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Clinico-pathological study of causes of perinatal mortality in a developing country
S Naidu1, J Moodley, M Adhikari
1MRC/UN Pregnancy Hypertension Research Unit and Department of Obstetrics and Gynaecology, University of Natal Medical School, Durban, South Africa.
Insights
High perinatal mortality rates, at 59/1000, indicate a need for improved obstetric and neonatal care. Key factors include abruptio placentae, hypertension, and prematurity, highlighting areas for service enhancement.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Public Health
Background:
- Perinatal mortality rates serve as crucial indicators of obstetric and neonatal service quality and community socio-economic status.
- These rates are vital for identifying deficiencies in healthcare provision.
- Understanding the causes of perinatal death is essential for targeted interventions.
Purpose of the Study:
- To identify the clinical causative factors associated with perinatal deaths.
- To utilize post-mortem evidence to support the identification of causes where available.
Main Methods:
- A prospective descriptive study was conducted over a 6-month period.
- Data collected included total deliveries, perinatal deaths, clinico-demographic information, and post-mortem findings.
- Analysis focused on identifying leading obstetric causes of mortality.
Main Results:
- A total of 7789 deliveries resulted in 460 perinatal deaths, yielding a rate of 59/1000 deliveries.
- Leading causes were abruptio placentae (25.3%), hypertension in pregnancy (24.9%), prematurity (17.4%), unexplained stillbirth (13.4%), and intrapartum asphyxia (9.2%).
- The study noted a high proportion of un-booked mothers (one-third) and a mean gestational age of fetal death at 31 weeks.
Conclusions:
- The perinatal mortality rate of 59/1000 is considered high, though comparable to other developing nations.
- Significant improvements are needed in the organization of obstetric and neonatal care, staffing, and antenatal service utilization.
- Enhancements in these areas are expected to substantially reduce the current perinatal mortality rate.
Abstract:
Perinatal mortality rates are an important indicator of the overall obstetric and neonatal services available, and the socio-economic status of the community. These rates are also used to identify shortcomings in services provided. The aim of this study was to identify clinical causative factors of perinatal deaths (supported by post mortem evidence where possible). This was a prospective descriptive study. The total number of deliveries and perinatal deaths over a 6-month period were recorded and clinico-demographic data noted. Post mortem examination information, if available, was also recorded. There was a total of 7789 deliveries over the 6-month period and 460 perinatal deaths, giving a perinatal mortality rate of 59/1000 deliveries; 45% (n = 207) of the perinatal deaths had post mortem examinations. The mean age was 26 years; 84.8% were single mothers. One-third of the group were un-booked: the mean gestational age of fetal death was 31 weeks, and the mean birth weight was 1700 g. Two-thirds of the perinatal deaths were stillbirths. The leading obstetric causes of deaths were: abruptio placentae (25.3%), hypertension in pregnancy (24.9%), prematurity (17.4%), unexplained stillbirth (13.4%) and intrapartum asphyxia (9.2%). The perinatal mortality rate of 59/1000 deliveries is high. Although this is comparable with other developing countries, there is a need for improvement in organisation of obstetric and neonatal care, staffing levels and access to and effective utilisation of antenatal services. These will probably lead to a significant reduction of this relatively high perinatal mortality rate.