Item ID Number 00579

Author Cutting, Robert T.

Corporate Author U. S. Department of Defense

Report/Article TftlQ Congenital Malformations, Hydatidiform Moles, andStillbirths in the Republic of Vietnam, 1960-1969

Journal/Book Title

Year 197°

MOUth/Dey December

Color D

Number of Images 34

DeSOriptOU NOtQS Alvin L. Young filed this item under the category"Human Exposure to Phenoxy Herbicides and TCDD"

Tuesday, February 20, 2001 Page 579 of 680

CONGENITAL MALFORMATIONS//v

HYDATIDIFORM MOLES

AND STILLBIRTHS

IN THE REPUBLIC OF VIETNAM

1960 -1969

Robert T. Cutting1

Tran Huu Phuoc 2

Joseph M. Ballol

Michael W. Benenson 1

Charles H. Evans 3

D e c e m b e r 1970

1US Army Medical Research Team (Walter Reed Army Institute of Research), Vietnam

(Present address: Walter Reed Army Institute of Research, Wash., DC 20012)

2Ministry of Health, Government of the Republic of Vietnam

30ffice of the Command Surgeon, Military Assistance Command, Vietnam

For sale by the Superintendent of Documents, U.S. Government Printing OfficeWashington, D.C. 20402 - Price 45 cents

I)

SYNOPSIS-ABSTRACT

A ten-year survey of the incidence of stillbirths, hydatidiform moles

and congenital malformations was conducted in the Republic of Vietnam

using records maintained at 22 hospitals. The study collected 480,087

livebirths, 16,166 stillbirths, 2,866 moles and 2,355 malformations of all

types. The military use of herbicides is depicted and the data are sorted

into two time periods, pre- or light-spraying years (1960-65) and heavy-ift&i,-

spraying years (1960-69). Comparing the earlier with the later period the

stillbirth rate was 36.1 and 32.0, the mole rate was 6.6 and 5.6 and the

malformation rate was 5.5 and 4.5 per 1000 livebirths. The survey is

biased by data from population centers.

ACKNOWLEDGMENTS

Dr. Trang Minh Tung - Minister of Health, Government of the Republic of Vietnam

Dr. Dinh Xuan Minh -- Special Assistant to the Minister of Health

Dr. Dang Quoc Phu -- Director, National Institutes of Public Health

Dr. Trung Minh Cac — Vice General Director of Health, Ministry of Health

Vo Liet Nu-- Chief, Records Section, Tu-Du Maternity Hospital

BG Richard R. Taylor — Command Surgeon, Military Assistance Command, Vietnam

Dr. Theodore R. Woodward — Professor of Medicine, University of Maryland,School of Medicine

Col. Robert J. T. Joy - Deputy for Medical and Life Sciences, Office ofDirector of Defense Research and Engineering

Maj. Herbert E. Segal - Division of Preventive Medicine, Walter Reed ArmyInstitute of Research

C O N T E N T S

Page

Synopsis-Abstract » i

Acknowledgments ii

Introduction 1

Methods 3

Results 4

Discussion ° 5

Conclusions 7

Tables 9

Figure 1 Location of Hospitals Visited 25

Figure 2 Number of Livebirths Collected by Year, Republic of Vietnam

1960 - 1969 26

Figure 3 Countrywide Incidence of Stillbirths, Malformations and Moles

per 1000 Livebirths per Year 27

Figure 4 Acres Sprayed by Year, Republic of Vietnam, 1960-1969 28

References. „ 29

I N T R O D U C T I O N

In 1969 Bionetics Research Laboratories reported an increase in-

cidence of developmental abnormalities in rats and mice born of mothers

which had received 2, 4, 5-trichlorophenoxyacetic acid (2,4,5-T) during

early pregnancy (1). Because herbicides* containing this compound had

been used for military purposes in the Republic of Vietnam (RVN), concern

was expressed about possible similar effects in humans. To determine

whether such effects could be shown in humans, the Ministry of Health,

RVN, (MOH) and the US Military Assistance Command, Vietnam (MACV)

undertook a cooperative study of obstetrical records over the 10 year in-

terval 1960 - 1969 in 22 hospitals. This report describes the incidence of

recorded congenital malformations, stillbirths, and hydatidiform moles in

RVN before (1960 - 1965) and after (1966 - 1969) large scale military use

of herbicides.

* A gent Orange, used in Vietnam defoliant operations, is composed of a1:1 mixture of the n-butyl esters of 2,4-dichlorophenoxyacetic acid and2,4,5-trichlorophenoxyacetic acid.

METHODS

Evaluations of Obstetrical Records and Survey Procedures.

