Elise Wollast

Epidemiology of pregnancies with unknown last menstrual period.

A group of women with unknown last menstrual period was studied representing 16% of a total of 22 404 pregnant women recorded using a common perinatal form. Unknown menstrual period is associated with high rates of low birth weight and with low socioeconomic and sociodemographic status. Such characteristics are also associated with a high rate of preterm deliveries. Thus any possible bias introduced in studies of prematurity by ignoring the group of women with unknown last menstrual period should be carefully checked.

Organization of Prenatal Care in Belgium

Prenatal care in Belgium is characterized by regional variations between the Flemish- and French-speaking communities. Generally, care in the former area is provided by a general practitioner or a gynecologist/obstetrician in private practice, and in the latter by a gynecologist/obstetrician on a private or public basis. The level of use of prenatal care observed is, on average, high, but variations do exist according to the socioeconomic and cultural characteristics of the families and the health care services which they frequent.

Perinatal Geography of Belgium

The use of routinely collected perinatal data allows calculation of health indicators at regional levels. It helps the health managers in making decisions and provides etiological clues for epidemiology. The information is more easily assimilated with the use of maps. In Belgium, the rates of perinatal mortality, low-birthweight and preterm births vary widely between the districts. Southern districts maintain the highest rates of low-birthweight and preterm births. Even though these two factors account for most perinatal mortality cases, within 20 years, a disproportion of perinatal mortality rates between the north and the south of the country was progressively inversed to the disadvantage of the north. Advances in perinatology of some major services of the southern part may explain a good deal of this change. Discrepancies between low-birthweight and preterm rates in some districts may be explained by biomedical characteristics of ethnic groups concentrated in these areas.

Episiotomy and third-degree tears

The relation of episiotomy to third-degree perineal tears was investigated in 21 278 singleton deliveries. The incidence of episiotomy was 28.4% (n = 6041). Third-degree tears occurred in 1.4% (85) of the deliveries with episiotomy and in 0.9% (132) of the deliveries without episiotomy (P less than 0.01). To avoid the effect of confounding factors, we analysed a sub-sample that included only vertex presentations with spontaneous occipitoanterior vaginal deliveries. After stratification for birthweight and parity, no relation between episiotomy and third-degree tear was found.