Cumulative prevalence of biological and social risk factors at birth in a city in São Paulo / Prevalencia acumulada de factores de riesgo biológicos y sociales al nacer en una ciudad de São Paulo / Prevalência cumulativa dos fatores de risco biológicos e sociais ao nascer em município paulista

ABSTRACT Objective: to identify the cumulative prevalence of biological and social risk factors at birth. Method: a cross-sectional study, with retrospective data collection, carried out with live births in a medium-sized city, from January 2018 to July 2020. A database was used with information aimed at identifying social and biological risks after birth, assessed descriptively. Results: the sample consisted of 4,480 newborns, of which 78.9% were classified as at usual risk, and 21.1% as at risk. The cumulative prevalence showed that most newborns had more than one risk factor, with biological risks being the most prominent: need for admission to Intensive Care Unit, birth with less than 37 weeks of gestation and weight less than 2,500 g. Among the social risks, the following stand out: newborns who had a dead sibling aged less than 5 years old; head of family without income; mothers under 16 years old and who did not undergo prenatal care. The biological risk rate was 7.39 times higher than the social risk rate. Conclusion: the cumulative prevalence of the risks found was significant, with a considerable part of the sample presenting some biological risk.

RESUMEN Objetivo: identificar la prevalencia acumulada de factores de riesgo biológicos y sociales al nacer. Método: estudio transversal, con recolección de datos retrospectiva, realizado con nacidos vivos en un municipio de mediano porte, de enero de 2018 a julio de 2020. Se utilizó una base de datos con información destinada a identificar riesgos sociales y biológicos después del nacimiento, evaluados de forma descriptiva. Resultados: la muestra estuvo constituida por 4.480 recién nacidos, de los cuales el 78,9% fueron clasificados como de riesgo habitual y el 21,1% como de riesgo. La prevalencia acumulada mostró que la mayoría de los recién nacidos tenían más de un factor de riesgo, siendo los biológicos los más destacados: necesidad de hospitalización en Unidad de Cuidados Intensivos, nacimiento con menos de 37 semanas de gestación y peso inferior a 2.500 g. Entre los riesgos sociales se destacan: los recién nacidos que tuvieron un hermano menor de 5 años muerto; cabeza de familia sin ingresos; madres menores de 16 años y que no realizaron control prenatal. La tasa de riesgo biológico fue 7,39 veces superior a la tasa de riesgo social. Conclusión: la prevalencia acumulada de los riesgos encontrados fue significativa, presentando una parte considerable de la muestra algún riesgo biológico.

RESUMO Objetivo: identificar a prevalência cumulativa de fatores de riscos biológicos e sociais ao nascer. Método: estudo transversal, com coleta retrospectiva de dados, realizado com os nascidos vivos de um município de médio porte, no período de janeiro de 2018 a julho de 2020. Utilizou-se banco de dados com informações voltadas para a identificação de riscos sociais e biológicos após o nascimento, avaliados de forma descritiva. Resultados: a amostra foi composta por 4.480 recém-nascidos, sendo 78,9% classificados como bebês de risco habitual, e 21,1%, como de risco. A prevalência cumulativa evidenciou que a maior parte dos recém-nascidos possuía mais de um fator de risco, sendo os riscos biológicos com maior destaque: a necessidade de internação em Unidade de Terapia Intensiva, nascimento com menos de 37 semanas de gestação e peso menor que 2.500 g. Dentre os riscos sociais, evidencia-se: recém-nascidos que tiveram irmão morto com idade menor que 5 anos de idade; chefe de família sem renda; mães com menos de 16 anos e que não realizaram o pré-natal. A taxa de risco biológico foi 7,39 vezes maior que a taxa de risco social. Conclusão: a prevalência cumulativa dos riscos encontrados foi significativa com considerável parte da amostra, apresentando algum risco biológico

Assessment of cord blood vascular endothelial growth factor levels and circulating CD34[+] cells in preterm infants with respiratory distress syndrome

