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Re: U.S. physicians...From: Terrence.Jones@ncal.kaiperm.orgTue Dec 26 12:48:05 1995
Agree with Dr. Cely, perinatal mortality in US is based on preterm birth remote from term, and its sequelae. Only 1/3 of preterm birth occurs prior to 34 wks, yet this accounts for over 80% of the M&M. Of those births prior to 34 wks, 1/3 are for maternal indications (most common severe preeclampsia) 1/4 are assoc with bleeding (abruption), and another 1/3 are secondary to PTPROM. Less than 20% occur in pts with no evidence of clinical infection, with intact membranes, in an otherwise healthy mother without bleeding. (Based on local driving conditions, urban Vs country, you're mileage may vary). The social and environmental conditions that conribute to the comparitive increase in the events that lead to abruption, choriodecidual infection, maternal/fetal stress are only minimally addressed by obstetric intervention. Howard Stern likens his parental upbriniging to a "wheel in a box", it's doubtful He'd make any better mileage, out of his box, in the deserts of Namibia. Terry Jones Kaiser SF
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