Extended Perinatal Mortality Audit in a Rural Hospital in India

Objective The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. Study Design Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following “Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan).” Results The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. Conclusion This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. Key Points

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KEMATIAN PERINATAL DI BLU RSU PROF. DR. R. D. KANDOU MANADO

Jurnal e-Biomedik ◽

10.35790/ebm.1.1.2013.4585 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

Mercy Tumundo ◽

Hermie Tendean ◽

Eddy Suparman

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Perinatal Death ◽

Developed Countries ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Normal Birth ◽

Perinatal Mortality Rate ◽

Still Births ◽

Early Neonatal Deaths

Abstract: Perinatal death is a big problem especially in a developing country. Some of the hospitals in Indonesia have declared that the number of perinatal death in developing countries is higher than in developed countries. The purpose of this research is to determine the incidence of the factors that affecting perinatal mortality at Prof. DR. R. D. Kandou General Hospital Manado. This research used retrospective descriptive method through medical records of perinatal deaths patients. There were 164 cases of perinatal deaths found where 109 cases still births and 55 cases were early neonatal deaths in 2011, so the number of perinatal mortality rate was 40.17 per mil. The highest number of perinatal death was from multigravide mother, mother with age ≥ 35 years old, spontaneous parturition. There were unknown caused of still births cases (77,06%) and sepsis in early neonatal deaths. The normal birth weight is also with most include of perinatal deaths. Keywords: still birth, early neonatal death, perinatal deaths, perinatal mortality rate. Abstrak: Kematian perinatal merupakan masalah besar khususnya di negara sedang berkembang. Beberapa rumah sakit pendidikan di Indonesia melaporkan angka kematian perinatal yang tinggi dibandingkan dengan laporan angka kematian perinatal di negara – negara maju yang jumlahnya rendah. Tujuan penelitian untuk mengetahui angka kejadian kematian perinatal serta faktor – faktor yang mempengaruhinya. Penelitian ini menggunakan metode deskriptif retrospektif dengan menggunakan data catatan medik pasien. Hasil penelitian yaitu jumlah kematian perinatal pada tahun 2011 sebanyak 164 kasus dengan 109 kasus lahir mati dan 55 kasus kematian neonatal dini sehingga angka kematian perinatal pada tahun 2011 yaitu 40.17 per mil. Kematian perinatal paling banyak pada ibu multigravida, ibu dengan kelompok usia ≥ 35 tahun, menggunakan jenis persalinan spontan. Pada lahir mati 77.06 % penyebab kematiannya tidak diketahui sedangkan sepsis paling banyak menyebabkan kematian neonatal dini. Berat badan lahir normal juga menjadi salah satu faktor terjadinya kematian perinatal. Kata kunci: lahir mati, kematian neonatal dini, kematian perinatal, angka kematian perinatal.

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Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

BMJ Open ◽

10.1136/bmjopen-2018-027504 ◽

2020 ◽

Vol 10 (7) ◽

pp. e027504

Author(s):

Victoria Nakibuuka Kirabira ◽

Mamuda Aminu ◽

Juan Emmanuel Dewez ◽

Romano Byaruhanga ◽

Pius Okong ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Stillbirth Rate ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Early Neonatal Mortality ◽

Early Neonatal Mortality Rate

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary outcome measuresPrimary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.Results526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.ConclusionThe introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.

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Determinants of perinatal mortality in Ethiopia from 2012 up to 2020: systematic review and meta-analysis

10.21203/rs.3.rs-143282/v1 ◽

2021 ◽

Author(s):

Daniel Getahun ◽

Samuel Habtegiorgis ◽

Wodaje Assfaw ◽

Moges Assemie

Keyword(s):

