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Factors Associated with Perinatal Mortality: A Descriptive Observational Study
  JSAFOG
PRACTICE GUIDELINE
Factors Associated with Perinatal Mortality:
A Descriptive Observational Study
1MB Bellad, 2K Srividhya, 3Kangle Ranjit, 4SM Dhaded
1Professor, Department of Obstetrics and Gynecology, JN Medical College, Nehru Nagar, Belgaum, Karnataka, India
2Resident, Department of Obstetrics and Gynecology, JN Medical College, Nehru Nagar, Belgaum, Karnataka, India
3Associate Professor, Department of Pathology, JN Medical College, Nehru Nagar, Belgaum, Karnataka, India
4Professor, Department of Neonatology, JN Medical College, Nehru Nagar, Belgaum, Karnataka, India
Correspondence: MB Bellad, Department of Obstetrics and Gynecology, JN Medical College, Nehru Nagar, Belgaum-590010 Karnataka, India, Phone: (0831) 2471525, 919448124893, e-mail: mbbellad@hotmail.com, belladmb@gmail.com,
 
Abstract
Objective: The objective of this study was to find out various causes of perinatal mortality and the factors associated with perinatal death.
Methods: A descriptive observational study done in a teaching hospital (Referral hospital at district) attached to Jawaharlal Nehru Medical College, Belgaum. All perinatal deaths during the period between December 2007 to May 2009 were included in the study.
Results: There were 3904 deliveries and 193 perinatal deaths during the study period. Perinatal mortality rate (PNMR) was 49.4/1000 births. The stillbirth rate was 43/1000 births. Antepartum hemorrhage and severe pre-eclampsia were the common causes of perinatal deaths.
Conclusion: Antepartum hemorrhage and pregnancy induced hypertension are leading causes of perinatal deaths. Majority of these complications occur in the later part of pregnancy increased vigilance during antenatal care can reduce these deaths.
Keywords: Perinatal deaths, causes, factors, antenatal care, perinatal morbidity, mortality.
 
INTRODUCTION

Perinatal mortality is taken as a index of the efficacy of not only antenatal and intranatal care, but also of the socioeconomic condition of the community.1 Perinatal mortality rate in developing countries is three to five folds higher than that in developed countries.2 The current perinatal mortality rate (PNMR) in India is 49 per 1000 births as per the NFHS. The advent of effective antibiotics, establishment of organized blood transfusion services, introduction of routine antenatal care and neonatal facilities has led to a decreasing perinatal mortality. Though this decrease in evident even in India, perinatal mortality is still high as compared to developed countries.2 According to World Health Report (2001), perinatal mortality accounts for more than four percent of deaths in the world, most of them occurring in developing countries. This hospital based study was undertaken to know the causes of perinatal mortality and thus help in its prevention.

METHODS

A prospective hospital based descriptive observational study. All perinatal deaths over a period of 18 months (from December 2007 to May 2009) in a teaching hospital were included. Stillbirth defined as fetal death more than or equal to 28 weeks gestation and early neona-
  -tal death (END) defined as death occurring in the first seven days of birth. Maternal details like age, parity, registered (minimum three visits) or unregistered were noted. Mode of delivery, gestational age and birth weight of fetuses were recorded. Autopsy was performed in those, whose parents provided informed consent. The data obtained was tabulated and analyzed using rates, ratios and percentages.

RESULTS

During the study period there were 3904 total number of deliveries with 193 perinatal deaths (168 stillbirths and 25 early neonatal deaths). The perinatal mortality rate (PNMR) was 49.4 per 1000 births and the stillbirth rate was 43 per 1000 births (Table 1). The autopsy rate was 58.5% (n = 113).
Out of 193 perinatal deaths 153 (79.2%) were unregistered. Most of the women were in the age group 20 to 30 years (82%). Nearly fifty percent (48.7%) of the women were illiterate and 57% belonged to lower socioeconomic class (Income less than Rs. 2500.00). Most of the babies were delivered by vaginal route (66.8%; n = 129) (Table 2).
According to gestational age, most of the perinatal deaths were preterm and only 18.6% were term (Table 3).
Perinatal mortality was highest in low birth weight babies (< 2,500 gm) (Table 4).
 