The initial efforts were directed to assess the availability and accuracy of obstet-rical records in Vietnamese medical facilities, and to develop techniques for review andinterpretation. A pilot study performed in seven provincial and district hospitals and oneSaigon hospital (Tu-Du) revealed that Vietnamese obstetrical records were availableand accurate, and developed reviewing techniques. The survey was then extended to

other medical care facilities throughout the country.

Hospital Ledger.

In all but four hospitals, a Daily Summary Ledger, prepared by the chief midwivesserved as the primary source document. This contained 15-20 categories of informationon each obstetrical or gynecologic patient. The following information was recorded:hospital admission number; patient's name, age, parity, and date of admission; presen-tation, time, and method of delivery; baby's sex, weight, and general condition at birth;placenta weight; estimate of blood loss; and name of person attending. A "remarks"column recorded such data as vacuum extraction, reversion, placenta delivery assist-ance, Caesarean section and indication, blood transfusion, uterine revision, maternalor infant complications with treatment and results, and, most germane to this study,congenital malformations. Some hospitals also included in the Ledger the patient'saddress and occupation, father's name and occupation, baby's name, date of dischargeor departure prior to discharge, and whether patient paid for her care. The accuracy ofthe information in the Daily Summary Ledger in each hospital was tested by comparingit to the information in random samples of individual medical records. Several hundredsuch comparisons failed to reveal any discrepancies. No Daily Summary Ledger waskept at Hue, My Tho, or Tay Ninh; at these hospitals each individual obstetrical andgynecological record available was individually examined.

Records System at Tu-Du

A system of automatic data processing is used at Tu-Du Maternity Hospital inSaigon which was devised by a staff member trained in statistics in the United Statesand who has been chief of that medical records office for 12 years. The system usesmanual coding of the information derived from the hospital records, transposition topunch cards and compilation. Eighteen malformation types are specified; these includeall those commonly observed, the remainder are categorized as unspecified.

Criteria for Stillbirth, Malformation and Mole.

Abortions were distinguished from stillbirths by recorded fetal weight. Stillbirthwas defined as fetuses weighing 750gm. or more and without evidence of life aftercomplete separation from the mother. Only a few weighed less than lOOOgm. In therare case where fetal weight was not recorded, stillbirth was defined as a birth with agestation period of twenty-four weeks or longer.

Malformations were counted in both livebirths and stillbirths. Malformations asso-ciated with abortions were not counted. More than one malformation was occasionallyrecorded for a single infant and these malformations were counted individually. In nocase were more than three malformations recorded for a single birth. Hydatidiform moleswere counted only if delivered.

Hospitals Surveyed

The location of each hospital visited is shown in Figure 1. All are Ministry ofHealth public hospitals and are free to those who do not desire or cannot afford to pay.

RESULTS

A total of 499,119 birth events were counted. There were 480,087 livebirths,16,166 stillbirths, and 2,866 hydatidiform moles. Table 1 shows the location and typeof hospital by geographic area, the years for which data were available and the numberof livebirths counted. A small number of birth events for the years 1959 and 1970 werecollected and are included in Table 1 for completeness. If these data are excluded,there are 488,852 total birth events, which include 470,200 livebirths, 15,812 stillbirthsand 2,840 hydatidiform moles during the 1960-69 decade under consideration.

Figure 2 shows the number of livebirths collected by year. Hospitals outside theCapital contributed the largest portion of the progressive increase in number of livebirths.Only a few hospitals had records for the entire decade. There is a relative lack of datafor the first half of the decade. Before 1969, hospital records were kept for varyingperiods of time. Since 1969, MOH has required records maintenance for a minimum offive years.

The incidence of abnormal birth events by geographic area is shown in Table 2,and includes 1959 and 1970 data. All rates are expressed as per 1000 livebirths. Widevariations in some hospitals' annual incidence of all birth events were observed, and insome hospitals the rates were unrealistically low. Except in the smallest hospitals,variation in rates was usually greater between hospitals than the year-to-year variationwithin hospitals. Excluding the small district hospitals, stillbirth rates varied from8.7 at Long Dien (4,214 livebirths over 7 years) to 62.7.at Qui Nhon (6,303 livebirthsover 4 years). Hydatidiform mole rates varied from 1.4 at Tan An (24,596 livebirths

'over"» years) 10 ib'i'iTai'""Can ivno (16,066HVfeeinttgtfVerCU years). Maltormation ratesvaried from 1.1 at Tan An to 7.4 at Hue (5,271 livebirths over 2.3 years).

Table 3 presents annual birth abnormality rates for the years 1959 - 1970. If 1959and 1970 data are excluded, the rates for the decade are: stillbirth - 33.6, moles -6.0,and malformations - 4.9. Figure 3 depicts the decline in the countrywide stillbirth rate,

and the stable mole and malformation rates. The rates of stillbirths, moles and malfor-

mations for the four geographic areas are compared in Table 4.

Congenital Malformations.