Perinatal Mortality ◽

Birth Interval ◽

Maternal Education ◽

Perinatal Death ◽

Random Effect Model ◽

Previous History ◽

Cochrane Library ◽

Child Birth ◽

Time Period ◽

History Of

Abstract Background: The perinatal mortality is defined as neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation for developing countries. Perinatal mortality is a worldwide health problem even if variation exists among countries. Despite the presence different studies done on the determinants of perinatal mortality in Ethiopia, there is no comprehensive and currently updated study in this time period in Ethiopia. The objective of this study was to determine the determinants of perinatal mortality in Ethiopia from 2012 up to 2020 time period.Method: The articles were identified through electronic search of reputable databases: Google scholar, PubMed, Cochrane library, MIDLINE, EMBASE and Ovid Maternity and Infant Care Databases. Nine studies were selected based on a comprehensive list of inclusion and exclusion criteria. Analysis was done by using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistic and I2 tests were used and a random effect model was also used to estimate the pooled prevalence of perinatal mortality rate. Results: The determinant factors for perinatal mortality were gestational age less than 37weeks , birth weight greater than or equal 2500 gram , had not history of previous abortion, had not history of perinatal death, illiterate maternal education, not using partograph , not vaccinated women about TT vaccine, had not history of obstetric complication ,level of hemoglobin greater than or equal to 11mg/dl ,women who had no prenatal visit ,child birth interval less than two years and non-vertex fetal presentation were significantly associated with perinatal mortality.Conclusion: Government should give especial emphasis for women’s with previous history of abortion, perinatal death and child birth interval less than two years.as well as strengthen all the above associated variables.

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Attributes of turnaround rural hospitals: Case study findings and research opportunities

Journal of Hospital Administration ◽

10.5430/jha.v6n6p8 ◽

2017 ◽

Vol 6 (6) ◽

pp. 8

Author(s):

Asa B. Wilson

Keyword(s):

Theory Of The Firm ◽

Access Point ◽

Hospital Performance ◽

Rural Hospitals ◽

Rural Hospital ◽

Classical Economics ◽

The Status ◽

History Of ◽

Closure Conversion ◽

The Impact

Background: Rural and Critical Access Hospitals (CAHs) have a history of operating challenges and closure-conversion threats. The history is reviewed including the supportive public policy provisions and administrative tactics designed to maintain a community’s hospital as the hub and access point for health services. Limited research indicates that rural facilities are not strategic in their responses to challenges. A question emerges regarding the enduring nature of operating difficulties for these facilities, i.e., no understanding with explanatory value.Objective: The author, as the CEO in six rural hospitals designated as turnaround facilities, used inductive participant-observer involvement to identify operating attributes characteristic of these organizations. An objective description of each facility is provided. While implementing a turnaround intervention, fifteen behaviors or outcomes were found to be consistent across all six entities. This information is used to posit factors associated with or accounting for identified performance weaknesses.Conclusions: It is conceptualization that observed organizational behaviors can be explained as remnants of an agrarian ideology. Such a mindset is focused on preserving the status quo despite challenges that would require strategic positioning of the organization. In addition, emerging studies on community types indicates that follow-up research is needed that assesses the impact of community attributes on rural hospital performance. Also, this study shows that a theory of the rural hospital firm based on neo-classical economics has no explanatory value. Thus, a theory of the firm can be developed that includes behavioral economic principles.

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Explanation of Perinatal Mortality Rate in Collaborative Study

PEDIATRICS ◽

10.1542/peds.52.6.891 ◽

1973 ◽

Vol 52 (6) ◽

pp. 891-891

Author(s):

Arnold S. Goldstein ◽

Henry H. Mangurten

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Umbilical Artery ◽

Collaborative Study ◽

The United States ◽

Mortality Rates ◽

Single Umbilical Artery ◽

Neonatal Deaths ◽

General Mortality ◽

Future Management

The article by Froehlich and Fujikura1 on the prognosis of single umbilical artery is a much needed and highly informative addition to the literature. It presents a great deal of information and some important implications as to future management. We question the mortality rates quoted. They are given as percentages, and include stillbirths and neonatal deaths, i.e., perinatal mortality. The figure given as the general mortality rate is 3.8% or 38 per 1,000 births. Previous figures cited for perinatal mortality in the United States have varied from approximately 19 per 1,000 to approximately 26 per 1,000.2-4 We wonder how the figure of 38 per 1,000 was determined.

