Perinatal mortality in high risk pregnancy: a prospective study of preventable factors

The present study was undertaken to identify the preventable factors operative in high fetal and neonatal losses. Over a period of one year, of total of 1,600 consecutive deliveries, 1,107 were considered to be at-risk: there were 33 fetal and 31 early neonatal deaths with an overall perinatal mortality rate of 40/1,000 births. Perinatal mortality was higher in mothers who had received inadequate antenatal care and/or with bad obstetric history. Major maternal and obstetric factors associated with a high PMR were: advancing maternal age and parity, antepartum hemorrhage, diabetes, anemia, instrument and vaginal breech delivery. Overall cesarean section rate was 16.9%. Infants with a gestational age of less than 37 weeks and/or of birth weight of less than 2,500 g contributed for 56.2% and 68.7% of the total perinatal losses respectively. PMR was three fold higher among twins compared with singleton births. Identifiable causes of perinatal deaths observed were: asphyxia (31%), congenital anomalies (18.7%), sepsis (18.7%) and low birth weight (25%). It would appear that preventable factors are operative in over two third of the cases of perinatal loss and better maternal health, obstetric and neonatal care can improve the perinatal outcome in majority of the cases.