Table 5 presents the 2,355 congenital malformations by type collected from allhospitals. Only obvious congenital malformations were recorded. Forty percent of all

malformations were not specified by type in the Ledger nor in the individual medical

records of the patients. Anencephaly, cleft lip/palate, clubfoot and hydrocephaly ac-counted for over 80% of all specified malformations. Congenital heart disease was notrecorded nor were there autopsy reports on those infants who were dead at birth or diedshortly thereafter. The hospital records do not distinguish between harelip and cleftpalate, the general term "bee de lievre" being used for both malformations. Unusualdeformities, such as those associated with thalidomide, were not reported.

Individual Hospital Data

Tables 9 through 29 present the birth defect data for each individual hospital surveyed.

Herbicide Usage in Vietnam.

Figure 4 shows the number of acres sprayed by year in Vietnam during the decade (3).

Prior to 1966 there was comparatively little use of herbicides. Since 1966, more than

800,000 acres were sprayed annually. The birth defect data were grouped into pro- andlight-spraying years (1960 - 1965) and heavy-spraying years (1966 - 1969). In Table 6the data for these two periods are compared. The data for the years 1959 and 1970 are

not included in this Table.

DISCUSSION

This study does not directly test a relationship between herbicides and birth abnor-

malities. Such an assessment would require prospective studies with examination of one

population before and after exposure, or examination of two comparable populations withonly one exposed to herbicides. Information about the precise dose of herbicide to

which pregnant women were exposed and the week of pregnancy would be required. Care-ful examination and follow-up appraisal of all livebirths would be necessary to detect

tne presence ot inapparent maitorniauons. Ail stillborn ana luiant ueatns wouia require

post-mortem examination. The dose of herbicide could then be related to embryologicaldevelopment of malformations. It is obviously impossible to carry out such a study.

This study has several biases. The first is that nearly all the information wasderived from population centers and larger hospitals. In the six district hospitals visited(Tables 1 and 2) there were only 9857 livebirths with 86 stillbirths (a rate of 8.7), 3moles (a rate of 0.3) and 14 malformations (a rate of 1.4). The two Saigon maternityhospitals contributed 59% of the data.

The second bias is the absence of data from private medical sources. There areseveral private hospitals in Saigon with large obstetrical departments and excellentstandards of practice. Many other cities have private hospitals. All cities had severalprivate "cliniques" usually directed by a single physician. Wealthier Vietnamese oftenattend these private hospitals, and the birth defect rates in this population might differfrom those obtained in this survey. This is suggested by data from the Da Lat provincehospital which has two classes of patients. One class, presumably wealthier, pays forobstetrical care. Both classes are served by the same obstetrical personnel and thesame labor and delivery rooms. The only difference is assignment to different areas ofthe hospital for the post-partum period. The hospital maintains the records separatelyand the information was so collected and analyzed in this study (Tables 1, 2, 20, and 21).The paying class had lower stillbirth, mole and malformation rates.

The third bias is that the data are restricted almost exclusively to ethnic Vietnamese.There are a half million Chinese living in the Saigon/Cholon area and they use the sixprivate Chinese hospitals in the area, none of which were surveyed. Montagnards as arule do not enter district or province hospitals, but deliver at home.

Untoward events limited the availability of data at some hospitals. These include amortar round exploding in the record room at My Tho in 1968, a flood in the record roomat Qui Nhon in 1965, the loss of 1961 and 1962 Hung Vuong records which were borrowedfor a medical school project, administrative disposition of record files, before 1965 atCan Tho and Ban Me Thout and before 1967 at Pleiku and Tay Ninh, and finally the 1968Tet Offensive when several hospitals became battlegrounds and some records weredestroyed.

During the earlier part of the decade, some hospitals reported very few birth defectsand hospital personnel frankly admitted incomplete reporting during those years. Mostof the directors of the hospitals visited had been appointed within the past few years,and improvement in records keeping coincident with their assignment resulted in morecomplete reporting during the latter part of the decade. This has caused comparativelyhigher reported rates for recent years and in some hospitals the data suggest an upwardtrend when one actually may not exist; i.e., at Baria,Nha Trang, and Ban Me Thuot.

Changes in local obstetrical referral practices influence rates in specific hospitals.For example, those district hospitals near province hospitals began to refer problemcases to the province hospital when doctors with obstetrical training were assigned.Referral practice has been influenced by gradual improvement in roads, public trans-

portation, and security. The referral system accounts for the higher abnormality ratesin province hospitals. This influence is also noted in the Capital area. For example,Tan An and Bien Hoa refer many problem and mole patients to the Tu-Du hospital inSaigon.

Rates are influenced by other factors. A study of moles begun in the Nha Trang

hospital in 1968 resulted in a striking increase in the mole rate, probably due to morecomplete reporting and to the referral of a larger number of patients with suspected molesfrom surrounding districts.