Respiratory distress syndrome [RDS] secondary to surfactant deficiency is a common cause of mobility and mortality in premature infants. Vascular endothelial growth factor [VEGF] is a major angiogenic factor and prime regulator of endothelial cells proliferation. So, VEGF may contribute to surfactant secretion and pulmonary maturation. Additionally, circulating CD34[+] stem - progenitor cells are elevated along with its mobilizing cytokines in neonatal RDS. This study aimed to elucidate the role of cord blood VEGF and the circulating CD34[+] cells in preterm infants with and without RDS. This study was conducted on 55 preterm neonates divided into 25 preterm [15 males/ 10 females] without RDS with mean age of 31.60 +/- 1.56 weeks and 30 preterm neonates with RDS [18 males/ 12 females] with mean age of 29.95 +/- 1.09 weeks. Twenty healthy neonates [14 males/ 6 females] served as controls with mean age of 38.20 +/- 3.57 weeks. All neonates were subjected to full history taking; thorough clinical examination and laboratory investigations including determination of VEGF levels in cord blood samples using ELISA and circulating CD34[+] cells in peripheral blood by flowcytometery. The results of this study revealed that cord blood VEGF levels were significantly decreased in preterms with RDS versus preterms without RDS and controls with p values of both < 0.0001. Furthermore, the circulating CD34[+] cells were significantly increased in preterm infants with RDS versus preterm infants without RDS and controls [p < 0.05 and < 0.0001 respectively]. Premature rupture of the membrane, gender of the newborn, birth weight and antenatal steroid administration had neither significant effect on the cord blood VEGF nor on the number of CD34[+] cells. There was inverse significant correlation between GA and the number of CD34[+] cells. It was concluded that low cord blood VEGF is associated with RDS and its level negatively correlated with the severity of the disease. Thus, it may play a role in recovery from acute lung injury in preterm infants. Moreover, the marked high level of circulating CD34[+] cells in preterms with RDS may give clear evidence of its promise therapeutic role in the future

Bronchopulmonary dysplasia in ventilated neonates :incidence and risk factors

Bronchopulmonary dysplasia occurs in neonates who need supplemental oxygen at 36 weeks gestational age and those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Mechanical ventilation is an invasive life support procedure that may cause lung injury through a combination of oxygen toxicity, barotrauma, and volutrauma. Alveolar development is interrupted and parenchyma destroyed leading to emphysematous changes, decreased lung compliance, and impaired gas exchange. There is a positive correlation between ventilator settings, duration of assisted ventilation and development of BPD. The aim of the study was evaluation of the incidence of bronchopulmonary dysplasia among ventilated neonates and determination of associated risk factors. A retrospective study conducted in the Neonatal Intensive Care Unit Cairo University over the period from January 2007 to December 2008. It included 633 ventilated neonates out of 3321 total admissions [19.06%]. All data were collected from patient's records. Patients were diagnosed to have bronchopulmonary dysplasia if they needed supplemental oxygen at 36 weeks gestational age or those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Patients were classified to 2 groups: BPD group and non BPD group. Bronchopulmonary dysplasia [BPD] developed in 221633 ventilated neonates [3.48%]. Twenty of them had gestational age between [28 - 32] weeks [90.90%],14/22 were males [63.63%], 13/22 were delivered by CS [59.09%], BPD developed in 18/290 [6.2%] neonates ventilated by SIMV from start, 3/178 ventilated by NCPAP followed by SIMV [1.7%], 1/165 ventilated by NCPAP only [0.61%], with P-value 0.002 [significant]. Eleven neonates out of 22 BPD cases [50%] were discharged. Twenty one out of 285 neonates diagnosed as respiratory distress syndrome [7.4%] developed BPD. In BPD group, Mean Fraction of inspired oxygen was 60.68 +/- 16.90, compared to 33.24 +/- 21.57 in non BPD group P value < 0.001 Highly Significant [HS]. Mean PIP in BPD group was 21.94 +/- 4.22 and 21.32 +/- 5.26 non BPD group, P Value 0.63. Mean PEEP was3.94 +/- 0.24 in BPD group and3.79 +/- 0.45 in non BPD group, P value 0.17. Mean Rate was 39.29 +/- 8.27 in BPD group compared to 36.23 +/- 12.10 in non BPD group, P value 0.32. Mean Flow was 7.83 +/- 0.71 in BPD group and 7.66 +/- 0.57 in non BPD group, P Value 0.25. Mean I/E Ratio was 0.40 +/- 0.02 in BPD group and 0.38 +/- 0.03 in non BPD group, P value 0.04 [significant]. Mean birth weight in BPD group was 1.22 +/- 0.21 compared to 2.27 +/- 0.80 in non BPD group, P value <0.001 [H.S.]. Mean duration of ventilation was 35.77 +/- 4.07 days in BPD group compared to 6.36 +/- 4.07days in non BPD group, P value<0.001 [H.S]. Mean length of hospital stay was 39.36 +/- 4.58 days in BPD group compared to 8.12 +/- 5.68 days in non BPD group, P value <0.001. In conclusion; The use of NCPAP is associated with a lower incidence of BPD compared to SIMV. The least required oxygen should be delivered to minimize oxygen toxicity and reduce the incidence of chronic lung disease

