Raymond J. Jennett

Brachial plexus palsy: An old problem revisited

OBJECTIVES It is an almost assumption in obstetric literature that brachial palsy is due to extreme lateral traction on the fetal head during the last phase of delivery. In contrast, there have been reports in the neurologic literature of probable intrauterine origin of brachial plexus palsy. Data to dispute or support the latter view were sought. STUDY DESIGN With this overview in mind, our perinatal data base was searched for all instances of shoulder dystocia and independently for all diagnoses of brachial plexus impairment. RESULTS Seventeen instances of brachial plexus impairment associated with shoulder dystocia were found. Twenty-two instances of brachial plexus impairment without mention of shoulder dystocia were ascertained. The characteristics of the two groups were remarkably different, especially in birth weight and in maternal age and parity. CONCLUSIONS The data are strongly suggestive that intrauterine maladaptation may play a role in brachial plexus impairment. Brachial plexus impairment should not be taken as prima facie evidence of birth process injury.

Prenatal diagnosis of intracerebellar hemorrhage: Case report

Evidence continues to accumulate that neurologic damage can occur during the antenatal period, unrelated to intrapartum events. We report a case in which intracerebellar hemorrhage was diagnosed by antepartum ultrasonographic examination. Correlation of fetal heart rate patterns, Apgar scores with neonatal course, and neuropathologic findings are presented. Medicolegal implications are discussed.

Apgar index: A statistical tool☆

Twenty-seven years has elapsed since Virginia Apgar proposed a new method of evaluation of the newborn infant. The proposal gained rapid and almost universal acceptance and has stood the test of time. Considered at first to be both a guide for resuscitation and a statistical tool, the latter is now its main use. Although the original score was applied at 1 minute of age, both a 1-minute scoring and a 5-minute scoring are now the general custom. There is, however, no general consensus as to which is the better indicator of outcome. Use of both as separate entities is cumbersome. A method which with a single number gives weight to both the 1-minute score and the 5-minute score and also to the relative change is described. An analysis of selected variables with use of this index is presented.

A computerized perinatal data system for a region.

The development of regionalized systems for perinatal care requires a record system which will provide a flow of patient information to and from referring and center hospitals. It should also provide for the risk evaluation of patients being cared for within the region as well as for the quality and statistical evaluation. When the Arizona Perinatal Program was established in 1975 with funding by the Robert Wood Johnson Foundation, the decision was made to adopt and expand a perinatal data system under development at St. Josephs Hospital in Phoenix. This data system is made up of two major components: (1) a paper record system in which the documents completed by physician or nurse serve both as the medical record and a computer-input document and (2) a computer capable of simultaneous communication with 17 different terminals, directly or by telephone lines. Programs to meet the goals of patient care, quality evaluation, and statistical assessment are described.

A Computerized Perinatal Data System the Arizona Experience

Abstract. The development of a regional data system was one of the major objectives of the Arizona Perinatal Program funded by the Robert Wood Johnson Foundation. To achieve this objective, a decision was made to adopt and expand a perinatal data system under development at St. Josephs Hospital in Phoenix. This shift from what was planned as a highly sophisticated single hospital system, which would include real‐time data storage as well as paper acquired data, required certain sacrifices and resulted in certain problems as well as significant gains for the region. The data system is made up of two major components — (1) a paper record system in which the documents completed by physician or nurse serve both as the official medical record and a computer‐input document and (2) a computer using the Meditech Interpretive Information System (MIIS) version of the MUMPS operating system and language. Programs to achieve the goals and objectives established for the system are described; Lessons learned from this experience which may be helpful to others interested in similar developments are described.

A Computerized Perinatal Data System

A computerized perinatal data system has been proposed and is under implementation at St. Josephs Hospital and Medical Center, Phoenix, Arizona, USA. The concept encompasses all phases of perinatal care from pre-natal consultation through transferral of infant care to the family paediatrician. A complete record system was designed and computerized to serve both in-house and regional institutions with an on-line data system. Extensions into labour-delivery and nursery are under way and will provide augmentation of health care delivery as well as serving educational, audit, and research needs.