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The predictive validity of Hobel's criterion (score of 10 or more) for high prenatal and intrapartum risk and two alternative definitions was evaluated in two sociodemographically similar samples from two different institutions. At one institution, intrapartum risk was associated with neonatal morbidity independently of prenatal risk; at the second institution, both were related to neonatal morbidity, depending on the definition of high risk. Definition of high risk as a score of 15 or more improved the prognostic ability of Hobel's method at the first institution, but not at the second. Grouping prenatal and intrapartum risk as low (0 to 9), medium (10 to 19), and high (20 or more) provided a clearer understanding of the association between prenatal/intrapartum risk and neonatal morbidity, although differences between the two institutions persisted. Modifications and validation of risk assessment methods are necessary when used in populations other than the one for which they were originally developed.

This study compares 796 pregnancy outcomes at a maternity center (BMC) with 804 hospital (TJUH) pregnancy outcomes. The samples of pregnant women from the participating institutions were matched on sociodemographic characteristics; analysis of outcomes was performed controlling for medical-obstetric risk. Differences between the institutions were found mainly among women with low intrapartum risk. For these women, neonatal morbidity and length of infant nursery stay were lower at BMC than at TJUH. The percentage of infants with one-minute Apgar scores less than 7 or requiring resuscitation at birth was greater at BMC, but the percentage of infants with five-minute Apgar scores less than 7 as well as neonatal mortality rates did not differ between the two institutions. The number of women with intrapartum or postpartum fever was too small to permit comparison. The study results suggest that care delivered at BMC is safe with regard to the evaluative criteria used.

Pregnancy outcomes were compared between a stratified random sample of 796 women delivering a live birth at a maternity center (BMC) and a frequency matched sample of 804 women delivering a live birth at a tertiary hospital (TJUH) in 1977-1978. The relationship of use of obstetric procedures with pregnancy outcomes was investigated within and between the two samples. The neonatal morbidity rate, as measured by Hobel's neonatal risk score, was significantly higher and mean birth weights were lower at TJUH than at BMC when adjusted for institutional differences in use of obstetric procedures, medical-obstetric risk, and demographic characteristics. Conversely, the proportion of newborns with low 1-minute Apgar scores (fewer than seven) was significantly greater at BMC. The relationship of use of obstetric procedures with each outcome varied between the two institutions as well as across the three measures of pregnancy outcomes. The relationship of use of some procedures with each outcome may be explained in part by use of the procedure because of a suspected poor outcome of pregnancy, rather than an elevated risk of poor outcomes because of use of the procedure. Self-selection of some patients to BMC cannot be ruled out as a possible explanation for institutional differences.

This study examines the use of episiotomy and the frequency of perineal lacerations in a primary care maternity center staffed by certified nurse midwives (Booth Maternity Center) and a tertiary care teaching hospital where deliveries were performed by physicians (Thomas Jefferson University Hospital). The study sample (1262 women) was a stratified random selection of singleton live births in 1977 and 1978 at Booth Maternity Center and Thomas Jefferson University Hospital, with the demographic characteristics of women at Booth Maternity Center used as the sampling frame. Data were abstracted from medical records. Clinical and demographic factors that might be associated with the likelihood of having an episiotomy or experiencing a perineal laceration were examined using logistic regression. After controlling for other significant factors, women at Thomas Jefferson University Hospital were twice as likely to have an episiotomy as women at Booth Maternity Center. Use of an episiotomy was associated with a decrease in perineal lacerations of first- or second-degree, but a fourfold increase in the incidence of third-degree lacerations.

The use of seven obstetric procedures was studied in two institutions that use different approaches to maternity care. The study population included 796 women delivering at Booth Maternity Center and 804 women with similar sociodemographic characteristics delivering at Thomas Jefferson University Hospital during 1977 and 1978. Several differences were found between the two institutions. The majority of selected procedures were used more often at Thomas Jefferson University Hospital than at Booth Maternity Center. The greatest differences were found for women at low intrapartum risk, while differences were smallest for women at high prenatal and intrapartum risk. The two institutions differed in their use of procedures for women at various levels of prenatal and intrapartum risk. The findings suggested that most of the differences did not reflect different levels of risk in the populations served, but were due to other unidentified factors.

Lactose intolerant populations are heterogeneous with respect to their milk-drinking habits. A gradation of lactase activity in the intolerant population may result in sufficient lactose hydrolysis to obviate symptoms and lead to continued milk consumption. This paper reports on differences in maximum blood sugar rise in lactose intolerant children who are observed to consume or reject milk. Of the 89 black elementary school children, 48 (54 per cent) evidenced a flat lactose tolerance curve. Twenty-eight of these 48 children (58 per cent) were defined as nonmilk drinkers. The maximum blood sugar rise was 12.3 mg/100 in the 20 lactose malabsorbers who were defined as milk drinkers. It appears that some lactose malabsorbing children may have sufficient, albeit lower, levels of lactase to hydrolyze moderate amounts of milk.

Infanits of poor (as measured by an index) mothers were 15 percent smaller than infanits of nonpoor mothers. Infants from poor families had multiple anatomic evidences of prenatal undernutrition.