Management of anesthesia in Goldenhar syndrome: case-series study

Goldenhar syndrome or oculo-auriculo-vertebral dysplasia [OAVD] is characterized by a wide range of congenital anomalies including ocular, auricular, facial, cranial, vertebral and cardiac abnormalities. It is associated with the anomalous development of the first and second branchial arches. Patients with this syndrome usually suffer from unilateral maxillary and mandibular hypoplasia and vertebral anomalies which often result in limitation of neck movement. For this reason, intubation is very difficult in these patients and anesthesiologists usually face difficulty in airway management. Newborns with this syndrome often have premature internal organs, low birth weight and airway disorders. As a result, a safe anesthesia in such patients requires a complete knowledge regarding the metabolism and side effects of anesthetic drugs. Our first case was a preterm 28-day old female with a fetal age of 28 weeks, birth weight of 1,200 g and gestational age of 32 weeks. At the time of admission, she weighed 1,500 g. She developed jaundice shortly after birth for which she underwent exchange transfusion. She was hospitalized in NICU for 14 days. Our second case was a 2 kg, 20-day old newborn with a fetal age of 37 weeks. Our third case was a full term 10-month old infant weighing 8 kg and our forth case was a 14 kg, 29- month old child who was a candidate for emergency surgery of dermoid cyst and bilateral upper lid coloboma. Anesthesia induction was performed by inhalation anesthesia with N2O/O2= 50% and sevoflurane [0.5-3.5%]; and in BIS [Bispectral Index] = 43, the appropriate size LMA [laryngeal mask airway] was inserted. Anesthesia was maintained by using N2O/O2=50% and sevoflurane [1-2.5%]. The BIS value was maintained in the range of 42-47. The surgical operations lasted for about 60-150 minutes. Patients regained consciousness 5 minutes after the completion of surgery and were transferred to the recovery room with stable vital signs. They were transferred to the ward 90 minutes later. Patients were discharged from the hospital the next morning with no post-up complications

Necrotizing enterocolitis in premature babies; Laparotomy versus peritoneal drainage

Premature infants with necrotizing enterocolitis [NEC] or intestinal perforation [IP] are treated either surgically with laprotomy or peritoneal drain placement. [1] To develop a hypothesis about the relative effect of these 2 therapies on risk adjusted outcomes through 18 months in premature infants. [2] To obtain data that would be useful in designing and conducting a successful trial of this hypothesis. A prospective, observational study. In pediatric surgical departments of Military Hospital Rawalpindi and Combined Military Hospital Rawalpindi. From Nov 2005 to April 2007. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laprotomy. Severe NEC or IP in 156 of 2987 premature infants; 80 were treated with initial drainage and 76 were treated with initial laprotomy. By 16 months, 76 [50%] had died; outcome remained worse in subgroup with NEC. Laprotomy was not performed in 76% [28 of 36] of drain treated survivors. Drainage was commonly used, and outcome was poor. Our findings, particularly the risk adjusted odds ratio favoring laparotomy, indicate the need for a large, multicenter clinical trial to assess the effect of initial surgery therapy on out come at > 16 months

Tratamiento con eritropoyetina humana recombinante / Human recombinant erythropoietin therapy

