Recent experimentally derived evidence has confirmed earlier suggestions that seizures which occur within 48 h of birth in babies born at or later than 37 completed weeks gestation are particularly likely to reflect intrapartum asphyxia. We have compared 54 cases of such seizures with 41 090 controls in a geographically defined population. Nulliparity, hydramnios, post-term pregnancy, oxytocin augmentation of labour, abnormalities of fetal heart rate and/or meconiumstained amniotic fluid, prolonged second stage of labour, emergency caesarean section, assisted vaginal delivery, low Apgar score and resuscitation at delivery and subsequent ventilatory support were all statistically significantly more common among cases than among controls. Five of the 54 babies who developed seizures died within 28 days of birth and 11 of the 49 survivors had an impairment diagnosed by 3 years of age which was usually associated with some degree of cerebral palsy. Comparison of the frequency of antecedent perinatal risk factors in the seizure babies who died, those who survived with disabilities and normal survivors failed to reveal any clear pattern.Current knowledge about prenatal and perinatal causes of neurological dysfunction have recently

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The observation that perinatal mortality among babies delivered at home has tended to increase beyond that among babies delivered in consultant obstetric units has caused alarm and prompted recommendations that delivery at home should be further phased out. With data derived from the Cardiff Births Survey the possibility was investigated that this trend might reflect a changing ratio of planned to unplanned domiciliary births. At the beginning of the 1970s deliveries at home that were planned to be so outnumbered those that were not by nearly five to one. By 1979 unplanned deliveries at home outnumbered planned deliveries. The characteristics of the mothers, the health care they received, and the outcome of delivery differed strikingly between planned and unplanned deliveries at home.It is concluded, firstly, that every year the maternity services must try to meet the various needs of about 2000 women in England and Wales who give birth at home without planning to do so; and, secondly, that the heterogeneity of births at home and in hospital will continue to obstruct the search for unbiased estimates of the risks attributable to delivery in specialist obstetric units, general practitioner units, and at home.

SUMMARY This paper makes use of the opportunity provided by comparable obstetric data bases to examine area and social class variations in perinatal outcome and associated factors in areas smaller than those usually reported. Analyses are based on singleton births to primiparous residents in the catchment areas ofthe Aberdeen Maternity and Neonatal Database (n = 4948) and the Cardiff Births Survey (n = 11893) between 1976 and 1981. The factors considered relate to the obstetric population (height, age, and smoking), obstetric practice (induction and assisted delivery), and perinatal outcome (curtailed gestation, low birthweight, and perinatal death). Our analysis confirms the existence of both area and social class differences and suggests that, except in the case of teenage pregnancy and smoking, the association observed between those factors and area and social class are largely independent of each other.There exists a large body of research' demonstrating the variety of relationships between the circumstances in which people live and aspects of human reproduction. Most of this has shown that the chance ofadverse perinatal outcomes and their associated risk factors are consistently higher for babies born to women in working class compared with middle class families, and are also higher for babies born to mothers whose usual place of residence is in the north or west compared with the south or east of Britain.The authors of the Decennial Supplement for the years 1970-72 considered both class and regional mortality together. They concluded that "although social class does explain some of the differences in infant mortality between the regions, marked differences remain unaccounted for".2The broad objectives of this paper are to explore their conclusion further, focussing instead on perinatal mortality. Variations in the incidence of factors associated with perinatal death' are also considered. For each of these variables (death and risk factors) a series of four interrelated questions are posed. The first pair of questions relates to comparisons between geographical areas and asks:

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