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Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
Perinatal Mortality Trend at KMC Teaching Hospital
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Perinatal Mortality Trend at KMC Teaching Hospital

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Perinatal Mortality Trend at KMC Teaching Hospital

Perinatal Mortality Trend at KMC Teaching Hospital

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  • 1. PERINATAL MORTALITY TREND AT KATHMANDU MEDICAL COLLEGE TEACHING HOSPITAL Sheelendra Shakya 1 , D.S. Manandhar 1 , S. Padhey 2 1 Department of Pediatrics, 2 Department of Obstetrics and Gynaecology Kathmandu Medical College
  • 2. Introduction: <ul><li>Perinatal period extends from 22 weeks of completed gestation (or weighing 500 grams or above) upto first seven days of life. </li></ul>
  • 3. <ul><li>PERINATAL MORTALITY RATE (PMR) </li></ul><ul><ul><li>Only babies weighing 1000 grams or above and who have completed 28 weeks of gestation are included in the calculation. </li></ul></ul><ul><li>EXTENDED PERINATAL MORTALITY RATE (EPMR) </li></ul><ul><ul><li>Babies weighing up to 500 grams or who have completed 22 weeks of gestation are included in the calculation. </li></ul></ul>
  • 4. Objective: <ul><li>To determine the PMR and the factors associated with it at KMCTH in the year 2007 and to compare this with the published data of previous years. </li></ul><ul><li>To find out important factors causing perinatal deaths using Wigglesworth’s classification and help in developing appropriate interventions to reduce those factors. </li></ul>
  • 5. Methodology: <ul><li>Retrospective study of the entire stillbirths and early neonatal deaths in 2007. </li></ul><ul><li>Data collected from record books of the Special Care Baby Unit, Labour Room, Operation Theatre and Hospital records. </li></ul><ul><li>Factors causing perinatal deaths classified according to Wigglesworth’s classification. </li></ul><ul><li>Comparison made with 2 similar studies done at KMCTH in previous years. </li></ul>
  • 6. Methodology: <ul><li>Neonatal deaths are discussed in the department within 24 – 48 hours of death. </li></ul><ul><li>Although autopsies are not done, Laryngoscopic examination and LP are performed soon after neonatal death to help in the diagnosis. </li></ul>
  • 7. RESULTS <ul><li>Jan – Dec 2007 </li></ul><ul><li>Total Birth: 903 </li></ul><ul><li>Total Stillbirth (SB): 15 </li></ul><ul><li>Total Stillbirth rate per 1000 births: 16.6 </li></ul><ul><li>SB <1kg: 1 </li></ul><ul><li>Total Stillbirth rate (excluding <1kg): 15.5 </li></ul><ul><li>Early Neonatal Death(ENND): 9 </li></ul><ul><li>Total ENND rate per 1000 live births: 10 </li></ul><ul><li>Total perinatal death (including <1kg): 24 </li></ul><ul><li>PMR : 25.5 </li></ul><ul><li>EPMR 26.6 </li></ul>
  • 8. Distribution of perinatal deaths by weight Weight SB SB % ENND ENND % <1kg 1 6.7 0 0 1-<1.5kgs 3 20 3 33.3 1.5-<2.5kgs 3 20 4 44.4 >2.5kgs 6 40 2 22.2 Not mentioned 2 13.3 0 0 Total 15 100 9 100
  • 9. Relationship of PMR with Birth Weight Weight Total PND PND % Total births PMR <1kg 1 4.2 1 1000 1-<1.5kgs 6 25 15 400 1.5-<2.5kgs 7 29.2 127 55.1 >2.5kgs 8 33.3 758 10.6 Not mentioned 2 8.3 2 Total 24 100 903 26.6
  • 10. Relationship of PMR with birth weight
  • 11. Distribution of perinatal deaths according to gestational age Gestational age SB ENND Total PND No. % No. % No. % <28 weeks 1 6.7 0 0 1 4.2 28 – 36 weeks 8 53.3 6 66.7 14 58.3 37 – 41 weeks 6 40 3 33.3 9 37.5 Total 15 100 9 100 24 100
  • 12. Distribution of Stillbirth Sex No. % Male 6 40 Female 9 60 Total 15 100 Type No. % Fresh 6 40 Macerated 6 40 N/A 3 20 Total 15 100 40% 40% 20% Fresh Macerated N/A
  • 13. CAUSE OF STILLBIRTH 0 2 4 6 8 10 12 No. of cases SB Unknown 66.7% PET 13.3% Congenital Anomalies 6.7% Intrapartum asphyxia 6.7% APH 6.7%
  • 14. ENND by time of death 0% 33% 11% 56% <1 hr 1 – 24 hrs 24 – 72 hrs >72 hrs
  • 15. PRIMARY CAUSE OF ENND 44.4% 22.2% 11.1% 11.1% 11.1% 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Prematurity Birth Asphyxia Congenital Anomalies MAS Septicaemia No. of cases ENND
  • 16. Comparison between the 3 studies Category Oct ‘02 to Sept ‘03 Nov ‘03 to Oct ‘05 Jan ‘07 to Dec ‘07 Total stillbirth rate per 1000 births 30.2 14.5 16.6 Total stillbirth rate (excluding <1kg) 18.1 13.4 15.5 Total ENND rate per 1000 live births 18.3 6.7 10 Total ENND rate (excluding <1kg) 12.9 6.1 10 PMR per 1000 births 30.7 19.1 25.5 Extended PMR per 1000 births 47.9 21.1 26.6 Caesarean section out of total births (in %) 26.4% 29.7% 29.9% Instrumental delivery out of total births (in %) 1.4% 4.2% 4.4% Total Deliveries 563 1517 903
  • 17. PERINATAL MORTALITY TREND AT KMCTH 30.7 47.9 19.1 21.1 25.5 26.6
  • 18. Comparison of cause Wigglesworth’s classification(%) Oct ‘02 to Sept ‘03 Nov ‘03 to Oct ‘05 Jan ‘07 to Dec ‘07 Group I (normally formed macerated stillbirths) 18.5 43.8 25 Group II (SB or NND with congenital anomalies) 14.8 12.5 8.3 Group III (conditions associated with immaturity) 31.3 28.1 33.3 Group IV (asphyxial conditions developing in labour) 40.7 12.5 25 Group V (conditions specific to the neonate) 3.7 3.1 8.3
  • 19. PERINATAL MORTALITY TREND AT KMCTH By Wigglesworth’s Classification
  • 20. Limitations: <ul><li>The total number of births and perinatal deaths are small in number hence a few deaths in any category will show a disproportionate increase in that category. </li></ul>
  • 21. Conclusion: <ul><li>There has been a significant reduction in PMR of ’03 –’05 compared to figures of ’02-’03. </li></ul><ul><li>Although there is a slight increase in PMR of ‘07 compared to ’03-’05, it is not that significant as the numbers are few. </li></ul>
  • 22. To further reduce PMR <ul><li>Antenatal care </li></ul><ul><li>Prevention of preterm births, which is very difficult </li></ul><ul><li>Providing better care and monitoring during the intranatal period </li></ul><ul><li>Regular use of partograph and timely intervention and </li></ul><ul><li>Intensive care of very low birth weight and sick neonates. </li></ul>
  • 23. Acknowledgement <ul><li>Thanks are due to </li></ul><ul><li>All the staff of Dept. of Paediatrics </li></ul><ul><li>All the staff of Dept. of Obstetrics and Gynaecology </li></ul><ul><li>All OT and Record Section staff </li></ul><ul><li>MIRA Office </li></ul>Heartfelt condolences to the families who have lost their babies.
  • 24. Thank you

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