Chryssa Tzoumaka-Bakoula

Previous obstetric history and subsequent preterm delivery in Greece

A total population sample of 6524 multigravid women who were certain of the date of their last menstrual period was obtained from the population-based Greek National Perinatal Survey of April 1983. The sample was used to determine the associations between features of the maternal obstetric history and preterm delivery. There were significant associations between preterm delivery and previous fetal losses, whether early (miscarriages and/or induced abortions) or late (stillbirths). For mothers who had experienced miscarriage(s), induced abortion(s) or stillbirth(s) the odds ratios were 1.40, 1.36 and 1.15, respectively, compared with mothers without any fetal loss. The odds ratio increased substantially with the increasing number of losses and reached 5.60 for the small group of mothers who had had prior miscarriage, termination and stillbirths. The results changed very little when the socioeconomic characteristics of the family were taken into account.

Birthweight Specific Perinatal Mortality in Greece

ABSTRACT. Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.

Hypertensive disorders of pregnancy in Greece

Unique population data on the incidence of hypertension during pregnancy was obtained during the 1983 Greek National Perinatal Survey. Of the 9915 women delivering in April who had their blood pressures measured during pregnancy, only 3.0% had a diastolic pressure of over 90 mmHg. The data can be compared with 11.6% of 15,744 women delivering in the United Kingdom in one week of April 1970 and for whom data on antepartum blood pressures were available (p less than 0.0001). Corresponding rates for proteinuric pre-eclampsia were 0.7 and 3.1% (p less than 0.0001). In Greece, there was no consistent variation with parity but a strong trend with advancing maternal age. The perinatal mortality rate among pregnancies with diastolic pressures of 91 mmHg and more was 6%, three times the national rate. Such cross-cultural comparisons of hypertension in pregnancy form a valuable basis on which to develop hypotheses to explain the aetiology of this condition.

Are there gaps in the provision of perinatal care in Greece

STUDY OBJECTIVE: The objective was to test the hypothesis that easy access to sophisticated hospitals is associated with a reduction in perinatal mortality. DESIGN: The study was a nationwide questionnaire survey of a birth cohort. SUBJECTS: All deliveries greater than 500g weight of singleton live births and stillbirths occurring throughout Greece during April 1983 were included. Completed questionnaires were returned for 10,953 deliveries (8% of total annual registered births in Greece), and data on 10,790 singleton births were analysed, including 127 stillbirths and 137 early neonatal deaths. MEASUREMENTS AND MAIN RESULTS: The questionnaires contained information on demographic characteristics of each parent, mothers reproductive history, and clinical course of pregnancy, labour and perinatal period. Mothers living in big urban centres were compared with the rest of the country. Overall mortality rates were similar but births in the big urban centres were of significantly lower weight due to fetal growth retardation. Logistic regression analysis, taking account of birthweight, parity, maternal age, and maternal education showed that there was an advantage to mothers living in big urban centres, perinatal mortality being 63% higher in the rest of the country (chi 2 = 7.4, p less than 0.01). CONCLUSION: The evidence obtained supports the original hypothesis and suggest that a reduction in the high perinatal mortality rate in Greece may be achieved by restructuring the perinatal services.

124 PRETERM BIRTHS IN GREECE. A POPULATION BASED STUDY

Data on 10654 births (3368 to primigravidae and 7286 to multigravidae mothers) which occurred in Greece during April 1983, were used to define the factors associated with preterm delivery. The preterm delivery rates were 5.9% and 8.4% for primi and multigravidae respectively. Analysis was carried out for these two groups separately. For primigravidae, independent statistical associations with and a protective effect for drugs such as iron and vitamins taken during pregnancy. For multigravidae, the statistically important independent factors were mothers age, marital status, smoking in pregnancy, past history of fetal losses (miscarriages and/or induced abortions and/or stillbirths), and hospitalisation during pregnancy. These mothers showed a different pattern of antenatal visits during the first and second trimesters and a protective effect for drugs such as iron and vitamins taken during pregnancy.