INCIDENCE OF MALFORMATIONS IN BIRMINGHAM ENGLAND 1950-1959

An attempt was made to identify all malformations among the 190,236 births that occurred in Birmingham in the ten years 1950–59. This was done by examining (a) obstetric summaries completed either by hospital staff or, for domiciliary births, by midwives; and (b) notifications of stillbirths, certificates of cause of death, and necropsy reports of infants who died in the first two weeks. The number of malformed individuals found was 3637 (19.1 per 1000 births). A more complete ascertainment was achieved in respect of the 1950–54 births by following the children to the age of six years and searching hospital records, death registers, necropsy reports, and the City's Public Health and Education Departments' registers of the physically handicapped and of the mentally subnormal. By these methods 2527 malformed individuals in a population of 94,474 births were identified (26.7 per 1000). The malformation rate was higher for hospital births than for children born at home; the difference was due to selection of patients for hospital delivery and not to inferior recording of domiciliary births. Details of all malformations recorded are given in table 6 and in the appendix. The most frequent malformations, each with an incidence of at least one per 1000 births, were clubfoot, cardiac anomalies, anencephalus, spina bifida, clefts of lip and palate, Down's disease, hydrocephalus, and polydactyly. These accounted for three–fifths of the total. Combinations of several malformations in the same individual occurred much more frequently than if association between malformations were fortuitous. Apart from the well–known associations of cardiac malformations with Down's disease and clubfoot with spina bifida and anencephalus, the most frequent combinations noted were cardiac defects with clubfoot and with clefts of lip and palate, and clubfoot with hydronephrosis and with reduction deformities of the upper limb. Copyright © 1968 Wiley‐Liss, Inc., A Wiley Company