Volume 100, Issue 8

The objective of this study was to determine whether a relationship exists between adequacy of prenatal care and preterm delivery, low-birth-weight, and small-for-gestational-age infants. Data from 1771 patients enrolled in an ongoing study of maternal growth in young gravidas were studied. The indices of both Kessner and colleagues (the Kessner index) and Kotelchuck (the Kotelchuck index) were used to determine adequacy of prenatal care. Patients receiving adequate care were compared with those receiving intermediate or inadequate care and the incidence of preterm birth, low-birth-weight, and small-for-gestational-age infants was determined in each group. The study controlled for potential confounding variables, that is, black ethnicity, maternal age, pregravid body mass index, parity, adequate prenatal weight gain, smoking, and previous delivery of low-birth-weight or preterm infant. The data were analyzed by logistic regression. When classified according to the Kessner index, 290 (16.4%) of the women received inadequate care, 961 (54.3%) received intermediate care, and 520 (29.4%) received adequate care. By the Kotelchuck index, 651 (36.8%) of the women received inadequate care, 201 (11.3%) received intermediate care, 604 (34.1%) received adequate care, and 315 (17.8%) received adequate-plus care. By use of the Kessner index and by estimating gestation from the last menstrual period, it was determined that women who received inadequate care had a 2.8 times greater risk (95% confidence interval [CI], 2.07-3.78), and by use of the Kotelchuck index, a 2.1 times greater risk (95% CI, 1.58-2.81) of having a preterm delivery. When the obstetric estimate of gestation was used, risk was 2.01 times greater (95% CI, 1.44-2.80) with the Kessner index and 1.4 times greater (95% CI, 1.0-1.94) with the Kotelchuck index. There was little effect of prenatal care on incidence of small-for-gestational-age infants. The results of this study confirmed that inadequate prenatal care is associated with an increased risk of preterm delivery.

A retrospective analysis of 1- and 5-minute Apgar scores of patients at term gestation (37 to 42 weeks) with evidence of clinical intra-amniotic infection and meconium-stained amniotic fluid was performed. The patients were selected from the labor and delivery records of two Detroit hospitals during the study period from January 1988 through May 1994. The author suggests that the presence of clinical intra-amniotic infection with meconium-stained fluid does not affect Apgar scores of term infants.

Hollow viscus perforation due to inflicted blunt abdominal injury is uncommon. Diagnosis is frequently delayed because of inaccurate or absent history, nonspecific or delayed physical findings or both, and laboratory tests with low sensitivity. Computed tomographic scanning of the abdomen is the best diagnostic test available. A high index of suspicion is essential to diagnose visceral perforation early, as significant morbidity and mortality results from diagnostic delay.