Perinatal Mortality in Jamaica 1986-1987

ABSTRACT. A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51 % of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70 % to the rest of the time period when the post-mortem rate was only 40 %. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 % of deaths overall and 59 % of deaths in infants of more than 2 500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20 % of deaths. Sixty percent of the infants in this group weighed less than 2 500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.     

Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51% of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70% to the rest of the time period when the post-mortem rate was only 40%. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40% of deaths overall and 59% of deaths in infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20% of deaths. Sixty percent of the infants in this group weighed less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.     

Perinatal Mortality in a Saudi Maternity Hospital

ABSTRACT. Perinatal mortality was analyzed in infants to mothers who delivered at the main Maternity hospital in Riyadh and who represented a large proportion of the obstetric population in the city. The crude perinatal mortality rate was 39.8 per 1000 births. The hirth weight-specific mortality rates were compared with the corresponding Swedish rates. The ratio between the birth weight-specific mortality rates in Riyad and Sweden increased from the lightest to the heaviest hirth weight category. Thus the perinatal mortality rate was 2.3 times higher in infants less than 1500 g, and 8.8 times higher in infants with birth weights of 3500 g and more. Similarly, the ratio between the gestational age-specific mortality rates in Riyadh and Sweden increased with advancing gestational age. The perinatal mortality rate of infants less than 28 weeks was 1.6 times higher, and that of term infants 4.8 times higher than in Sweden. The findings indicated shortcomings in the obstetric services. The perinatal mortality rate of teenage mothers, who comprised 17 percent of the material, was 9.1 times the Swedish rate. Other risk groups were para 0 mothers and mothers with a previous infant loss.     

Birthweight Specific Perinatal Mortality in Greece

ABSTRACT. Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.     

Perinatal mortality 1982-2001 at Vila Central Hospital, Vanuatu

OBJECTIVE: To determine the perinatal mortality at Vila Central Hospital (VCH) and thereby make an estimate of Vanuatu's perinatal mortality. METHODS: Labour floor and nursery records from VCH, Vanuatu's only tertiary referral hospital, were examined and collated for the period 1982-2001. Death certificate books were also examined. The perinatal mortality rate was calculated as the sum of stillbirths (infants = 20 weeks and/or = 500 g) and neonatal mortality (deaths <28 days). Premature infants were recorded for infants less than 37 weeks gestation and small-for-gestational-age for infants less than 2500 g. RESULTS: The mean perinatal mortality rate for the period was 27/1000, (range 15-36/1000). The mean stillbirth rate was 15/1000, (range 8-22/1000). The neonatal mortality was 12/1000, (range 4-18/1000). Premature babies accounted for 37/1000 births, (range 11-80/1000). Small-for-gestational-age infants were recorded in 45/1000 births, (range 16-83/1000). The mean twinning rate was 12/1000. Seven spontaneous triplets, two quadruplets and two pairs of siamese twins were born. Sepsis, meconium aspiration and birth asphyxia were the commonest causes of neonatal death. CONCLUSION: Accurate data collection is difficult in Vanuatu. There is the risk of under-ascertainment however, the figure of 27/1000 represents the current best possible estimate of perinatal mortality at VCH over the last 20 years. VCH is Vanuatu's premier hospital and it is likely that the national figure for perinatal mortality is higher, probably in the range of 37-39/1000. This places Vanuatu's perinatal mortality at a level 30 years or more behind Australia. These figures represent the largest account of hospital based perinatal data collected from any Pacific island nation.     

Neonatal mortality patterns in an urban hospital.

Neonatal mortality rate is perhaps the most reliable indicator of the perinatal outcome. An assessment of perinatal outcome can be made through knowledge of causes of death. This study was carried out to evaluate the neonatal deaths in our hospital. Live births (n = 7309) and deaths (n = 328) during a 6 months period were retrospectively analyzed. These were grouped into non-preventable and potentially preventable causes of death. The single most important factor contributing to the mortality was respiratory distress (29.3%) followed by sepsis (24.4%) and birth asphyxia (16.2%). The non-preventable causes of mortality (e.g., lethal congenital malformations, extremely low birth weight) accounted for 10.4% of the total mortality. The idealized neonatal mortality rate was 4.6/1000 live births, while the salvageable death rate was 40.2/1000 live births. The mortality increased significantly if the birth weight fell below 2 kg. The salvageable deaths could perhaps be prevented through better antenatal and intranatal care, ventilatory support and prevention of sepsis.     