South Asian Federation of Obstetrics and Gynecology, January-April 2010;2(1):49-51 49
 

 
MB Bellad et al
 
Table 1: Perinatal mortality rate and stillbirth
Factors Associated with Perinatal Mortality: A Descriptive Observational Study

Table 2: Characteristics of women (n = 193)
Factors Associated with Perinatal Mortality: A Descriptive Observational Study

Table 3: Gestational age
Factors Associated with Perinatal Mortality: A Descriptive Observational Study

Table 4: Birth weight and perinatal mortality
Factors Associated with Perinatal Mortality: A Descriptive Observational Study

Most of the perinatal deaths were due to antepartum hemorrhage, severe PIH, eclampsia, preterm, birth asphyxia and congenital malformation. However, cause was undetermined in 34 cases (20.2%) (Table 5).

DISCUSSION

Perinatal death is a traumatic experience for both mother and the obstetrician. Despite advances in fetomaternal medicine, perinatal de-
  Table 5: Causes of perinatal deaths
Factors Associated with Perinatal Mortality: A Descriptive Observational Study


-ath rate continues to be high.
The PNMR in the present study was high 49.4 per 1000 births which was comparable to other studies.1-3 The stillbirth rate was 43 per 1000 births in comparison with other studies.2,4,5 since this hospital teaching institute majority of these deaths occur in those who present late.
As observed in many of the studies nearly 80% (79.2%) of these perinatal deaths occurred among unregistered group in this study.1,2,6,7 This is one of the areas in developing country like India needs efforts to implement effective antenatal care. The associated factors like socioeconomic status and female literacy had influence the adverse pregnancy outcome. Women�s education was inversely associated with perinatal deaths as observed in this study (48.7% women were illiterate and 57% belonged to lower socioeconomic class).2 In the present study, Similar findings were noted in other studies.2,6,9 Education automatically increases awareness and helps in overall improvement. Perinatal deaths were more in multigravidae compared to primigravidae as noted in other studies.2,8,10 Close monitoring is very essential even in multigravidae as obstetric complications increase with increase in parity.
Low birth weight (LBW) is an important cause of deaths in this study as observed in many of the studies.1,3,4,5 The factors responsible for these can be identified during the antenatal period as most of these can present with conditions that may be associated LBW.
Abruptio placenta and severe pre-eclampsia were the important cause of perinatal mortality. Similar findings were noted in other studies.1-4 Though there are no stratigies at present to prevent these conditions but severity of its effect and mortality can reduced by effective antenatal care, intranatal care and good neonatal care.
Effective antenatal care with early registration and increased visits in later part of pregnancy along with proper intranatal and neonatal care can reduce the perinatal deaths. Early registration helps in proper evaluation and identification women at risk. Improving the womens� education not only improves effective ANC but also improves awaren-
 
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Factors Associated with Perinatal Mortality: A Descriptive Observational Study
 
-ess specially during emergencies.

CONCLUSION

Effective antenatal care is still lacking among the pregnant women. Improvement in education and socioeconomic status are the key components of good pregnancy outcome are still lacking. Skilled health care provider (in antenatal, intranatal and neonatal care) with proper referral system and increased awareness in women are essential to reduce perinatal deaths.

REFERENCES
  1. Sujata, Das V, Agrawal A. A study of perinatal deaths at a tertiary care teaching hospital. J Obstet Gynecol India 2008; 58(3):235-38.
  2. Korde-Nayak VN, Gaikwad PR. Causes of stillbirth. Obstet Gynecol India 2008;58(4):314-18.
  3. Shinde A. The study of perinatal mortality in a rural area. J obst-
 
    -et Gynaecol India 2001;51(2):77-79.
  1. Ravikumar M, Devi A, Bhat V, et al. Analysis of stillbirths in a referral hospital. J Obstet Gynaecol India 1996;46:791-96.
  2. McClure EM, Wright LL, Goldenberg RL, Goudar SS, Parida SN, Jehan I, et al. The global network: A prospective study of stillbirths in developing countries. Am J Obstet Gynecol 2007;197:247e1-5.
  3. Kulkarni R, Chauhan S, Shah B, Menon G, Puri C. Investigating causes of perinatal mortality by Verbal Autopsy in Maharashtra, India. Indian J Comm Med 2007;32(4):259-63.
  4. Pradeep M, Rajam L, Sudevan P. Perinatal Mortality: A Hospital based study. Indian Pediatr 1995;32:1091-94.
  5. Fretts RC. Etiology and Prevention of stillbirth. Am J Obstet Gynecol 2005;193:1923-35.
  6. Chitra Kumari, Kadam NN, Kshirsagar A. Intrauterine fetal death: A prospective study. J Obstet Gynaecol India 2001;51:94-97.
  7. Lucy D, Umakant S, Niharika P. Perinatal mortality in a referral hospital of Orrisa: A 10 years review. J Obstet Gynecol India 2005;55(6):517-20.
 
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