La eritropoyetina recombinante (rHuEPO) se ha transformado en la citoquina más utilizada terapéuticamente en el mundo. Luego del éxito obtenido en pacientes con insuficiencia renal terminal, se pudo establecer la utilidad de la terapia con rHuEPO para mejorar otras anemias, incluso en pacientes pediátricos y neonatos. El tratamiento o la prevención de la anemia del prematuro mediante el uso de rHuEPO llevó a una significativa reducción en cantidad de transfusiones y en exposición a dadores. Aún debe establecerse una clara definición sobre cuáles niños prematuros deben recibir tratamiento rutinariamente. Otras indicaciones en período neonatal incluyen anemias hiporregenerativas hemolíticas. La eficacia de la rHuEPO en niños mayores, con excepción de la insuficiencia renal crónica, no ha sido tan exhaustivamente evaluada como en adultos. Mientras que durante los últimos años se han realizado gran cantidad de estudios en adultos con anemia asociada al cáncer o a infección por HIV, permitiendo establecer conclusiones claras sobre su eficacia, sólo escasa cantidad de estudios con pequeño número de pacientes han sido realizados en niños. Hasta la fecha, los resultados sugieren que la terapia con rHuEPO en niños es tan útil como en adultos, pero la realización de estudios aleatorizados prospectivos incluyendo gran número de pacientes es esencial para alcanzar conclusiones definitivas. Los resultados de estudios dirigidos a evaluar la eficacia de la rHuEpo para mantener una dosis adecuada de ribavirina en pacientes en tratamiento por hepatitis C son alentadores. La utilización potencial de los efectos no hemopoyéticos de la rHuEPO en neonatos es un terreno novedoso y apasionante. El rol de la Epo como citoprotector para sistema nervioso central y mucosa intestinal está bajo investigación exhaustiva.

Hypertrophic pyloric stenosis in a premature. A case report

A four day old baby girl weighing 1.3 kg admitted with respiratory distress. She was delivered by Caesarean section prematurely at 30'h week of gestation due to early rupture of membrane without labor pains. There was no birth asphyxia. She was provided incubator care. As baby was vomiting NG tube was placed. She had non bilious vomiting whenever trial feed given. Surgical opinion was the sought. X ray abdomen showed large gastric shadow with paucity of gas in rest of the abdomen [Figure I]. A diagnosis of malrotation was made. Baby was thus explored. At laparotomy gut was found normally placed with normal caliber of the duodenum. Pylorus was found thickened with dilated stomach. Its appearance was not very classical. Pyloromyotomy was attempted. During the procedure perforation occurred at duodenal end that was closed. Post-operative recovery was uneventful. Baby was put on TPN for 4 days. Trial feed started which was tolerated and then beast feed allowed. She was later discharged

Reanimaçäo neonatal: proposta de instrumentalizaçäo do cuidado à equipe de enfermagem / Neonatal resucitation purpose of care instrumentalisation to nursing team

Este trabalho é um relato de experiência de treinamento a equipe de enfermagem atuante em centro obstétrico, a partir da necessidade de capacitaçäo apresentada pela equipe após a inauguraçäo de uma UTI Neonatal, que recaracterizou a clientela gestante atendida no hospital, mudando o perfil do atendimento ofertado e incluindo a assistência ao recém-nascido de alto risco. A proposta de capacitaçäo através de treinamento e orientaçäo teórico-prática obtiveram aprimorar as açöes do cuidado ao neonato, proporcionando uniformizaçäo das técnicas e a instrumentalizaçäo da equipe de enfermagem na efetivaçäo do cuidado necessário para a reanimaçäo neonatal, garantindo um atendimento eficiente e com qualidade aos bebês prematuros ou nascidos a termo, que necessitem de manobras de ressuscitaçäo. Para alcançar a viabilidade da proposta, a metodologia usada foi desenvolvida em tres etapas: 1ª - aplicaçäo de um questionário denominado Pré-Teste; 2ª - elaboraçäo de um manual simplificado o qual segue recomendaçöes da American Heart Association e American Academy os Pediatrics divulgado pela Sociedade Brasileira de Pediatria, e que serviu como parâmetro de orientaçäo dos funcionários em seu treinamento; 3ª - aplicaçäo de um questionário denominado Pós-Teste, o qual evidenciou o crescimento da equipe, conquistando através do processo ensino-aprendizagem

Effects of hypertension of pregnant mothers on neonates, Taleghani Hospital- 1999