Perinatal mortality trends in a referral hospital

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992–93 (Group B). The perinatal mortality rate (PMR) in Group A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.     

Neonatal mortality pattern in rural based medical college hospital

The present study was undertaken to establish priorities in neonatal care and to find out neonatal mortality pattern in a rural based medical college hospital. One hundred and twentythree neonatal deaths out of 1461 live births constituted the study material. The neonatal mortality rate was 84.2/1000 live births. The mortality in preterm, full term and post term infants was 43.13,4.02,7.02 percent respectively (p<0.001). The mortality in relation to birth weight was 100 percent (<1000 g); 71.43 percent (1000–1499 g); 37.14 percent (1500–1999 g); 7.63 percent (2000–2499 g) and 2.94 percent (>2500 g). Almost 70 percent of all deaths were because of severe birth anoxia and septicemia (including meningitis) either alone or in combination.     

A study of perinatal mortality rate from rural based Medical College Hospital

The present study conducted in a rural medical college aimed at analysing the perinatal mortality and its determinants in a rural set up. Fiftyeight still births and sixty two early neonatal deaths among 1107 consecutive deliveries gave a perinatal mortality rate of 108.4 per 1000 deliveries. Fifty percent of the total deliveries were unbooked. The perinatal mortality was higher in unbooked cases (16.3%), twins (33.2%) and preterms (33.9%) as compared to that in booked cases (5.3%), singletons (9.6%) and term deliveries (6.7%). Sixty nine percent of the still births were due to causes like obstructed labour, toxemia of pregnancy, antepartum hemorrhage, hand prolapse, and cord prolapse where timely intervention would have reduced the perinatal mortality significantly. Early neonatal deaths were mainly associated with prematurity and were largely due to birth anoxia, intraventricular hemorrhage, aspiration and infections.     

OUTCOME OF TWIN BIRTH Review of 1636 Children Born in Twin Birth

Abstract. During the five-year period 1964–68 96733 births were registered in the 28 hospitals equipped with maternity facilities in the Uppsala hospital region. Of these babies, 1636 were born in 818 twin deliveries. Data on gestational age, sex, weight and length at birth, birth order, hospital type, congenital malformations and perinatal mortality are analysed. Altogether 17.3 per 1000 of the children born during this period were born in multiple births. The perinatal mortality for the twin babies was 64 per 1000 born, with the mortality higher in the less specialized hospitals than the others. Twin no. 1 suffered perinatal death in 67 cases per 1000 and twin no. 2 in 60 cases per 1000. For twins of primiparae the losses were 92 per 1000 children and for twins born to multiparae 51 per 1000. Altogether 72 per 1000 male twins died perinatally compared to 52 per 1000 female twins. The most heavy losses occurred among the low-weight premature twins and in these cases both twins often suffered perinatal death.     

The choice of place of delivery. Effect of hospital level on mortality in all singleton births in New York City

In an analysis of all singleton births and neonatal deaths with known birth weights and gestational ages in New York City maternity services during a three-year period (1976 to 1978), intensive care services at the hospital of birth were found to influence mortality only in preterm (less than 37 weeks' gestation) or low-birth-weight infants (less than 2251 g). By contrast, for infants who were born at term and of normal birth weight, mortality rates did not differ by level of perinatal care available at the hospital of birth. On the average, preterm and low-birth-weight infants were at a 24% higher risk of death if birth occurred outside of a level 3 center, regardless of whether birth occurred at a level 1 or level 2 hospital. Preterm and low-birth-weight infants, though constituting only 12% of births, accounted for 70% of neonatal deaths in New York City. The remaining infants, ie, those born at term and of normal birth weight, who experienced no measurable mortality advantage when born in a level 3 hospital, accounted for 88% of all births.     

Early seizures indicate quality of perinatal care.

