Clinico-pathological study of causes of perinatal mortality in a developing country

Abstract

Perinatal mortality rates are an important indicator of the overall obstetric and neonatal services available, and the socio-economic status of the community. These rates are also used to identify shortcomings in services provided. The aim of this study was to identify clinical causative factors of perinatal deaths (supported by post mortem evidence where possible). This was a prospective descriptive study. The total number of deliveries and perinatal deaths over a 6-month period were recorded and clinicodemographic data noted. Post mortem examination information, if available, was also recorded. There was a total of 7789 deliveries over the 6-month period and 460 perinatal deaths, giving a perinatal mortality rate of 59/1000 deliveries; 45% ( n = 207) of the perinatal deaths had post mortem examinations. The mean age was 26 years; 84·8% were single mothers. One-third of the group were unbooked: the mean gestational age of fetal death was 31 weeks, and the mean birth weight was 1700 g. Two-thirds of the perinatal deaths were stillbirths. The leading obstetric causes of deaths were: abruptio placentae (25·3%), hypertension in pregnancy (24·9%), prematurity (17·4%), unexplained stillbirth (13·4%) and intrapartum asphyxia (9·2%). The perinatal mortality rate of 59/1000 deliveries is high. Although this is comparable with other developing countries, there is a need for improvement in organisation of obstetric and neonatal care, staffing levels and access to and effective utilisation of antenatal services. These will probably lead to a significant reduction of this relatively high perinatal mortality rate.