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Risk factors for perinatal mortality: a case control study from Thiruvananthapuram, Kerala, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172330 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2452 ◽

Cited By ~ 1

Author(s):

Mayadevi Brahmanandan ◽

Lekshmi Murukesan ◽

Bindu Nambisan ◽

Shaila Salmabeevi

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Perinatal Mortality ◽

Case Control Study ◽

Gestational Hypertension ◽

Significant Risk ◽

Case Control ◽

Maternal Risk ◽

Perinatal Mortality Rate ◽

Control Study

Background: The greatest risks to life are in its very beginning. Although a good start in life begins well before birth, it is just before, during, and in the very first hours and days after birth that life is most at risk. This prospective case control study was designed on maternal risk factors for perinatal mortality.Methods: This was a case control study conducted in the Department of Obstetrics and Gynecology and Department of Paediatrics, Medical College Trivandrum for one year period in 2004-2005. The cases were all the fresh and macerated still births and early neonatal death cases during the study period. The controls were chosen as the next delivery entry in the OR register.Results: During this period, the total number of deliveries was 14,796 and there were 431 perinatal deaths. The perinatal mortality rate was 29.12. This was much higher compared to Kerala’s perinatal mortality rate of 10, the reason being that the study is conducted in a tertiary referral hospital with one of the best new born care nurseries and a large number of referrals. The most significant risk factors for perinatal mortality were low socio-economic status, referrals, late registration, prematurity, low birth weight, intra-uterine growth restriction, maternal diseases like gestational hypertension and gestational diabetes and intrapartum complications like abruption.Conclusions: Perinatal mortality rate serves as the most sensitive index of maternal and neonatal care. Good antenatal care and prevention of preterm birth may play a key role in further reduction of PMR.

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A Review of Caesarean Sections at 30 Weeks Gestation or Less in the West of Scotland 1988–1989

Scottish Medical Journal ◽

10.1177/003693309203700207 ◽

1992 ◽

Vol 37 (2) ◽

pp. 47-48 ◽

Cited By ~ 2

Author(s):

J. Dodgson ◽

F. Mackenzie ◽

C.A. Forrest

Keyword(s):

Retrospective Study ◽

Mortality Rate ◽

Caesarean Section ◽

Perinatal Mortality ◽

Maternal Morbidity ◽

Neonatal Period ◽

Infant Survival ◽

The West ◽

Neonatal Deaths ◽

Present Pregnancy

A retrospective study was carried out of caesarean sections at 30 completed weeks of gestation or less between 1/1/88 and 31/12/89 in Glasgow and The West of Scotland. One hundred and thirty-three caesarean sections were carried out resulting in 150 babies. Fifteen (11.3%) of these were classical sections. There were 30 neonatal deaths. The perinatal mortality rate was 170 per 1000. Survival was related to increasing gestation from 27 weeks onwards and also to birthweight from 900 grams onwards. In-utero transfers fared badly with seven out of 21 babies (33%) failing to survive beyond the neonatal period. Although survival continues to improve in newborns, the use of caesarean section should still be viewed with caution as the benefits in the very premature situation with regard to infant survival may be outweighed by the increased maternal morbidity both in the present pregnancy and future pregnancies.

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Caesarean Section and Perinatal Mortality in South Western Nigeria

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v4i1.3332 ◽

1970 ◽

Vol 4 (1) ◽

pp. 46-48

Author(s):

OC Ezechi ◽

OM Loto ◽

VI Ndububa ◽

FO Okogbo ◽

PM Ezeobi ◽

...

Keyword(s):

Caesarean Section ◽

Perinatal Mortality ◽

Caesarean Delivery ◽

Health Workers ◽

Perinatal Death ◽

Fetal Loss ◽

Birth Asphyxia ◽

Neonatal Deaths ◽

Health Delivery ◽

June July

Aim: Caesarean section carries a substantial hazard to the unborn fetus, especially if done as an emergencyprocedure. In our environment fetal loss following a caesarean delivery is usually attributed to the procedureby patients and relations who do not readily accept caesarean section as a delivery option.Method: A 10 year descriptive study of caesarean section related perinatal mortality in four tertiary hospitalsin South western Nigeria.Results: Nineteen thousand one hundred and seventy nine deliveries were conducted in the hospitalsduring the study period; five thousand one hundred and ninety five (27.1 %) of which were caesareandeliveries. Two hundred and thirty five of the caesarean deliveries were associated with perinatal death (6.9%.). Majority of these deaths were among the unbooked (73.8%), multiparous (69.0 %) patients and emergencycaesarean delivery (83.4%). Prolonged/ obstructed labour (45.4%), preeclampsia/eclampsia (18.8%) andfetal distress (11.5%), were the commonest indication for caesarean deliveries. While majority of the perinataldeath were still born (60.3%), (39.7%) were early neonatal deaths. The common causes of early neonataldeath in these patients were severe birth asphyxia (37.4 %), neonatal sepsis (22.0%) and prematurity (16.4%).Conclusion: The cause of perinatal mortality associated with caesarean delivery in our environment arepreventable with public enlightenment, provision of affordable and accessible prenatal and neonatal care,discipline, behavioural and attitudinal change of health workers, and the political will on the part of policymakers to maternal and child health delivery care more effective.DOI: 10.3126/njog.v4i1.3332Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 46-48

