Factors influencing early perinatal mortality in a rural district hospital

Early perinatal mortality (EPM) was prospectively analysed in a rural District Hospital during a 4 month period. 2,171 deliveries were recorded with an early perinatal mortality rate (EPMR) of 53/1000. Factors significantly influencing EPM included maternal age, education, marital and socio-economic status. Antenatal care, gestation at delivery, birthweight, pregnancy and labour complications were other significant factors. A maternal mortality rate of 2.8/1000 was also recorded. The study findings and possible lines of intervention are discussed.

Shanghai needs to improve its perinatal care

In view of the situation that the perinatal mortality rate of Shanghai keeps dropping, doctor Hua Jiazeng from the Shanghai No. 1 Maternity Hospital told the reporter recently that to further lower down the perinatal mortality rate in Shanghai, the perinatal care should be improved through replacing maternity facilities and equipments, keeping the mother and her baby together in the same ward in hospital, and raising the breastfeeding rate. According to the latest statistics, the maternity mortality rate is now 23.8/100.000 in Shanghai, and the perinatal mortality rate has been 12-13/1000 in the past 10 years. These numbers show that there is still a gap between Shanghai and some developed countries regarding perinatal care. There are 3 reasons behind this: 1) since the early 1980s, Shanghai has been in the birth peak period and each year there are 180,000 babies born on the average, as a result, short of beds and lack of staff, the quality of puerperium monitoring and parturition treatment is impaired; 2) maternity facilities and equipments in quite a few hospitals are obsolete and do not suit the needs of modern maternity care anymore, and many hospitals still put newly-born babies together in a big ward which make babies easy to be infected; and 3) breastfeeding rate is dropping as more families do not choose breastfeeding. Doctor Hua suggests: first, we should make a good use of the 3-level maternal and childcare network covering the whole city, strengthen primary care, and pay particular attention to the women of 1st pregnancy at middle age and the unhealthy pregnant women; 2nd, health and medical sectors should put some funds on improving maternal facilities and equipments, increase maternity staff, and raise the income of maternity workers; lastly, all hospitals should keep the mother and baby in the same ward, and greatest efforts should be made to raise the breastfeeding rate.

Seasonality of preterm births in Japan

Seasonal variations in the proportion of preterm births in Japan from January 1979 to December 1983 are analysed using a traditional method of time-series analysis, which divides the variation in a series into trend, seasonal variation, other cyclic change, and remaining irregular fluctuations. It is shown that the proportion of preterm births in Japan have a clear seasonal periodicity with two peaks in summer and winter. Analysis of seasonality by period of gestation shows that interesting differences in kurtosis and skewness exist between summer and winter, i.e. the summer increase in preterm births was characterized by an increase of skewness which means an extension of the lower part of the distribution. On the other hand, the winter increase was characterized by a decrease of kurtosis which corresponds to a flat-topped distribution. This result suggests that causes of preterm births might be different between the two seasons. Theoretical simulations based on actual birth data in Japan over the period, are carried out to examine how season of conception could influence seasonal variations in the proportion of preterm births. Results show that, at least for first births, seasonality in conception rates could be one explanatory factor for the observed seasonal variation in proportions of preterm births. Another analysis reveals that conception in May and June are more likely to result in preterm births in Japan.

Outcome of very low birthweight neonates in a developing country: experience from a large Malaysian maternity hospital

Between January 1989 to April 1990 (16 months), a prospective observational study was carried out on 329 consecutive very low birthweight (VLBW) less than or equal to 1500 grams) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur before their first discharge from the hospital. The objectives of the study were to determine the common causes of early morbidity and mortality of this group of Malaysian neonates. The study shows that the incidence of Malaysian VLBW neonates was 9.9 per 1000 livebirths (95% confidence intervals 9.0 to 10.8). The mean duration of stay in the hospital was 19.3 days (SD = 21.4). One hundred and ninety-six (59.6 percent) of the VLBW neonates died. They accounted for 60 percent (196/334) of all neonatal deaths in the hospital during the study period. Mortality was significantly higher in neonates of birthweight less than 1000 grams (p less than 0.01) and of gestation of less than 33 weeks (p less than 0.001). The three most common clinical problems were respiratory distress syndrome (RDS) (72.6 percent), septicemia (28.0 percent) and intraventricular haemorrhage (IVH) (21.9 percent). Death occurred in 71.1 percent of the septicemic patients. The most common causative organisms of septicemia were multiresistant klebsiella (52.3 percent) and multiresistant acinetobacter (14.7 percent). RDS (33.2 percent), septicemia (29.6%) and IVH (17.9 percent) were the three most common causes of death. Improvement in the nursing staff situation and basic neonatal care facilities in this hospital and prevention of premature delivery could help to decrease morbidity and mortality in this group of neonates.

