Perinatal Mortality Jan To June 2004

PERINATAL MORTALITY JANUARY – JUNE 2004 Presented by DR. R. O. UGWU Department of Paediatrics U.P.T.H. Port Harcourt.

LABOUR WARD  TOTAL DELIVERIES =1481(34 TWIN BIRTHS;

1 SET OF TRIPLETS.  TOTAL DEATHS = 63 (1 SET OF TWINS)  MALES = 25 (39.7%)  FEMALES = 38 (60.3%)  MODE OF DELIVERY • CAESEREAN SECTION = 18 (28.6%) • SPONTANEOUS VERTEX = 39 (61.9%) • OTHERS = 6 (9.5%) BREECH = 5;VACUUM = 1

LABOUR WARD  BIRTH WEIGHTS

LESS THAN 1000G = 1(1.59%) 1000G – 1499G = 8 (12.7%) 1500G – 2499G = 16(25.4%) 2500G AND ABOVE = 37 (58.73%) UNKNOWN WEIGHT = 1 (1.59%)

LABOUR WARD  GESTATIONAL AGE

LESS THAN 37 WEEKS = 21 (33.33%) 37WEEKS – 42 WEEKS = 38 (60.32%) ABOVE 42 WEEKS = 3 (4.76%) UNKNOWN GA = 1 (1.59%)

LABOUR WARD PARITY PARA 0 = 30 (47.62%) PARA 1 = 13 (20.63%) PARA 2 = 8 ( 12.7) PARA 3 AND ABOVE = 11 (17.46%) UNKNOWN PARITY = 1 (1.59%)

LABOUR WARD  DIAGNOSIS AT PRESENTATION

IUFD (CAUSE NOT STATED) MSB = 12 ;FSB = 6 APH (ABRUPTIO PLACENTAE) = 7 RUPTURED UTERUS = 5 SEVERE PRE-ECLAMPSIA = 5 BREECH = 3 DM = 3 CORD PROLAPSE = 2 RETAINED 2ND TWIN = 1 CHORIOAMNIONITIS = 1 ANENCEPHALY = 1

ISOLATION WARD  TOTAL DELIVERIES = 181 (6 TWIN BIRTHS; 2

SETS OF TRIPLETS  TOTAL DEATHS = 61  MALES = 32 (52.5%)  FEMALES = 29 (47.5%)  MODE OF DELIVERY • CAESEREAN SECTION = 20 (32.8%) • SPONTANEOUS VERTEX = 24 (39.3%) • OTHERS=17 (27.9%) BREECH=8; VACUUM =5 CRANIOTOMY = 3; LAPAROTOMY =1

ISOLATION WARD  BIRTHWEIGHTS

LESS THAN 1000G = 5 (8.2%) 1000G – 1499G = 3 (4.9%) 1500G – 2499G = 11 (18%) 2500G AND ABOVE = 42 (68.9%)

ISOLATION WARD GESTATIONAL AGE LESS THAN 37 WEEKS = 23 (37.7%) 37 WEEKS – 42 WEEKS = 27 (44.3%) ABOVE 42 WEEKS = 2 (3.3%) UNKNOWN GA = 9 (14.8%)

ISOLATION WARD  PARITY

PARA 0 = 9 (14.8%) PARA 1 = 24 (39.3%) PARA 2 = 8 (13.1%) PARA 3 AND ABOVE = 17 (27.9%) UNKNOWN PARITY = 3 (4.9%)

ISOLATION WARD  DIAGNOSIS AT PRESENTATION

IUFD (CAUSE NOT STATED) MSB = 13; FSB = 9 APH = 4 PRETERM LABOUR =4 OBSTRUCTED LABOUR = 5 ECLAMPSIA = 2 TRANSVERSE LIE = 1 PROM = 1 CORD PROLAPSE = 1 BREECH = 1 NOT STATED = 19

SCBU  TOTAL ADMISSIONS = 512  TOTAL DEATHS = 108 (21.1%)

M=61 (56.5%); F=47 (43.5%)  PERINATAL DEATHS = 82 (76%) M=48 (58.5%); F=34 (41.5%) LABOUR WARD =35 (42.7%) ISOLATION WARD = 11 (13.4%) OUTBORN = 36 (43.9%)

MOST FREQUENTLY ENCOUNTED EVENTS IN PERINATAL DEATHS (SCBU)

 BIRTH ASPHYXIA = 45  PREMATURITY = 35  NNS = 30  NNJ = 17  MAS = 8

PERINATAL MORTALITY RATE OVERALL PERINATAL DEATHS = 170 LABOUR WARD = 98 ISOLATION WARD = 72 OVERALL DELIVERIES = 1662 LABOUR WARD = 1481 ISOLATION WARD = 181 PNMR = 102.3/1000 1990 = 89.8/1000; 2001/02 = 103.8/1000

PERINATAL MORTALITY RATE  LABOUR WARD = 66/1000

 ISOLATION WARD = 398/1000

CONCLUSION PNMR OF 102/1000 IS VERY HIGH DELIVERIES IN ISOLATION WARD ACCOUNTED FOR A GREATER % MAJORITY ARE TERM BABIES MAJORITY ARE NORMAL WT. BABIES MAJOR CAUSE OF DEATH WAS BIRTH ASPHYXIA

RECOMENDATION EVERY EFFORT SHOULD BE MADE TO ANTICIPATE AND PREVENT BIRTH ASPHYXIA IN ORDER TO REDUCE THE PNMR IN OUR CENTRE.

CAUSES OF BIRTH ASPHYXIA INTRAUTERINE – Utero placental insufficiency, abruptio placentae, cord accidents, fetomaternal haemorrhage INTRAPARTUM – Birth trauma (CPD, ICH), Breech , Shoulder dystocia), Hypoxia- ischaemia (cord compression), abruptio placentae, uterine hyperstimulation – misoprostol/oxytocin, maternal medications, extreme prematurity etc.)

PREVENTION OF BIRTH ASPHYXIA IDENTIFICATION OF HIGH RISK PREG. EARLY PRESENTATION EARLY INTERVENTION PROMPT AND ADEQUATE RESUSCITATION SKILLED MANPOWER ADEQUATE EQUIPMENT