An analysis of antepartum, intrapartum, and postpartum variables was performed in a retrospective controlled study of 34 normally formed term infants who had perinatal asphyxia and subsequently displayed generalised seizures within 48 hours of birth. The aim was to identify any association, firstly between these variables and seizures, and secondly between these variables and subsequent morbidity and mortality among the seizure group. Maternal age greater than 35 years, duration of labour, meconium stained liquor, abnormal intrapartum fetal heart rate trace, and operative delivery were associated with seizures. A low Apgar score at five minutes, and intermittent positive pressure ventilation at birth of longer than 10 minutes were associated with subsequent morbidity and mortality. A striking relation between poor intrauterine growth and either death or handicap in the asphyxia group emphasised the value of growth measurements as a predictor of outcome. The overall incidence of seizures was 1.6 per 1000 term deliveries. There was a significant correlation between the seizure incidence and the intrapartum mortality rate. The incidence of seizures secondary to asphyxia in term infants, occurring less than 48 hours after delivery, may be a valuable index of the quality of perinatal care.     

2005年中南地区产科新生儿流行病学调查

目的：通过对我国中南地区城市医院分娩的新生儿的调查,了解我国中南地区新生儿出生情况。方法：抽取我国中南地区的23所医院进行调查。回顾性调查了2005年1月1日至同年12月31日期间出生的产科住院新生儿15582名。结果：（1）新生儿男女性别比为1.16∶1;（2）早产儿发生率为8.11%;（3）极低出生体重儿发生率为0.73%;（4）分娩方式：自然分娩占57.52%,剖宫产占40.82%（其中因社会因素剖宫产占29.91%）,其他产式占1.66%;（5）新生儿窒息发生率为3.78%,其中重度窒息占0.75 %;（6）新生儿死亡率为0.55%,其中早产儿死亡率为5.56%。结论：（1）我国中南地区早产儿发生率和新生儿窒息发生率均较高;（2）我国中南地区剖宫产比例较高,尤其是社会因素所占的比例过高。     

Fatal Malformations in Jamaica

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were found in 96 (8.6%) of 1112 perinatal and neonatal deaths coming to necropsy and in 28 (2.6%) of 1085 not so examined.

The central nervous system was most commonly affected, followed by the renal, gastrointestinal, and cardiovascular systems in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malformation syndromes/sequences were identified.

Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, their importance will increase when deaths from other causes, such as birth asphyxia, decline. The type of malformation currently fatal in a particular population is relevant when planning diagnostic and surgical services for neonates and infants. It is also important to any discussions about provision of prenatal diagnostic services.     

Neonatal mortality determinants in Jamaica

The Jamaican Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths (Wigglesworth Classification), and the determination of characteristics of both mother and infant that are associated with increased mortality. A death questionnaire was completed on babies who were born between September 1986 and August 1987, and who died in the neonatal period throughout the island of Jamaica. The neonatal mortality rate was 17.9 per 1000 live births with early and late rates of 16.0 and 1.9 per 1000, respectively. The major contributors to neonatal demise were prematurity and intrapartum asphyxia (74 per cent). Twins had a seven-fold greater risk of dying than singletons. Babies born to mothers under 15 years had a four-fold greater risk of dying than those of mothers 25-29 years. The neonatal mortality rate for Jamaica is high, with room for improvement, particularly in the prevention of perinatal asphyxia.     

Perinatal mortality--report of a hospital based study

The perinatal mortality rate (PNMR) per 1000 births is reported in 27,394 consecutive births. It was 75.6, of which 40.0 were neonatal deaths and 35.6 were fetal losses. The PNMR was significantly higher at the two extremes of maternal age, in parity five and above, and with a previous history of fetal or neonatal loss. Other maternal contributing factors were antepartum haemorrhage, hydramnios and infections. One-third of the babies weighed 2500 g or less. The PNMR dropped precipitously from 340.48 in the birth weight group 1501 to 2000 g, to 46.6 in the group 2001 to 2500 g, indicating a cut-off point at 2000 g for a baby at high risk needing special care. The common necropsy causes of death were asphyxia (24.33%), pulmonary conditions (20.02%), congenital malformations (13.6%), and infections (6.19%). No cause of death could be detected at necropsy in 22.12% and no clinico-pathological cause of death could be assigned in 26.76% of deaths. A majority of deaths due to asphyxia could have been prevented by better antenatal and intranatal care. Low birth weight was an important cause of perinatal deaths, and better maternal nutrition and antenatal care could play an important role in reducing this.     