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A qualitative perinatal audit at a rural health facility in Eldoret, Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20200413 ◽

2020 ◽

Vol 7 (2) ◽

pp. 449

Author(s):

Kimbley Omwodo

Keyword(s):

Rural Health ◽

Perinatal Mortality ◽

Health Facility ◽

Perinatal Death ◽

Gestational Hypertension ◽

Medical Condition ◽

World Health ◽

Maternal Condition ◽

Perinatal Deaths ◽

Perinatal Audit

Background: Objectives of the study were to ascertain the pattern of occurrence of perinatal mortality by applying the World Health Organization (WHO), International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period, ICD perinatal mortality (ICD-PM), following the introduction of a qualitative perinatal audit process at a rural health facility in Kenya.Methods: A single centre retrospective analysis demonstrating the application of the WHO, ICD-PM. Data pertaining to perinatal deaths for the period from 1st May 2017 to 31st August 2018 was obtained from Plateau Mission Hospital perinatal audit records.Results: There were 22 perinatal deaths during the study period, 17 were included in the study. The overall perinatal death rate was 11 per 1000 births. Antepartum deaths were as a consequence of fetal growth related problems (33.3%), infection (33.3%) or unexplained (33.3%) with pregnancy-related hypertensive disorders (gestational hypertension, pre-eclampsia and eclampsia) being the most frequent medical condition associated with the mortalities. Neonatal deaths (47.1%) were the most frequent in the study and were a consequence of low birth weight and prematurity (25.0%), Convulsions and disorders of cerebral status (25.0%). The maternal condition in most of these cases being complications of placenta, cord and membranes. Acute intrapartum events and were least in this setting accounting for 17.4% of deaths.Conclusions: The ICD-PM is generalizable and its use in perinatal death classification emphasises focus on both mother and baby. Our study showed the majority of perinatal deaths occurred in the early neonatal period & affected mostly preterm infants.

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Trends and Determinants of Perinatal Mortality in a Tertiary Care Hospital of Nepal

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v20i1.29133 ◽

2021 ◽

Vol 20 (1) ◽

pp. 77-82

Author(s):

Yuba Nidhi Basaula ◽

Radha Kumari Paudel ◽

Ram Hari Chapagain

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Neonatal Sepsis ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Care Hospital ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Perinatal Mortality Rate ◽

Increasing Trend

Introduction: Perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20 to 30 per thousand births. This study was carried out to review the different aspects of PMR and classifying them and identify the causes of perinatal and neonatal deaths and assessing the need for improvement in quality of pregnancy and newborn care. Methods: It was a retrospective study carried out in Bharatpur Hospital, Chitawan, Nepal. Data of all stillbirths from 22 weeks of pregnancy and neonatal deaths up to seven days of life was taken from monthly perinatal audit and annual mortality review. The data was taken from July 2017 to Jun 2019. All the perinatal deaths were then classified. Results: Over a two year period, there were total 25,977 births and total death was 369. Thus perinatal mortality rate was 12.3 per thousand births. Still births (fresh and macerated) contributed almost 82.4% of the perinatal deaths and neonatal death contributed 17.6% of total deaths. Deaths related to unexplained intrauterine fetal death (IUFD) showed an increasing trend and have increased by more than 20% in past two years from 39.1% to 60.8%. Deaths due to perinatal asphyxia, neonatal sepsis, respiratory distress syndrome and extreme prematurity were increased. Conclusions: PMR over the two years has shown increasing trend at our institute. There is need to improve antenatal, obstetric as well as intra-partum services to further reduce the still birth as well as deaths due to prematurity, RDS, neonatal sepsis and perinatal asphyxia.

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