Social and obstetric factors relating to perinatal mortality in Glasgow

McIlwaine, Gillian Marjorie (1974) Social and obstetric factors relating to perinatal mortality in Glasgow. PhD thesis, University of Glasgow.

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Abstract

The perinatal mortality rate (defined as stillbirths and all first week deaths per 1000 total births) in the City of Glasgow is higher than that of other large cities in Scotland and England. It is generally agreed that this rate is influenced partly by the health and physique of the mothers and partly by the standard of obstetric care they receive. Because of concern for Glasgow's high perinatal mortality rate this study was set up to examine all perinatal deaths occurring to women resident in Glasgow during 1970. The aims of the study were three-fold - (1) to classify all perinatal deaths by clinical cause using the Aberdeen Classification; (2) to identify the women who wore losing their babies; (3) to determine what charges, if any, might be recommended in obstetric and paediatric care to improve the perinatal outcome. A historical review of the development of Glasgow is given in the Introduction, showing how the poor environmental conditions of Glasgow today stem from the rapid growth of the city during the Industrial Revolution. The development of the Health Services and housing policies are also described. Perinatal deaths to be studied were identified from data held in the computer-based system of linked child health records. Completeness of ascertainment was confirmed by examining hospital records. The clinical cause of each death was then determined and coded, using the classification designed by Baird, walker and Thomson (1954). During 1970 there were 16,748 births to Glasgow women. Two hundred and seventy-two babies were stillborn. and 190 died in the first week of life a total of 462 perinatal deaths. The records of 437 oases (262 stillbirths and 175 neonatal deaths) including 33 deaths occurring in multiple pregnancies, were studied. Two-thirds of the deaths belonged to groups of deaths - unexplained prematurity fetal dofeots and antepartum haemorrhage, and are less amenable to obstetrical intervention, being related to the effects of unfavourable environmental influences on the mother's reproductive function. The deaths in each of the eight groups were studied in detail and it was felt that improved care and a greater awareness of the importance of early antenatal care would have substantially reduced the number of perinatal deaths. Partioular attention was paid to maternal weight gain during pregnancy in those ,patients whose babied died. Unfortunately, however, the details of weighty weight gain end percentile baby weight were not known for all patients. The impression gained was that the association of material. weight gain and fetal wellbeing was not thought to be important by the medical staff, as in the mature - cause unknown group particularly during the last trimester of pregnancy, the weight gain pattern was poor but no action was taken. An attempt was made to assess the paediatric care during the neonatal period. Unfortunately the hospital record's did not contain nearly enough information for retrospective analysis. It was found, however, that of the 175 neonatal deaths, babies had an Apgar score of loos than 5,100 babies suffered from some form of respiratory distress, and 43 babies had an intracranial haemorrhage. The perinatal deaths in multiple pregnancies were studied in detail, as were the domiciliary confinements. When the perinatal deaths were studied by place of delivery, it was seen that the percentage distribution of deaths varied from hospital to hospital due to a number of factors. A large number of patient booked late in pregnancy or received no antenatal care. In some hospitals there was a long delay between the time the request for booking was received and the patient being seen at the clinic. She housing conditions in which the patients lived were often very poor and there wore marked differences in perinatal rates by ward of residence. The clinical, classification of death was compared with that of the registered cause of death, Despite the poor environmental conditions of a large number of families in Glasgow it was felt that the perinatal mortality rate could be reduced immediately by stressing the importance of antenatal care, by closer supervision of the high risk patients, and by encouraging greater use of family planning services. In the long term a programme of health education and reorganisation of the obstetric services with close co-operation between all those Involved with antenatal care should improve the perinatal outcome. Methods whereby this can be achieved are discussed.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Adviser: M C Macnaughton
Keywords: Epidemiology
Date of Award: 1974
Depositing User: Enlighten Team
Unique ID: glathesis:1974-73379
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 14 Jun 2019 08:56
Last Modified: 14 Jun 2019 08:56
URI: http://theses.gla.ac.uk/id/eprint/73379

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