The feasibility of relating the birth data collected to the quantity of herbicide sprayedby province by year was studied. Initially it seemed possible that abnormal birth event

rates might be correlated to the amount of herbicide sprayed. The records for each aerial

spray mission, including map coordinates of the area covered and the type and quantityof herbicide used, were made available by MACV. However, it was not possible to de-termine what proportion of any province's total yearly birth events are included in thissurvey. Neither the MOH Maternal and Child Health Program nor the birth registry systemcollect complete data. RVN officials estimate that currently only 70% of all births are

reported to MOH and only 50% are reported as registered to the National Institute of

Statistics. Our inability to obtain a consistent sample of birth events by province pre-

cluded meaningful correlation between spray and birth event data.Comparisons of birth event data between countries are difficult because of variations

in reporting procedures and differences in definitions of the various events. The inci-dence of stillbirths, moles, and malformations from studies in large Asian populations

(4-13) is shown in Tables 7 and 8. The data from this study fall within the ranges

reported by other workers.

CONCLUSIONS

Medical records at Vietnamese medical facilities were found to be sufficiently com-

plete and accurate to compile birth events data for the decade of the sixties. Exceptin the Saigon area, there was frequent under-reporting of abnormal birth events particu-

larly in the first part of the decade, resulting in unrealistically low rates in some

hospitals for that earlier period.

This survey collected information on 480,087 livebirths, 16,166 stillbirths, 2,866moles and 2,355 congenital malformations of all types from medical records main-tained at 22 hospitals representing the Coastal, Interior, Capital and Delta geographicregions. There was a decline in the countrywide stillbirth rate and stable mole andmalformation rates during the decade, weighted by the Saigon experience which con-

tributed 59% of the data.Meaningful correlation of any province's annual abnormal birth events to quantitative

herbicide data was precluded by our inconsistent sampling of birth data.

Sorting the data into two time periods, before (1966-65) and after (1966-69) the large

scale military use of herbicides, failed to show any influence of herbicides. Rather, adownward trend was observed in all categories of abnormal birth events. In comparing

the earlier with the later period the countrywide stillbirth rate was 36.1 and 32.0, themole rate was 6.6 and 5.6, and the malformation rate was 5.5 and 4.5. These rates arewithin the ranges reported for other Asian populations.

A natural variation was observed in the incidence of abnormal birth events as recordedduring the decade. This variation was frequently of a greater magnitude between hospitals

than the year-to-year variation within hospitals. The effect of any single variable (i.e.,

herbicides) cannot be demonstrated unless it changes this natural variation and is notmasked by other variables. Such a change was not found in this survey.

Vietnam

Herbicides

Malformations

Moles

Stillbirths ,

TABLE 1. LOCATION AND TYPE OF HOSPITALS SURVEYED, YEARS OF DATAAVAILABILITY, AND NUMBER OF LIVEBIRTHS COUNTED

HOSPITAL TYPE* YEARS** LIVEBIRTHS

Coastal PlainLong DienBariaNha TrangQui NhonTuy PhuocDa NangHueHue Districts (3)

DPPPDPPD

1962-701960-701964-701966-691966-701967-691968-701967-70

4,37513,54315,7896,1901,190

13,0615,2713,553

InteriorTay NinhPleikuBan Me Thuot

jDa Lat (Paying)Da Lat (Nonpaying)

PPPPP

1967-691968-701966-701960-701960-70

6,9472,4885,8084,65810,860

CapitalTu-Du Maternity Hospital C 1960-69Hung Vuong Maternity Hospital C 1959-69Bien Hoa C(P) 1961-69

182,45099,60040,099

DeltaCai RangCan ThoMy ThoKien HoaTan An

TOTAL

DPPPP

1969-701965-691969

1964-701961-69

74016,0563,92218,89124,596

480,087

*D » District, P = Province, C = Capital

** Data for 1970 restricted to the first 3-4 months

TABLE 2. INCIDENCE OP BIRTH ABNORMALITIESBY GEOGRAPHIC AREA

HOSPITAL StillbirthsRate*Moles Malformations

Coastal PlainLong DienBariaNha TrangQui NhonTuy PhuocDa NangHueHue Districts (3)

8.726.247.062,14,42,48,4.7

01.96.33.20.84.36.80.3

1.82.72.94.00.82.87.41.1

InteriorTay NinhPleikuBan Me ThuotDa Lat (Paying)Da Lat (Nonpaying)

