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C.H. Rasul
M.A. Hussain*
A.H.M. Siddiquey+
M.S. Rahman+
From the Department of Peaiatrlcs, Khulna Medical College, Khulna, Bangladesh; *Department of Obstetrics and Gynecology, Institute of Post Graduate Medicine and Research, Dhaka, Bangladesh; and +Department of Child Health, Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
Reprint requests: Dr. C.H. Rasul, Associate Professor, Department of Pediatrics, Khulna Medical
College, Khulna-9000, Bangladesh.
Manuscript received: February 2,1998; Initial review completed: March 20, 1998;
Revision accepted: November
9, 1998.
Perinatal mortality rate (PNMR) is defined as the number of still births (SB)
and the first week death (FWD) per thousand total births(1,2). It
is the most sensitive index of maternal and neonatal care and the
socioeconomic standard of a particular area. In developed countries, the PNMR has fallen to
10-20 per thousand total births as compared to an alarmingly high
rate of 60-120/1 000 total
births in developing countries(3,4). High risk pregnancies have higher PNMR and comprise the majority of perinatal death(3). The present study was conducted to find out PNMR in a teaching hospital and to evaluate the causes
,and risk factors of PNMR.
Subjects and Methods
This was a prospective study for a period of one year, between August 1994 to July 1995. The study was done in RMCH jointly by the Departments of Child Health and Obstetrics and Gynaecology. RMCH is a teaching hospital attached to the Rajshahi Medical College (RMC).
It is the tertiary referral hospital for the North-Western part of
Bangladesh which drains about 5lakh population in the city and the adjoining area.
Most of our cases are unbooked and without any antenatal check-up. All the deliveries occuring
during the study period were included for analysis. The newborn babies were followed upto seven days following their births to record any health problem. A special data sheet was designed to record" all the information about the mothers and their newborn babies. The data in the RMCH were collected by a doctor appointed and trained for this purpose. We could not do autopsy as it is not routinely practiced in our country.. The authors used to. meet once weekly to review the data sheet and to find out the clinical cause of first week death.
Results
The total number of deliveries during this study were 1801 and among them 275 were perinatal deaths (PND), so the PNMR was 152.7. Out of of these deaths 2l() (78.6%) were still births and 59 (21.4%) died within first week of birth.
The causes of still birth remained unknown in all. The causes of first week deaths c could be determined (Table l) and hypoxic n .ischemic encephalopathy topped the list. fl Others included congenital anomaly and metabolic derangement. The relation between 4 perinatal deaths and maternal risk factors !I were shown in Table II. Eclampsia
came out
as the most common risk factor. Young age,
under nutrition and diabetes mellitus Were grouped under others.
Discussion
.
Our study was the first of its kind so far done in RMCH. Perinatal mortality rate varies widely from country to country and also from one part to the other part of the same country. The PNMR for RMCH was 152.7/1000 total births. Shamsuddin et al. observed a PNMR
TABLE I
Causes of First Week Deaths (n=59)
|
Cause
|
Number |
Percentage |
|
Hypoxic ischemic |
|
|
|
encephalopathy |
36 |
61.0 |
|
Septicemia |
8 |
13.6 |
|
Birth injury |
6 |
10.2 |
|
Hypothermia |
2 |
3.4 |
|
Rh incompatibility |
2 |
3.4 |
|
Others |
5 |
8.4 |
TABLE II
Maternal Risk Factors in Relation to Perinatal Deaths
(n
= 275)
|
Risk factors
|
Number |
Percentage |
|
Pre-eclampsia/
|
|
|
|
Eclampsia |
91 |
33.1 |
|
Bad Obstetric history |
34 |
12.4 |
|
Ante-partum hemorrhage |
37 |
13.5 |
|
Severe anemia |
28 |
10.2 |
|
Hypertension |
21 |
7.6 |
|
Others |
64 |
23.3 |
of 169.1/1000 total births in the Sylhet Medical College Hospital(2). Korejo and Jafarey reported a PNMR of 101.8/1000 total births from Jinnah Post-Graduate Medical Center, Karachi(5). Singh et
al. reported PNMR of 41/1000 total births from All India Institute of Medical Sciences, India(4): The PNMR reported from Ludhiana Teaching Hospital in Punjab, India, was 74/1 000 total births(6). This difference in the rate of PNMR is because of the difference in the standard of the perinatal care and the difference in the socio-economic condition. In contrast to the above reports, PNMR is less than 20/1000 total births throughout the developed countries of the world(7). This great decline in PNMR in the developed countries reflects their high standard of obstetric and neonatal practice.
Among the total perinatal deaths, still births comprised 78.6% which is similar (85%) to the finding of another study in Bangladesh(2). We could not find out the etiology of still birth in our cases. This was due to the fact that most of our cases were unbooked, received no ante-natal check-up and were admitted with intra-uterine fetal death. Clinical evaluation however, was done to ,find the cause of early neonatal death. Hypoxic ischemic encephalpathy (61 %) came out as the most frequent cause of first week deaths which is similar to findings in Ludhiana(6). Septicemia and hypothermia appeared as a complication of low birth weight(8).
Several maternal risk factors have been noted by different authors(3,9) to be associed with increased PNMR.
According to our findings, pre-eclampsia/eclampsia Was the single most important (33.1 %) maternal risk factor while another study from Karachi showed that the APH was the most important maternal risk factor for perinatal mortality(5). Bad obstetric
history such as previous still birth, abortion and obstructed labor stood out as the important contributory factors according to other
studies(10).
In conclusion, our study demonstrated a very high PNMR for RMCH. Antenatal check up and, neonatal care can significantly reduce this very high PNMR.
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2.
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p 12.
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