Relative risk of early and late death in infancy among offspring of non-native-born parents residing in Washington State

It has been suggested that geographic variation in the early neonatal (0-6 days) and postperinatal (7-364 days) mortality rates for the United States derives from positive and negative associations, respectively, with the probability of an average couple sharing one or more HLA antigens. If this theory is correct, then the ratio of 0-6-day deaths to 7-364-day deaths among the offspring of migrant parents should be similar to that seen in the area from which the mother and the father originally migrated. Information on deaths among the offspring of migrant couples by the mother's region of birth was obtained from computerized vital statistics for Washington state for the period 1968-1977. Information on infant deaths occurring in the mother's region of birth was obtained from published vital statistics for the United States for 1980-1984. Ratios of 0-6-day deaths to 7-364-day deaths in 9 geographic regions for the period 1980-1984 were placed in 4 intervals. These intervals became the standard against which the 0-6/7-364-day ratios in the offspring of migrant parents were compared by means of a test for trend in proportions. As predicted, a significant positive trend was observed when the mother and the father were born in the same region but not when they were born in different regions.

Delayed interval delivery of two remaining fetuses in quintuplet pregnancy after embryo reduction: report and review of the literature

A case report is presented with a prolonged interval between delivery of 25 days. A quintuplet pregnancy resulted from hormonal stimulation of ovulation. Two fetuses remained after an embryo reduction was performed at 11 weeks gestation. At 22.5 weeks gestation the first twin (310 g) was delivered after spontaneous rupture of membranes. Using tocolytic agents, the second twin (710 g) was born at 26 weeks of gestation. This case is discussed and a review of the literature is given.

Survival in very low birthweight infants at the University of Port-Harcourt Teaching Hospital, Nigeria

Between January 1984 and December 1987, 1509 singleton neonates were admitted into Special Care Baby Unit at the University of Port Harcourt Teaching Hospital; 29(1.9%) of these were Extreme Low Birthweight (ELBW), 86(5.7%) were Very Low Birthweight (VLBW), 406(26.9%) were Low Birthweight (LBW) and 988 (65.5%) were Normal Birthweight (NBW) infants. Survival rates in the four categories were 10.3%, 46.5%, 89.2% and 94.7% respectively. Factors which significantly influenced survival in the VLBW infants included higher mean birthweight (p less than 0.01) longer mean gestation (p less than 0.001) and lower incidence of birth asphyxia (p less than 0.02 with Yates's correction). Furthermore the survivors were significantly more mature for their gestation than those who died (p = 0.008, Fisher's Exact test). Care of the VLBW infant is not beyond the capabilities of Special Care Baby units in developing countries. In the light of our report, survival of Low Birthweight infants is a strong reflection of that of VLBW infants and survival of this category of babies could be improved by instituting general measures such as those aimed at reducing the incidence of LBW in the environment and by specific measures like carrying out prompt and effective resuscitation of the asphyxiated neonate and preventing sepsis.