37.927.743.620.051.0

6.32.42.11.15.6

1.40.80.91.76.3

CapitalTu-DuHung VuongBien Hoa

34.832.321.8

9.24.11.1

7.15.02.4

DeltaCai RangCan ThoMy ThoKien HoaTan An

COUNTRYWIDE

18.954.443.830.322.9

33.7

1.815.810.41.71.4

6.0

1.86.44.61.21.1

4.9

*per 1000 livebirths

10

TABLE 3. INCIDENCE OF STILLBIRTHS, HYDATIDIFORM MOLES ANDCONGENITAL MALFORMATIONS, BY YEAR

Year LivebirthsStillbirthsWT. Rate*

MolesNo. Rlfte*

MalformationsNo7 Rate*

195919601961196219631964196519661967196819691970

3,25825,10624,35521,32633,06039,00946,82153,01369,84473,18884,4786,629

1251,022919744

1,1531,3811,6321,8392,1592,2882,675

229

38.340.737.734.934.935.434.834.730.931.331.234.5

9186164134207249318323359381519' 17

2.87.46.76.36.36.46.86.15.95.26.12.6

1118412114818721020232027633434117

3.47.35.06.95.65.44.36.03.94.64.02.6

TOTAL 480,087 16,166 33.7 2,866 6.0 2,355 4.9

*per 1000 livebirths

TABLE 4. COMPARISON OF STILLBIRTHS, MOLES AND MALFORMATIONSBY GEOGRAPHIC AREA

Area LivebirthsStillbirthsRo~IRate*

MolesNo;

MalformationsNoT Rate*

CapitalCoastalInteriorDelta

322,14962,97230,76164,205

10,3682,3711,2322,195

32.538.640.034.3

2,134240128364

6.63.84.25.7

1,90019293170

5.83.03.02.6

TOTAL 480,087 16,126 33.7 2,866 6.0 2,355 4.9

*per 1000 livebirths

11

TABLE 5. TYPE, NUMBER, DISTRIBUTION, AND RATE OF CONGENITALMALFORMATIONS OBSERVED IN 480,087 LIVEBIRTHS

Type Number Percent of Total Rate*

Not specifiedAnencephalyCleft lip/palateHydrocephalyClubfootVentre batracien**MonsterUmbilicalAchondroplasiaPolydactylyAbnormal genitaliaSpina bifidaEviscerationHermaphroditeImperforate anusTumorAscitesSiamese twinsMalformation of legsLarge abdomenMalformation of handsMicrocephalySyndactylyOthers (specified)

935525452136817642111388876654333332

15

39.722.319.25.83.53.21.80.50.60.30.300000.20.2000000

.1

.1

.1

.1

.1

.10.6

1.951.090.940.280.170.160.090.020.030.020.020.020.010.010.010.010.010.010.010.010.010.010.010.03

TOTAL 2,355 100.0 4.91

*per 1000 livebirths

**Enlarged abdomen with or without ascites

12

TABLE 6. COMPARISON OF BIRTH EVENTS DATA IN LIGHT-SPRAYING TOHEAVY-SPRAYING YEARS, COUNTRYWIDE AND BY GEOGRAPHIC AREAS

Light^Spraying (1960-65) Heavy-Spraying (1966-69)N o T R a t e f N o . R a t e *

CountrywideLivebirths 189,677 - 280,523Stillbirths 6,851 36.1 8,961 32.0Moles 1,258 6.6 1,582 5.6Malformations 1,052 5.5 1,271 4.5

Coastal PlainLivebirths 12,580 - 47,347Stillbirths 366 29.1 1,892 40.0Moles 20 1.6 211 4.4Malformations 27 2.1 148 3.1

InteriorLivebirths 7,052 - 21,619Stillbirths 360 51.0 794 36.7Moles 39 5.5 85 3.9Malformations 34 4.8 54 2.5

CapitalLivebirths 151,726 - 167,165Stillbirths 5,641 37.2 4,602 27.5Moles 1,141 7.5 984 5.9Malformations 965 6.4 924 5.5

DeltaLivebirths 18,319 - 44,392Stillbirths 484 26.4 1,673 37.4Moles 58 3.2 302 6.8Malformations 26 1.4 145 3.3

*per 1000 livebirths

13

TABLE 7. COMPARISON OF STILLBIRTH, MALFORMATION, ANDANENCEPHALY RATES AMONG ASIAN POPULATIONS

Country

Hong Kong

India

Indonesia

Japan

Malaysia

Philippines

Singapore

Taiwan

Thailand

Vietnam

Author

HsuStevenson

SanghviKolahStevenson(Bombay)Stevenson(Calcutta)

Suharjono

Neel

Stevenson

JongcoAbad-VasquezStevenson

Stevenson

Wei

Siriraj Hosp.

