Maternal malnutrition,perinatal mortality and foetal pathology--a clinicopathological study

The close relationship between the maternal malnutrition and consequent birth of low birth weight babies and the perinatal mortality is now an accepted fact and has been studied extensively in developed countries, though the problem is more acute in developing countries. The present study was proposed to find out relationship between the maternal nutritional status and the perinatal mortality. Autopsy was performed on 100 babies dying perinatally and pathological examination of different foetal organs in both well and malnourished mothers was also undertaken. Maternal nutritional status was evaluated by estimating haemoglobin level and total serum protein level. A mother with haemoglobin level below 11 g/dl and/or serum protein level below 5 g/dl was considered as malnourished. Pathological findings in the dead babies included low birth weight (500-1,999g), haemorrhage in multiple organs, atelectasis of the lungs, fatty changes in the liver, cystic changes of the kidneys and ill developed parenchyma of the pituitary.     

Maternal mortality

Maternal mortality in Chittaranjan Seva Sadan, Calcutta, in 1983, 1985 and 1986 was 2.45, 3.01 and 2.8 per thousand respectively. Abortion contributed a little in 1983 and 1985, whereas it was 15.7% in 1986. Haemorrhage was the commonest single cause of death in 1983 (28%) and 1985 (21.4%) as opposed to eclampsia in 1986 (28.9%). Infective hepatitis during pregnancy and labour was the commonest indirect cause of maternal mortality followed by anaemia. Usual difficulties like lack of antenatal care, multiparity, low socio-economical status, illiteracy, etc, in populated developing countries are responsible for this sad state of affairs in this country as well.     

Maternal grieving response after perinatal death

The nature and incidence of psychological and related physical disturbances were investigated in 110 mothers who had lost a child in the perinatal period. The mothers were interviewed six to 36 months after their loss. The demographic characteristics, hospital experiences, effects of bereavement and perceived social support system of the women were assessed. A pathological bereavement outcome, which was defined as a marked deterioration in health and evidence of increased social adjustment problems, was identified in 21% of the women. A pathological bereavement outcome was found to be related to two main factors--a reported crisis during pregnancy and the perceived support of the husband and/or family. Whether the mother saw but did not hold her baby was also a factor. These results suggest that the loss of a baby may have at least as severe an effect on a woman as the death of her husband. The implication of these findings is that women who are at risk of a pathological outcome of bereavement may be identified soon after their loss.     

Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting

Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.     

Specialized perinatal care: impact on perinatal mortality.

A neonatal intensive care unit was established at one hospital in 1972 when the neonatal mortality was 7.6 and the perinatal mortality 20.9 per 1000 deliveries. In 1973, with full operation of that unit and partial introduction of a high-risk pregnancy unit for fetal monitoring, the rates decreased to 6.4 and 14.9, respectively. With full operation of both units the rates decreased further, to 3.4 and 9.0 in 1974 and 3.8 and 8.9 in 1975. The frequency of cesarean section was 10.1% in 1972-73 and 11.6% in 1974-75. It is concluded that the centralization of obstetric and neonatal care, together with the development of qualified medical and nursing teams, had a major impact in reducing perinatal mortality, and that the frequency of cesarean section was not affected by the introduction of fetal monitoring, although the indications for this precedure became more specific.     

Maternal mortality in India

Authors worked on maternal mortality in India from 1992-94. This article is a review article on the basis of authors' experience. The article starts with the brilliant sentence, 'Maternal mortality in India is unacceptably high' and ends with the suggested strategies to solve the problem.     

Ethnic differences in perinatal mortality

Of the 3869 normally formed, singleton deliveries in Dudley Road Hospital in 1979, 3690 were to either European (1644), Indian (1087), Pakistani (556) or West Indian (403) mothers. The perinatal mortality rates in the Indian group with birth weights of 2000 - 2999 g and 3000 - 3999 g were higher than in any of the other ethnic groups (11·5/1000 and 6·7/1000 respectively).     

An audit of perinatal mortality

Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal outcome, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were the hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8%), birth asphyxia (22.2%) and sepsis (13.5%). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended.