal alcoholism during pregnancy may result in severe prenatal growth deficiency. In this prospective study, the relationship of moderate maternal alcohol consumption to infant birth weight is explored. Subjects were 263 paying members of a health maintenance organization who delivered single live children. Their alcohol consumption before pregnancy, and in early and late pregnancy, was estimated. In order to control for smoking, which is strongly related to both infant birth weight and maternal alcohol use, the sample was selected so that similar proportions of smokers were represented in both light and heavier drinkers. Multiple linear regression was employed. A regression equation was computed for each of the three periods in which drinking was estimated. Independent variables entered into the equation were maternal age, height, parity, daily cigarettes, alcohol use in the period, and gestational age and sex of child. The regression of birth weight on these variables revealed a significant relation...

Abstract: The incidence of hyaline membrane disease in 41 preterm infants born between January 1975 and January 1976 was investigated in a retrospective study. Terbutaline, a beta2-receptor stimulating drug, had been administered to the women in order to arrest premature labour. In spite of the treatment 24 preterm infants were delivered. The incidence of HMD in this group was 1/24. In a group of 17 neonates whose mothers had received no such treatment the incidence of HMD was 5/17. Comparison between the two groups revealed a significantly lower incidence of HMD in the terbutaline treated group than in the controls (p less than 0.05). There were no significant differences in maternal age, gestational age, birth weight or Apgar score between the two groups. The lower incidence of HMD in the terbutaline treated group is suggested to reflect a rapidly induced release of pulmonary surfactants in the preterm infants. Evidence for a similar sequence of events has earlier been shown to occur in animals under standardized experimental conditions.

Abstract: A survey of factors associated with perinatal mortality in 511 twins and fetal growth retardation and its reversal in 262 twins is presented. The incidence of stillbirth was almost 50% higher in twins than in singletons and the neonatal mortality was six times as high. Eighty percent of the neonatal deaths occurred in infants born prior to or at 30 weeks of gestation; 93% of the deaths were in infants weighing less than 1500 g and 75% occurred within 48 hours of birth. Fetal malnutrition was the main cause of stillbirth, and respiratory distress syndrome and asphyxia neonatorum were the main causes of neonatal death. One quarter of the twins had fetal growth retardation, a prevalence 10 times that in singletons. In almost all, the growth retardation was reversed by high-energy feedings. Although twins represented only 1% of all pregnancies and 2% of live births, they composed 12% of infants with early neonatal death and 17% of growth-retarded infants. A program is suggested for reduction of twin mortality and morbidity.

Abstract: Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for each of 109 mothers who were delivered of normal infants after gestations of 37 to 43 weeks. Infant parameters obtained included gestational age, birth weight, bilateral mid-arm circumference, and eight skin fold thickness measurements. The eight skin fold thicknesses were summed (SSFT) for each infant. Infants with SSFTs greater than 40 mm (N = 8) for the group were classified as "fatter" infants. All of the fatter infants were large for gestational age (LGA), but accounted for only one third of the LGA infants in the study. Birth weight, length, and cross-sectional mid-arm fat area were significantly increased in the fatter LGA group when compared to other LGA infants. Cross-sectional mid-arm muscle area was not significantly different for the fatter LGA infants compared to the other LGA group. Mothers were defined as obese or nonobese according to pregnant weight for height. Obese mothers had infants with significantly increased SSFTs when compared with infants of nonobese mothers. Multiple regression analysis showed that both prepregnant weight for height and weight gain during pregnancy were associated with increased subcutaneous fat in the neonate. Weight gain during pregnancy was associated with increased neonatal fatness and length, while prepregnant weight for height was associated with neonatal fatness independent of neonatal length.