Cutting

Period

1951-531961-64

1946-551960-631961-64

1961-64

1962-67

1948-54

1961-64

1962-631961-631961-64

1961-64

1955-62

1966

1960-651966-69

No. Births

32,1769,872

76,76329,55339,498

19,191

15,018

64,569

15,937

46,02528,66329,669

39,683

14,834

14,332

180,884249,779

StillbirthRate*

13.8

25.943.7

46.2

-

-

25.2

15.020.6

12.3

-

-

36.132.0

MalformationRate*

11.5

14.08.6

3.0

5.7

10.2

10.4

5.612.88.4

8.6

8.7

47.8**

5.54.5

AnencephalyRate*

0.561.3

0.80.91.5

0.3

1.0

0.6

1.0

G.80.60.5

0.5

1.2

0.4

1.11.0

*per 1000 livebirths**A11 malformations, major and minor

TABLE 8. COMPARISON OF HYDATIDIFORM MOLE RATESAMONG ASIAN POPULATIONS

Country Author Rate**

Hong Kong

Japan

Philippines

Taiwan

Vietnam

King*

Hasegawa*

Acosta-Sison*

Wei*

Cutting 1960-651966-69

1.8

4.3

5.9

8.0

6.65.6

*as reported by Marquez-Montes, et al.**per 1000 livebirths

TABLE 9. LONG DIEN DISTRICT HOSPITAL

Stillbirths MalformationsYear

196219631964196519661967196819691970 (1/3)

TOTAL

Livebirths

701101298747656601610508153

4,375

No.

113

1086333

Rate

1.49.9

10.013.412.210.04.95.9

19.6

Moles

000000000

NoT

200211200

38 8.7

Rate*

2.8

2.71.51.73.3

1.8

*A11 rates are expressed per 1000 livebirths

15

TABLE 10. BARIA PROVINCIAL HOSPITAL

Year

19601961196219631964196519661967196819691970 (1/3)

Livebirths

5881,3681,3531,3031,1691,3341,4441,6591,3911,562372

Stillbirths Moles MalformationsNo.

2738322739413632324111

Rate

4628242134312519232630

No.

00011329361

---

0.80.82 . 21.35.42 . 23.82 . 7

No.

34316332542

Rate

5.12.92.20.85.12.22.01.23.62.55.4

TOTAL 13,543 356 26.2 26 1.9 36 2.7

TABLE 11. NHA TRANG PROVINCIAL HOSPITAL

StillbirthsYear

1964196519661967196819691970 (1/4)

TOTAL

Livebirths No. Rate

1,5072,1112,1132,7673,1683,615

508

618613214914614622

40416250463743

MolesNo. Rate

Malformations

15,789 742 47.0

51041222416

100

3.24.71.94.36.911.311.8

6.3

No.

12

1458

106

46

Rate

0.70.96.71.82.52.8

11.8

2.9

16

TABLE 12. QUI NHON PROVINCIAL HOSPITAL

TOTAL

19661967196819691970 (1/3)

TOTAL

Year

196719681969

Livebirths

1,1781,4911,7721,749

6,190

TABLE 13

Livebirths

27226033126067

1,190

TABLE 14.

Livebirths

4,6204,3474,094

StillbirthsNo. Rate

60 5179 52133 75116 62

388 62.7

. TUY PHUOC

StillbirthsNo . Rate

2 74 157 213 111 15

17 14.3

MolesNo . R~ate

07 4.76 3.47 4.0

20 3.2

DISTRICT HOSPITAL

MolesNo. R~ate

1 3.70000

1 0.8

DA NANG PROVINCIAL HOSPITAL

StillbirthsNo. Rate

174 38198 46185 45

MolesNo. R~ate

16 3.519 4.421 5.1

21 3.4

MalformationsNo7

00100

Rate

3.0

0.8

MalformationsRoT

131410

Rate

2.83.22.4

TOTAL 13,061 557 42.7 56 4.3 37

17

TABLE 15. HUE PROVINCIAL HOSPITAL

StillbirthsYear Livebirths No. Rate

MolesNo. Rate

MalformationsNo. Rate

196819691970 (1/3)

1,1562,8371,278

5113273

444657

14 12.120 7.02 1.6

9219

7.87.47.0

TOTAL 5,271 256 48.5 36 6.8 39 7.4

TABLE 16. HUE DISTRICT HOSPITALS

Year LivebirthsStillbirthsNoT Rate

MolesNo. R~ate

MalformationsNoT Rate

Cua-Huo1969 5601970 (1/3) 178

Thanh-Noi1969 1741970 (1/3) 212

Tay-Loc1967 7831968 6941969 6751970 (1/3) 277

20

6243

3.5

7.62.85.910.8

1.7 10

00

1.7

1.21.41.5

TOTAL 3,553 17 4.7 0.3 1.1

18

TABLE 17. TAY NINH PROVINCIAL HOSPITAL

Year LivebirthsStillbirthsNoT Rate

MolesNo. Rate

MalformationsNo. Rate

1967(3/4)19681969

1,8182,5632,566

5510999

304339

81719

4.46.67.4

2.21.21.2

TOTAL 6,947 263 37.9 44 6.3 10 1.4

TABLE 18. PLEIKU PROVINCIAL HOSPITAL

Year LivebirthsStillbirths

N < T R a t eMoles

No"RateMalformationsNo. Rate

196819691970 (1/4)