Strategies to reduce perinatal and neonatal mortality

The perinatal mortality rate in India averages 66.3/1000 live births. 60% of all infant deaths occur during the 1st month, making the neonatal mortality rate 76/1000 in rural areas and 39/1000 in urban areas. These rates have remained static since 1974. Over 90% of all deliveries occur at home and are conducted by untrained birth attendants. The major causes of perinatal deaths are immaturity/low birth weight, birth asphyxia/trauma, neonatal infections, and congenital malformations. Neonatal tetanus alone is responsible for 230,000-280,000 deaths a year. Hypoxia, low birth weight, and tetanus are preventable, if primary perinatal care is provided and high-risk pregnancies are recognized and referred to facilities where fetal monitoring and neonatal care are available. It is proposed to train all of the country's 5 million traditional birth attendants by 1990 to deliver primary perinatal care. By 1990 also there will be 1 village health guide for every 1000 people. All traditional birth attendants must know how to give mouth-to-mouth resuscitation, and the infrastructure for an adequate referral system must be established. In order to reduce the incidence of low birth weight, the Integrated Child Development Service Scheme proposes that all pregnant women receive a dietary supplement of 500 calories and 25 gm protein, and that pregnant women be given a 2-hour midday rest period. The control of malaria and intestinal infections with chloroquine and antibiotics would do much to reduce low birth weight. Simple technologies for measuring birth weight indicators, such as chest circumference or mid-arm circumference, require only a tape measure. Finally, technics of mass communication must be utilized to spread knowledge of perinatal and neonatal care.     

Intraparturn and Neonatal Mortality in a Traditional Indigenous Community in Rural Guatemala

ABSTRACT. We identified high rates of intrapartum and neonatal mortality among children born in a traditional indigenous comm. unity in rural Guatemala. To examine the potential association of maternal characteristics and obstetric and newborn care practices with this mortality, we conducted a retrospective case–control study. Cases were infants born in 1986 and 1987 who died during birth or in the first month of life, as identified by civil records; for each case, the next child born who survived the first month of life was selected as control. In interviews with mothers of cases and controls standardized data were collected on demographic and socioeconomic characteristics of the mother, her general obstetric history, history of the pregnancy, labor, and delivery, condition and care of the infant at birth, and morbidity and treatments of the infant after birth. Sixty-one cases and their controls were included in the study. Based on clinical condition at birth, we subcategorized cases into infants stillborn or dying in the first 24 hours of life (intrapartum cases) and those dying in the first month after day 1 (neonatal cases). Factors significantly associated with both subcategories of cases were maternal illiteracy, primagravity, failure to use "modern" prenatal care, and inter-birth interval < 14 months. Intramuscular injection of oxytocin by the midwife during labor, and performance of ≥ 3 vaginal examinations by the midwife were each significantly associated only with the intrapartum subcategory of cases. Mother's estimate of infant size as "smaller than normal" was associated with neonatal, but not with intrapartum, cases. Reported clinical features of cases suggested birth asphyxia and/or trauma to be predominant among intrapartum cases, and sepsis to be the most common cause of neonatal mortality after day 1.     

Perinatal mortality in south east Rajasthan

Of 4443 consecutive births over a 1-year period, the perinatal mortality rate was 105.78/1000, the stillbirth rate was 63.47/1000, and the early neonatal death rate was 42.31/1000 livebirths. Perinatal loss was 10 times higher among low birth weight babies (2500 g), 8 times higher in preterm babies (37 weeks gestation), 4 times higher in mothers with poor antenatal care, and 9 1/2 times higher among rural people. Multiparae and primiparae, mothers under age 20 and above age 30, those with abnormal presentations of fetus, and obstetrical interference during delivery were the main factors associated with higher perinatal mortality rates. Asphyxia neonatorum was directly or indirectly responsible for 58.9% of the perinatal deaths. Suggestions are made to reduce the perinatal morality rate.     

Birthweight specific perinatal mortality in Greece

Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1,000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.