Outcome Measures in OBPP

Traditional outcome measurement scales, such as the Medical Research Council (MRC) score, the Active Movement Scale (AMS), and Mallet score, are used by surgeons to assess outcomes in patients with obstetric brachial plexus palsy (OBPP). The measurement scales used to evaluate patients fall under the International Classification of Functioning (ICF) domains of Body Function, Body Structure, Activity, Participation, and Environment and are used to assess function and disability of patients. Currently used outcome measures scales for OBPP are also contrasted with those used for another perinatal condition affecting the upper limb, cerebral palsy (CP).

Cerebellar hemorrhage in utero associated with ‘massive’ fetal thrombotic vasculopathy

Background: Cerebellar hemorrhage is a rare but serious perinatal condition with various etiologies leading to fetal and neonatal death and adverse neurological complications. Complete autopsy and placental examination are essential for identification of a cause of the bleeding. Objective: Present a case of cerebellar hemorrhage in utero associated with ‘massive’ fetal thrombotic vasculopathy (FTV). Method: Autopsy of a stillborn female fetus, 26 weeks gestation, with intrauterine growth restriction, delivered by a 37-year-old woman. Results: The fetus showed multiple recent peticheal hemorrhages along the cerebellar cortex. The placenta revealed a large thrombosed chorionic blood vessel. Microscopic findings showed multiple vascular thrombosis and massive FTV throughout the placental villi. These were recognized as two histologic patterns, ‘early’ stromal karryorhxis, and ‘late’ villous stromal involution. Conclusion: Massive FTV was a leading cause of fetal stress due to increased resistant of downstream placental villi. This longstanding stressful environment induced auto-regulation impairment of fetal cerebral blood flow resulting in cerebellar parenchymal bleeding. Careful placental examination is beneficial for understating the mode and mechanism of fetal death.

Morbidity Estimates of Conditions Originating in the Perinatal Period: United States, 1986 Through 1987

Morbidity estimates of conditions originating in the perinatal period have not been reported in the United States. Conditions originating in the perinatal period were identified according to the International Classification of Diseases. The National Hospital Discharge Survey provided a weighted, nationally representative sample of newborns discharged each year from short-stay, nonfederal hospitals. From 1986 through 1987, 33.7% of all newborns had at least one nonteratologic perinatal condition. However, 6.8% of all newborns had physiologic jaundice as their only discharge diagnosis. Nonphysiologic jaundice was diagnosed in 4.4%, maternal causes of perinatal morbidity in 3.1%, birth trauma in 2.5%, fetal distress in 2.3%, birth asphyxia in 2.1%, and infections specific to the perinatal period in 2.0% of all newborn discharges. The average hospital stay for all newborns was 3.5 days, but it was 5.3 days for newborns with at least one nonteratologic perinatal condition and 2.6 for newborns discharged without a morbid condition. This study provides nationally representative estimates of perinatal morbidity useful for comparisons with smaller hospital-based samples. In addition, the study provides estimates of the public health impact of these conditions in terms of hospital stay days.