Recent studies show that presence of hypertension during pregnancy results to neonatal morbidity and mortality. The aim of this study is to investigate and identify the neonatal out comes, which their mothers were afflicted with hypertension during pregnancy. This was a Cohort type of study and in this regard, 160 pregnant women with hypertension were considered from Obs and Gyn Department of Taleghani Hospital, Shahid Beheshti Medical Sciences University. 80 pregnant women without hypertension were considered as control group. Morbidity and mortality were compared in these neonates. Results of this study showed that in group of mothers afflicted with hypertension, morbidity and mortality of neonates were 7.5 times, low apgar scores, 9 times birth of premature neonate, 3.5 times, low birth weight of neonate [fetal growth retardation] 2 times of control group. Since hypertension in pregnant women has many serious side effects for neonates, therefore it is recommended that there should be improved cares during pregnancy and on time of recognition and control of this disease, which can be lead to serious problems, and mortality of neonates

Gestaçäo prolongada / Prolonged pregnancy

Os autores apresentam uma revisäo sobre a gestaçäo prolongada, enfermidade obstétrica que apresenta varios pontos discutiveis e de interesse para sua compreensäo como aqueles relacionados ao seu conceito, aos aspectos epidemiológicos, ao estudo da vitalidade fetal e a conduta obstétrica

Estudo da gestacao no periodo de 40 a 42 semanas: avaliacao da vitalidade fetal e resultados neonatais / Study of the gestations at 40 to 42 weeks: avaliation of the fetal well-being and perinatal outcome

Foram estudadas prospectivamente gestacoes no periodo de 40 a 42 semanas, verificando-se os indices de morbidade e mortalidade perinatais, correlacionando os resultados de vitalidade fetal com os resultados perinatais. Foram incluidas 52 gestantes, divididas em 2 grupos, GI 32 pacientes (primeira semana) e GII 20 pacientes (segunda semana). Resultados e conclusoes: a) incidencia de oligoamnio de 44,23 por cento; de liquido meconial de 28,85 por cento; de cardiotocografia alterada de 50 por cento e de cesareas de 57,70 por cento, nao houve obito perinatal; b) a distribuicao semelhante nos grupos I e II dos indices de morbidade mostrou a importancia do inicio da vigilancia fetal com 40 semanas; c) predominio de nuliparas (50 por cento), a irrelevancia da dopplervelocimetria umbilical e uterina no seguimento destas gestacoes e d) importante papel da oligoidramnia e o meconio no alto indice de cesarea ocorrido

Value of ultrasonography in the prediction of postmaturity and in improving pregnancy outcome in post-term pregnancy

Forty women in whom pregnancy has extended beyond 42 weeks has been studied by ultrasonography to assess its value in the prediction of post-maturity and in improving the outcome in post-date pregnancy. Post-maturity was found in 25% of cases of post-date pregnancy. The most valuable ultrasonic finding in the prediction of post-maturity was found to be oligohydramnios, 87.5% of cases of oligohydramnios have given birth to post-mature infants and 90.6% of post-date pregnancies with adequate amount of amniotic fluid gave birth to term appearing infants. The outcome of pregnancy was favourable in all cases without post-maturity however respiratory distress happened in half of the post-mature, infants, but no deaths occurred among them. Placental grading, gross fetal body motion as well as fetal respiratory movements were of limited value in the prediction of post-maturity in post-date pregnancy, but if grade [0] or [1] placenta is found, the pregnancy dates should be highly suspected. So, ultrasonography is mandatory in all cases of post-date pregnancy for prediction of post-maturity and taking the necessary measures as regards management as well as the immediate neonatal care and so the outcome of pregnancy could be improved

Bacteremia y sepsis neonatal / Bacteremy and neonatal sepsis

Entre los meses de enero y diciembre de 1989 se investigó la incidencia de septicemia entre los recién nacidos con riesgo perinatal de sepsis neonatal temprana. El 11.1 (por ciento) de las admisiones a la Unidad del Hospital Militar Gorgas, en el Distrito de Ancón, ciudad de Panamá, presentó factores de riesgo perinatales de sepsis neonatal temprana. De ello, 14.1 (por ciento) presentaron hallazgos radiológicos consistentes con el diagnóstico de neumonía intrauterina y un 1.6 (por ciento) presentó infección urinaria; sin embrargo, sus cultivos de sangre fueron negativos. Solamente 1 de 64 recién nacidos tuvo hemocultivos positivos y lo fué por Estreptococo beta-hemolítico del grupo B. La incidencia de sepsis neonatal confirmada fué de 1.7/1000 nacidos vivos mientras que la sospecha de sepsis neonatal en el mismo período y población, por la presencia de factores de riesgo perinatales, fué 65 veces mayor