TOTAL

8401,304344

2,488

203613

69

242838

27.7

420

4.71.5

2.4

200

2.3

0.8

19

TABLE 19, BAN ME THUOT PROVINCIAL HOSPITAL

YearStillbirths

Livebirths No. RateMoles

No. RateMalformationsNo. Rate

19661967196819691970 (1/3)

TOTAL

1,2011,4171,2271,292671

5,808

5657436037

253

4740354655

43.6

00093

12

6.94.5

2.1

3.9

0.9

TABLE 20. DA LAT PROVINCIAL HOSPITAL - PAYING

StillbirthsYear

19601961196219631964196519661967196819691970 (1/2)

TOTAL

Livebirths

236221232259760

276624679947424

4,658

No.

5333

18

Rate

2114131224

MolesW. R~ate

Malformations

(data missing from hospital)10 36 015 24 112 18 112 13 112 28 0

93 20.0

2.6

1.61.51.1

1.1

No.

10002

01031

Rate

4 .2---

2.6_

1.6-

3.22 .4

1.7

20

TABLE 21. DA LAT PROVINCIAL HOSPITAL - NONPAYING

Year

19601961196219631964196519661967196819691970 (1/2)

TOTAL

Livebirths

704793852985943

1,0671,0921.1361,2611,376651

10,860

StillbirthsNo.

5157416536785648584816

Rate

7272486638735142463525

554 51.0

MolesNo.

125455675381

61

Rate

17.16.34.75.15.35.66.44.42.45.81.5

5.6

MalformationsNo.

25895283

11114

68

Rate

2.86.39.49.15.31.97.32.68.78.06.1

6.3

TABLE 22. TU-DU MATERNITY HOSPITAL, SAIGON

Year

1960196119621963196419651966196719681969

TOTAL

Livebirths

12,35011,29411,48212,79517,09918,74719,42923,77626,67528,803

182,450

StillbirthsNo.

535519517500637705691626699829

Rate

43464539373836262629

MolesN c T K a t e

MalformationsNo.

43464539373836262629

145140122139182195189187188196

1212111211109.77.97.06.8

13887123125142115166125138144

6,258 34.8 1,683 9.2 1,303

Rate

117.7

119.88.36.18.55.35.24.9

7.1

21

TABLE 23. HUNG VUONG MATERNITY HOSPITAL, SAIGON

Year

1959*19601961**1962**1963196419651966196719681969

TOTAL

Livebirths

3,25811,2284,608238

11,0888,693

10,66511,34913,66712,25712,549

99,600

StillbirthsNo.

1254041336

412366360366397308342

Rate

4137292537433432292527

3,219 32.3

MolesNo.

92916046445250643859

07

Rate

2.82.83.5-4.25.14.94.44.73.14.7

4.1

MalformationsNo.

1140142

43405779787263

499

Rate

3.43.63.08.43.94.65.37.05.76.05.0

5.0

* Opened September 1959.** Records borrowed and lost for this period.

TABLE 24. BIEN HOA PROVINCIAL HOSPITAL

Year

196119621963196419651966196719681969

Livebirths

4,1664,3444,3314,3714 , 2 2 74,0564 ,7354,8115,058

StillbirthsNo.

142108112968984889181

Rate

342526222121191916

MolesNoT"

16

11581174

Rate

0 . 21.42.51.11.90 .20 .21.50.8

MalformationsNo.

117588

12122114

Rate

2 .61.61.21.81.93.02.54.42.8

TOTAL 40,099 891 21.8 44 1.1 98 2.4

TABLE 25. CAI RANG DISTRICT HOSPITAL

StillbirthsYear

19691970 (1/3)

TOTAL

Livebirths

551189

740

No.

113

14

Rate

2016

18.9

MolesNo.

10

1

Rate

1.8-

1.3

MalformationsNo.

10

1

Rate

1.8-

1.3

TABLE 26. CAN THO PROVINCIAL HOSPITAL

StillbirthsYear'

1965 (1/2)1966196719681969

Livebirths

1,7693,6503,6973,4983,442

No.

93163224210183

Rate

5347606053

MolesNo.

3455375474

Rate

1915101522

MalformationsNo.

525203220

Rate

2.86.85.49.15.8

TOTAL 16,056 873 54.4 254 15.8 102 6.4

TABLE 27. MY THO PROVINCIAL HOSPITAL

Livebirths

3,922

StillbirthsNo.

172

Rate

43.8

MolesNo. Rate

41 10.4

MalformationsNo.

