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National Maternity Hospital Dublin clinical report for the year 19931993 saw another increase in the number of infants delivered at the hospital Gynaecological activity remained extremely busy with an increase in the number of new gynaecological referrals of 7%. A total of 7,105 mothers were delivered during 1993. A total of 6,378 infants weighing 500 grams or more were delivered by 6,277 mothers. These figures represent an increase of 85 more infants born during the year compared to 1992. The number of primigravida delivered was 2,564, an increase of 139 over 1992. Seven hundred and eighty one mothers miscarried before 24 weeks gestation. There were 10 molar pregnancies and 37 ectopic pregnancies, both an increase on 1992. No mother died during the course of pregnancy or in the puerperium. There were 75 perinatal deaths and this number includes all dead born babies weighing 500 grams or more, together with all liveborn babies who did not survive the first 28 days of life. The total perinatal mortality rate was 11.7 per thousand, compared with 11.2 in 1992. An autopsy was performed on 64 occasions (85%). This figure is a great tribute to the Department of Pathology. A lethal congenital anomaly was responsible for 31 of the perinatal deaths (40%). There were three deaths from a neural tube defect. The perinatal mortality rate in normally formed infants was 6.9 per thousand. There were 24 deaths which occurred before the onset of labour in normally formed babies. In 10 of these cases, there was an obstetrical factor, of which the commonest was abruptio placentae. There were 14 antepartum deaths where no cause was found despite careful autopsy examination. There were 7 intrapartum deaths. Thirteen liveborn infants died within the first 28 days of life. Two neonatal deaths occurred in babies after 37 weeks gestation. Five deaths occurred in infants born between 28 and 37 weeks, and six occurred in infants born less than 28 weeks gestation. Total gynaecological activity saw a small decrease on the previous year due to a major renovation project of the operating theatres which was undertaken at the end of the year. Gynaecological cancer was diagnosed and treated in 68 women. Many of these women are referred from outside centres and the continued high rate of referral from around the country is a tribute to both the medical and nursing care these women receive. The rate of Caearean section was 9.8% compared with 8.5% in 1992, a significant increase. The rate in primigravidae was 12.1 %. It is unlikely that the rate will continue to increase and it is anticipated that the rate for 1994 will be significantly lower. The reasons for the increase appeared to relate mainly in primigravidae to the diagnosis of suspected fetal distress while in multiparous women there was an increase in the numbers presenting with a previous Caesarean section. Clearly an increasing rate in primigravidae leaves a legacy for the future. The operative vaginal delivery rate was 7%, remarkably low when one takes into account the continued increase in the incidence of epidural anaesthesia. The continued high rate of spontaneus delivery is a tribute to the very high standards of midwifery care practiced m the hospital. . . . . During the year 3.014 mothers and infants were seen outside medical hours as emergencies. This number continues to increase and places a strain on hospital resources outside normal working hours. . A concerted effort was made to increase breast feeding rates among mothers attending the hospital. A new policy, instigated by the midwives , has been most successful and 58% of mothers were breast feeding at the time of discharge.