Definition and classification of perinatal mortality

Analysis of problems related to the classification of perinatal mortality was made possible through the evaluation of data collected from the medical records of nine maternity hospitals in South-Hainaut. Medical records of 135 fetal and early neonatal deaths were investigated. Perinatal mortality statistics were compiled on the basis of five different definitions of perinatal mortality. Depending on which definition was used, perinatal mortality varied between 10.2% and 15.1%. This study shows that reporting of perinatal mortality in hospital registries according to the legal requirement is incomplete. Standard data should be collected for each pregnancy product, on the basis of clearly defined, national and international accepted definitions. It is suggested that the 1975 recommendations of the World Health Organization (International Classification of Diseases, 9th edition), be used for definition and classification of perinatal mortality.     

西安市围生儿死亡与围生期保健的关系

目的对西安市5年来围生儿死亡情况进行分析，找出原因，提出改进措施。方法对1998年10月～2003年9月30日的围生儿进行监测，死亡的围生儿详细填写死亡报告卡，逐级审核、上报，并利用SPSS10．0软件进行分析。结果5年来围生儿平均死亡率为15．21‰，随着围生期保健服务的提高，有逐年下降趋势；出生缺陷是围生儿死亡的首位死因，其次有窒息、脐带因素、胎盘早剥、早产、臀位难产、肺炎、颅内出血等；不同时期死因顺位不同。结论西安市围生儿死亡率较高，预防出生缺陷，减少围生儿窒息是降低围生儿死亡率的重要措施。     

Placental abruption and perinatal mortality in the United States

Placental abruption is an uncommon obstetric complication associated with high perinatal mortality rates. The authors explored the associations of abruption with fetal growth restriction, preterm delivery, and perinatal survival. The study was based on 7,508,655 singleton births delivered in 1995 and 1996 in the United States. Abruption was recorded in 6.5 per 1,000 births. Perinatal mortality was 119 per 1,000 births with abruption compared with 8.2 per 1,000 among all other births. The high mortality with abruption was due, in part, to its strong association with preterm delivery; 55% of the excess perinatal deaths with abruption were due to early delivery. Furthermore, babies in the lowest centile of weight (<1% adjusted for gestational age) were almost nine times as likely to be born with abruption than those in the heaviest (> or =90%) birth weight centiles. This relative risk progressively declined with higher birth weight centiles. After controlling for fetal growth restriction and early delivery, the high risk of perinatal death associated with abruption persisted. Even babies born at 40 weeks of gestation and birth weight of 3,500-3,999 g (where mortality was lowest) had a 25-fold higher mortality with abruption. The link between fetal growth restriction and abruption suggests that the origins of abruption lie at least in midpregnancy and perhaps even earlier.     

双胎围生儿患病率和死亡率动态分析

目的 了解双胎围生儿患病、死亡的流行趋势及相关原因,探讨降低双胎围生儿死亡率的途径。 方法 从中国妇婴保健中心1993-2000年对浙江、江苏、河北3省27个市(县)的围生保健监测数据中提取7 120例双胎妊娠的资料,进行描述性分析。 结果 双胎围生儿死亡率从1993年103.0‰降至2000年54.8‰,死胎死产率变化不明显,早期新生儿死亡率从1993年42.8‰降至2000年19.6‰;剖宫产率从1993年26.5%上升至2000年66.6%;妊娠合并症中重度妊高征、中重度贫血及胎儿窘迫的患病率略有波动;新生儿肺炎患病率有上升趋势,病理性黄疸、呼吸窘迫综合征和硬肿症的患病率有下降趋势。结论 1993-2000年本监测县市双胎围生儿死亡率逐年下降,早期新生儿患病率和死亡率的降低是死亡率下降的主要原因。