18

Rate

4.6

23

TABLE 28. KIEN HOA PROVINCIAL HOSPITAL

StillbirthsYear

1964196519661967196819691970 (1/3)

TOTAL

Livebirths

1,7933,0793,2693,5642,6803,2011,305

18,891

No.

6675

110108908935

573

RateMoles

No. RateMalformations

37243430342827

13

106364

0.60.93.11.71.11.93.1

3654332

30.3 33 1.7

No.

3654332

23

Rate

1.71.91.51.11.10.91.5

1.2

TABLE 29. TAN AN PROVINCIAL HOSPITAL

Year LivebirthsStillbirthsNo. Rate

MolesNo. Rate

MalformationsNo. Rate

196119621963196419651966196719681969

TOTAL

1,9052,1242,1982,3763,0753,0283,2293,2283,433

24,596

273633599565917681

563

141715283121292323

22547462

.3

1.00.92.31.72.31.31.80.60.9

-34326422

22.9 35 1.4 26

1.41.81.30.62.01.20.60.6

1.1

24

HUE

DA NANG

TAN ANMYTHO

TUY PHUOCQUI NHON

NHA TRANG

DALAT

BIEN HOA

SAIGONLONG DIEN

KIENHOA

LOCATION OF HOSPITALS VISITED

25Figure 1

NUMBER OF LIVE BIRTHS COLLECTED, BY YEARREPUBLIC OF VIETNAM, I960 - 1969

80

70

60

oo3 50

m 40UJ

30

20

10

CAPITAL AREA

OUTSIDE CAPITAL AREA

i

i

i

n.

I960 61 62 63 64 65 66 67 68 69YEAR

26Figure 2

COUNTRYWIDE INCIDENCE OF STILLBIRTHS,MALFORMATIONS,

AND MOLES PER 1000 LIVE BIRTHS PER YEAR

1960-1969

CC

§40\OoO

UJ 35zUJQO

^ 30

10

• - STILLBIRTH

x - MALFORMATION

o - MOLE

I960 61 62 63 64 65 66 67 68 69YEAR

70

27Figure 3

ACRES SPRAYED BY YEAR, REPUBLIC OF VIE I NAM1960-1969

OOO0~OO

OUJ

o:a.

<ro

0I960 61 62 63 64 65 66 67 68 69

Y E A R

28Figure 4

REFERENCES

1. Bionetics Research Laboratories: Evaluation of the Teratogenic Activity of SelectedPesticides and Industrial Chemicals in Mice and Rats. Vol. Ill, 1969

2. U. S. Department of the Army, Training Circular. TC-3-16. Employment of RiotControl Agents, Flame, Smoke, Antiplant Agents, and Personnel Detectors in Counter-guerrilla Operations, April 1969

3. U. S. Congress. House. Committee on Science and Astronautics. Report to theSubcommittee on Science, Research and Development. Prepared by the Science PolicyResearch Division, Legislative References Service, Library of Congress (CommitteePrint) Serial F. Aug 8, 1969. 91st Cong. 1st Sess. US Govt. Printing Office, 1969.p. 15

4. Penrose AC: Genetics of Anencephaly. J Ment Del Res 1:4-15, 1957

5. Stevenson AC, Johnson HA, Stewart MIP, Golding DR: CongenitalMalformations: A Report of a Study of Series of Consecutive Births in 24 Centers.Bull WHO 34:Suppl 9, 1966

6. Kolah PJ, Master PA, Sanghvi LD: Congenital Malformation and Perinatal

Mortality in Bombay. Ame J Obstet Gynec 97:400-406, 1967

7. Suharjono, Sunoto, Sudijonto, Sugiono M, Sutedjo: The incidence of CongenitalMalformation in the Dr Tjiptomangunkusumo General Hospital, Jakarta, 1962-1967.Paediatrica Indonesians 9:9-12, 1969

8. Neel JV; A Study of Major Congenital Defects in Japanese Infants. Amer J Hum

Genetics 10:398-445, 1958

9. Jonco AP, Carlos FC, Fernadez EV: Congenital Anomalies in Filipinos. J PhilippineMed Assn 41:57-60, 1965

10. Abad-VasquezL, Pascual-Poblete E, Jonco A: Congenital Malformation in the

Newborn. J Philippine Afed Assn 41:294-303, 1965

11. Wei PY, Chen YP: Congenital Malformations, Especially Anencephalus, in Taiwan.

Amer J Obstet Gynec 91:870-876, 1965

12. Annual Report, Siriraj Hospital, Bangkok, Thailand, 1966

13. Marquez-Montes H, de la Vega GA, Robles M, Bolio-Cicero A: Epidemiology andPathology of Hydatidiform Mole in the General Hospital of Mexico. Amer J Obstet

Gynec 85:856-864, 1963

29 GPO 903.233