Community-based evaluation survey of immunizations in Burkina Faso

A cluster sample survey was conducted in January 1989 in 3 provinces of Burkina Faso to evaluate an immunization programme (based on two contacts, providing inactivated poliomyelitis vaccine plus DPT) that had been launched in 1982-84. The objectives were to estimate neonatal tetanus (NNT) mortality and poliomyelitis prevalence in the study area. The target population (using the same sample of households comprised 2107 live infants born during the preceding year for the NNT survey, and 17,154 children aged 0-9 years for the poliomyelitis survey. The NNT mortality rate was 3.3 per 1000 live births, and the poliomyelitis prevalence rate was 2.8 per 1000 children aged 5-9 years. Dates of onset of poliomyelitis cases among children aged 0-9 years and the numbers of children at risk during the 10-year recall period, reconstituted with demographic indicators taken from standardized life-tables, were used to calculate the incidence rates of poliomyelitis. These rates could be compared in the 5-year period preceding the survey, and showed a decreasing trend consistent with routine surveillance data.

Perinatal deaths: relevance of Wigglesworth's classification

Out of a total of 4572 births over a period of 16 months occurring at St Philomena's Hospital, Bangalore, India, which has level II nursery facilities, there were 196 perinatal deaths. Perinatal mortality was 42.9/1000 total births. Case fatality rate was 12.4% for those born with a birthweight between 1501 to 2000 g, 35.5% for those between 1001 to 1500 g and 100% for those less than 1001 g. These deaths were grouped according to Wigglesworth's classification: 20% were due to prematurity and 24% to birth asphyxia. These two categories contributed to almost half of the perinatal deaths. Classification of perinatal deaths using Wigglesworth's classification appeared to be a practical and problem-oriented system. It also carried clear implications for improving perinatal care. The adoption of this method of classification by all major hospitals is recommended so that easy comparisons can be drawn over time and between different centres.

Prolonged rupture of membranes and neonatal outcome in a developing country

The neonatal outcomes in 109 pregnancies complicated by prolonged rupture of the fetal membranes were studied over a 3-year period. The overall neonatal mortality was 29 (26.6%). Nineteen of these deaths were from infections, of which 12 were pneumonia. There was also a high morbidity rate of 68.8%. Neonatal sepsis, cardiorespiratory depression at birth and prematurity were the most significant complications. Forty-eight (44%) of the infants in the study group had an infection, in contrast with three (2.9%) in the control group (p < 0.0001). No protective effect or benefit from prolonged rupture of fetal membranes in relation to the development of respiratory distress syndrome was demonstrated.

Occupational hazards and pregnancy outcomes

This study examined the association between exposure to occupational hazards and pregnancy outcomes using data from a case-control study conducted in 29 hospitals in Shanghai, China. The sample included 1,875 perinatal deaths and newborns with birth defects and the same number of controls. Information on mother's exposure to occupational radiation, chemicals, noise, and pesticides was investigated. Logistic regression analysis controlling for potential confounders showed that exposure to radiation before/during pregnancy was associated with antepartum fetal death, birth defects, small-for-gestational-age (SGA), and threatened abortion. Exposure to chemicals before/during pregnancy was associated with antepartum fetal death, early neonatal death, birth defects, preterm birth, and threatened abortion. Women exposed to pesticides during pregnancy had an increased risk of SGA and threatened abortion. Exposure to occupational noise during pregnancy increased the risk of antepartum fetal death. Furthermore, higher than expected numbers of congenital anomalies in the central nervous system (CNS) were identified among women exposed to chemicals before pregnancy and to pesticides during the first trimester of pregnancy. No significant association was found between occupational exposure and intrapartum fetal death. Although recall bias may be possible in our study, the findings encourage further research.

Neonatal and early postneonatal morbidity and mortality in a rural Guatemalan community: the importance of infectious diseases and their management