La sosnografía de tiempo real en la evaluación de la hemorragia cerebral peri e intraventricular / The sonography of real time in the evaluation of the cerebral hemorrage peri and intraventricular

De 1,776 sonograntes practicados en 1,312 pacientes con equipo de tiempo real, sectorial, seleccionamos 923 sonogramas practicados en 670 pacientes por sospecha de hemorragia cerebral, peri e intraventricular. El estudio demostró que solamente 117 pacientes tenían hemorragia. De los 107 pacientes que se pudieron seguir, en 68 casos la hemorragia era de grado I, en 14 niños era de grado II, en 19 era de grado III y en 6 pacientes era de grado IV. La mayoría (82/107) de los niños eran de pre-término (el promedio de la edad gestacional fué menor de 32 semanas) 23 eran de término y 2 niños eran de post-término. La hemorragia de grado I se resolvió, en la mayoría de los casos, sin dejar secuelas sonográficas ni neurológicas; pero en 10 pacientes el foco hemorrágico fué reemplazado por un quiste y su resolución se efectuó entre 7 y más de 204 días; y en otros dos casos fue reemplazdo por un quiste porencefálico, el cual en uno de los pacientes se veía todavía después de 134 días (último examen practicado). Todos los pacientes con hemorragia de grado II fueron de pre-término (el promedio de la edad gestacional fué de 33.1 semanas). El seguimientoo sonográfico de estos pacientes demostró que los focos hemorrágicos no fueron visibles después de 84 días, cuando efectuamos el último sonograma; y que solamente en 2 niños se observó ligera hidrocefalia. La mayoría de los niños con hemmorragia grado III (75 por ciento) eran prematuros (el promedio de la edad gestacional fué de 32 semanas); los otros (25 por ciento) eran de término. Fué el grado en el cual se produjo el mayor número de secuelas sonográficas, tales como hidrocefalia y/o atrofia. También en este grupo se encontró secuelas neurológicas más serias que en los anteriores. La hemorragia grado IV fué encontrada en el menor número de pacientes; pero fué el de peor pronóstico : 2/2 pacientes prematuros murieron; 1/3 de los de término murió a los 14 días de nacido; otro cursó con hidrocefalia y fué operado (presentó paralisis cerebral); el tercer caso se perdió del control; el niño de post-término y hemorragia de grado IV es seguido en la consulta de alto riesgo (a los 10 meses tiene secuelas neurológicas, no severas). En ocasiones, sonográficamente, es difícil diferenciar una hemorragia grado IV de otras condiciones tales como son la leucomalacia y el infarto periventricular. La sonografía de tiempo real, a través de la fontanela anterior, ha demostrado ser de gran utilidad en el diagnóstico y seguimiento de la he

Study on blood level of human placental lactogen in abnormal pregnancy.

The hormone human placental lactogen (HPL) was measured in 15 expectant mothers with pre-eclamptic toxaemia, 5 with postdated pregnancy and 2 mothers with intrauterine growth retardation (IUGR). These levels were compared with that of 43 expectant mothers without any complications. In preeclamptic toxaemia (PET), HPL showed higher or normal values but in severe cases of PET and in those with proteinuria, hormone level was depressed as compared to normal pregnancy. Also in younger mothers (22 years or less) with the complication, the hormone level was low, though no relation with parity was observed. In case of IUGR, the hormone level was within the normal range although one pregnancy ended in intra-uterine foetal death. Low level of the hormone was found in pregnancies ending in low birth weight babies and in postdated pregnancies with foetal postmaturity syndrome.

Mortality pattern in babies delivered by cesarean section and vaginal delivery.

A total of 7077 cases of delivery were studied in a rural based hospital where most of the mothers come without any antenatal care, from November, 1979 to December, 1980 to observe the mortality pattern in different types of delivery. Only live born babies were included in the study in which the mortality rate in elective cesarean section was found to be nearly equal to that in vaginal delivery. The percentage of mortality was higher (5.4%) in emergency cesarean section-the chief causes being asphyxia neonatorum, low gestational age and low birth weight.