Perinatal mortality at the Maternity hospital in Zajecar in 2015

Abstract

The perinatal period starts in the 22nd week of gestation and ends up with the complete seven-day period after birth. The following criteria are recommend in statistics for international comparison and according to the International Classification of Diseases (ICD) for perinatal mortality: 1) birth weight 1,000 grams and more, 2) 28 weeks of pregnancy and 3) physical length of CRL (crown rump length) 35cm. Perinatal mortality (PM) is determined as the number of stillbirths (foetal mortality (FM)), plus the number of live births and deaths during the first 7 days of life (early neonatal mortality (ENM)) per 1,000 births. It shows itself only in maternity wards, which are legally obliged to follow further status of each of their newborns. Perinatal mortality is caused by different factors, but they come from: the mother (diabetes, hypertension, thyroid disease, autoimmune disease, smoking), foetus (hydrops, infection, congenital and genetic anomalies) and the placenta (abruption, insufficiency, accident with the umbilical cord). Perinatal mortality is the most important indicator in the analysis of perinatal health care. The aim is to determine perinatal mortality at the Maternity Hospital in Zajecar in 2015, the structure of morbidity and mortality. Materials and Methods: We analyzed the pregnancy cards from the Counselling for Pregnant Women of the Health Care Centre Zajecar, labour protocol, histories of mothers and newborns at the Gynaecology and Obstetrics Department Zajecar in 2015 and protocols at the Neonatology of the Children's Ward. The obtained data were processed and shown in tables and diagrams. Results: At the Gynaecology and Obstetrics Department of the Health Care Centre Zajecar in 2015 there were 428 births of 433 infants (5 pairs of twins). The total number of stillbirths was 4 (9.23 ‰ - maternal FM) and infant deaths in the first week, including one pair of twins, 4 (9.32 ‰ -RNM). The rate of perinatal mortality in 2015 at the Zajecar Maternity Hospital is 18.4 ‰. Of the total number of stillbirths and newborns who died in the first seven days after birth, 50% were born by Caesarean section. The average age of pregnant women was 29 - the youngest was 22 and the oldest 40 years old. From the total of 7 pregnant women, two had not controlled pregnancy (one of them was a twin pregnancy), two were active smokers during pregnancy (one of them had not controlled her pregnancy). The average weight of children was 1,600 - the minimum weight was 1000g, maximum 2800g. The average gestation age was about 29 weeks. The average value of the CRL was 40cm - the lowest value was 30cm, the largest 52cm. In the structure of placental complications dominate: placenta abruption (50% in FM and 25% in RNM), and cord accident 25% (1 case short cord as the cause of FM). Conclusion: Our results show that the rate of perinatal mortality in 2015 is 18.4 ‰; in the structure of PM the dominant factors were those from the foetus and placenta. In order to further reduce PM, the priority is taking measures to prevent premature births, regular prenatal care of pregnant women and adequate treatment of the above pathological conditions.