We conducted a 1-year longitudinal prospective study of infants born in a traditional rural indigenous community of Guatemala. Three hundred twenty-nine infants surviving birth and the first day of life were followed during the first 3 months of life. Surveillance included routine household and well baby clinic visits and clinic visits for minor illnesses. Detection of potentially lethal illnesses depended on orientation of families and midwives to important symptoms and to the need for immediate medical evaluation if such symptoms were identified. We identified 38 episodes of lethal and potentially lethal illness. Thirty-five (92%) of these episodes were infectious diseases, principally sepsis during the neonatal period and acute lower respiratory infection in Months 2 and 3. Of all study infants, low birth weight (less than 2500 g) infants comprised 14% and premature (less than 37 weeks gestation) infants comprised 1%. Premature infants had a relative risk of lethal and potentially lethal illnesses of 11.1 (95% confidence interval, 3.6 to 34.4) compared with normal term infants, and no premature infant survived the first 3 months of life despite medical intervention. Low birth weight infants had a relative risk of 3.2 (95% confidence interval, 1.5 to 6.6), but with medical intervention all but 2 survived. Despite their lower risk, because of their much greater number normal term infants experienced 60% of lethal and potentially lethal illnesses. Among all study infants medical intervention was associated with survival of 86% of lethal and potentially lethal infectious illnesses and with a rate of neonatal mortality among study children significantly lower than rates documented in previous years in the same community.

Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51% of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70% to the rest of the time period when the post-mortem rate was only 40%. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40% of deaths overall and 59% of deaths in infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20% of deaths. Sixty percent of the infants in this group weighed less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.

Birth spacing and infant mortality in Brazil

The effects of birth spacing on neonatal and post-neonatal mortality in Brazil were found to be very consistent with models based on data from other South American countries. The model for neonatal mortality simplified to three significant variables, whereas the model for post-neonatal mortality included four significant interactions.

Mortality pattern among Nigerian children in the 1980s

A study of paediatric deaths in the University of Calabar Teaching Hospital, Calabar, Nigeria during a 4-year period (January 1984-December 1987) showed an overall mortality of 80 per 1000 paediatric admissions. A majority (47%) of the deaths were the newborn with a decline (7%) in children aged 61 months to 14 years. Major causes of death were tetanus, low birthweight and birth asphyxia in the newborn; malnutrition, pneumonia and measles in the pre-school age, and anaemia in the older children. Neonatal tetanus and malnutrition played a leading role in the overall mortality.

Perinatal mortality rate in a south Indian population

Perinatal mortality rate was assessed for 13964 consecutive births in SAT Hospital, Trivandrum, South India, during a period of one year. The overall perinatal mortality rate was 42.75, stillbirth rate 24.41 and early neonatal mortality rate 18.79. The perinatal mortality rate in multiple pregnancy was 156.65. Preventable causes of perinatal mortality still make a major contribution to perinatal deaths in developing countries.

A 2-year study of neonatal mortality in a large Malaysian hospital

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.

Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda

We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period.

Elimination of neonatal tetanus: 1995

India aims at the elimination of neonatal tetanus by 1995 by providing TT immunization services to all pregnant women in the country. Strengthening of the surveillance system is part of the strategy for the elimination of neonatal tetanus. There is a wide range of performance at state and district level. Many states have the potential of achieving the difficult and challenging goal of neonatal tetanus elimination within a few years.

Intrapartum and neonatal mortality in a traditional indigenous community in rural Guatemala

We identified high rates of intrapartum and neonatal mortality among children born in a traditional indigenous community in rural Guatemala. To examine the potential association of maternal characteristics and obstetric and newborn care practices with this mortality, we conducted a retrospective case-control study. Case were infants born in 1986 and 1987 who died during birth or in the first month of life, as identified by civil records; for each case, the next child born who survived the first month of life was selected as control. In interviews with mothers of cases and controls standardized data were collected on demographic and socioeconomic characteristics of the mother, her general obstetric history, history of the pregnancy, labor, and delivery, condition and care of the infant at birth, and morbidity and treatments of the infant after birth. Sixty-one cases and their controls were included in the study. Based on clinical condition at birth, we subcategorized cases into infants stillborn or dying in the first 24 hours of life (intrapartum cases) and those dying in the first month after day 1 (neonatal cases). Factors significantly associated with both subcategories of cases were maternal illiteracy, primagravity, failure to use "modern" prenatal care, and inter-birth interval less than 14 months. Intramuscular injection of oxytocin by the midwife during labor, and performance of greater than or equal to 3 vaginal examinations by the midwife were each significantly associated only with the intrapartum subcategory of cases. Mother's estimate of infant size as "smaller than normal" was associated with neonatal, but not with intrapartum, cases.(ABSTRACT TRUNCATED AT 250 WORDS)