r quickly and are unscathed, but a small number have persistent or worsening signs.1 A low Apgar score does not mean asphyxia has occurred at birth or in labor nor does it correlate well with later neurologic or cognitive outcomes, but a low score at 5 minutes indicates an increased risk of disability. A study from Norway on over 500,000 babies indicated that low scores were sellekchem strongly associated with cerebral palsy in children of normal birth weight and modestly in children of low birth weight.2 They showed that, at term, 0.1% of babies with an Apgar score of 10 had cerebral palsy, but 10% of those with an Apgar score of 3 or less were later diagnosed with cerebral palsy. The association of cerebral palsy with low birth weight infants was 4% with a high Apgar score and 17% with a low Apgar score.

All forms of cerebral palsy correlated with low scores, but the most pronounced was quadriplegia. The authors reiterate that 90% of children with a low Apgar score did not develop cerebral palsy. Footnotes These summaries are reproduced from the Journal Article Summary Service, a monthly publication summarizing clinically relevant articles from the recent world literature. Please see http://www.jassonline.com or e-mail az.oc.bewm@tneklohta for more information.
Last year, yet another study from the Netherlands indicated that induction rather than expectant management was a wiser course of action for hypertensive pregnancies at term.1 The authors argued that fewer maternal complications arose from a policy of inducing labor than monitoring progress.

The acceptance of this evidence and its implementation has been mixed, but the same team that produced the Hypertension and Preeclampsia Intervention Trial (HYPITAT) has now published an economic analysis of their work.2 This is a fascinating dissection of the overt and covert costs of active versus watchful management of hypertension and preeclampsia after 37 weeks of gestation in a developed health care system. The medical costs involved were antenatal surveillance, intrapartum care, theater costs, and postpartum care with the calculations of drugs, anesthetics, and skilled assistance all factored in. The nonmedical costs are revealing, taking into account sick leave from work for the woman and her partner, travel to and from hospital, and home care, as well as productivity and opportunity costs downstream.

The sensitivity, valuation, volume, cost-efficient, and cost-effective analyses used are foreign to those accustomed to clinical reasoning and open a new world of calculations that have pertinent applications GSK-3 given the current economic climate. Fortunately, their findings were clear cut, easy to follow, and serendipitously congruent with their obstetric recommendations. It turned out to be 10% less expensive to induce women than to engage in ongoing surveillance (�7077 vs �7908, respectively). It is hoped that more economic analyses will be undertaken in parallel with clinical interventions as there are r