PERINATAL
MORTALITY
By [Link]
n d a
Age
1. Definition
2. Perinatal Nomenclature
3. Predisposing Factors
4. Causes
5. Prevention
6. Interventions.
Perinatal Mortality
Perinatal mortality is defined as deaths among the fetuses weighing 500g or more at birth
(22 weeks gestation) or during delivery or within first 7 days of delivery.
The perinatal mortality rate is expressed in terms of such deaths per 1000 total births. It
closely reflects both the standards of medical care & effectiveness of social and public
health measures.
Perinatal deaths could be reduced by at least 50% worldwide if the key interventions are
applied for the newborn.
In developed countries ——- <10 per 1000 total births,
but In developing countries it is much higher. In India, it is 26/1000 total births.
The major health problem in Low & Middle Income Countries arises from the synergistic
effect of infection and preterm birth combined with non-utilisation of obstetric care.
Perinatal Nomenclature:-
500 1000 2500 3250 4000 Weight of the
fetus (g)
Preterm Term Post-Term
0 1 2 3 4
Neonatal Weeks after
Abortion Stillbirth death birth
Perinatal death
0 2 12 20 22 28 37 40 42 44 Weeks of gestation
Conception 1st
TRIMESTER 2nd TRIMESTER 3rd TRIMESTER
PRETERM Newborn TERM Newborn
Extremely Preterm = <28 wks Early Term = 37 to 38 wks +6days
Very early Preterm = 28 to 31 wks Full Term = 39 to 40 wks +6days
Early Preterm = 32 to 33 wks+6 days Late Term = 41 to 41 wks +6days
Late Preterm = 34 to 36 wks+6 days Post Term = 42 wks & Beyond.
Age - >35yrs, teenage. Multiple Pregnancy
Parity above 5. IUGR & Low-birth-weight babies.
Low Socio-Economic conditions. Preterm Labour
Premature Rupture of Membranes.
Poor maternal nutritional Congenital & Chromosomal
status. Epidemiological Fetoplacental Abnormalities.
factors Factors
Anemia ( <8 g/dl )
Hypertensive disorders. Malpresentations.
Daibetes Mellitus. Dystocia from disproportion.
Acute Fevers. Abnormal uterine action.
Infections (HIV). Medical Labor Amnionitis, Birth injuries.
disorders Complications
Hypoxia, hypothermia.
IUGR, Prematurity. PREDISPOSING
FACTORS
Antepartum Hemorrhage. About 20% of stillbirths
Preterm Labour. Obstetric have no obvious fetal,
Rh isoimmunization. Complications Unexplained placental, maternal or
Pre-Eclampsia, Eclampsia. obstetric causes.
Cervical Incompetence.
CAUSES of Perinatal Mortality
About two-thirds of all perinatal deaths occur among infants with less than 500g birth weight.
The causes involve one or more complications in the mother during pregnancy or labour, in the
placenta or in the foetus or neonate.
Main causes :- The main causes of death are intrauterine & birth asphyxia, low birth weight, birth
trauma and intrauterine or neonatal infections.
The causes can be further categorised as :- Antenatal, Intranatal, Postnatal & Unknown causes.
1) ANTENATAL CAUSES:-
Maternal diseases - HTN, DB, Anemia, TB, CVS disorders.
Pelvic diseases - endometriosis, ovarian tutors.
Anatomical defects - Uterine & Cervical anomalies.
Endocrine imbalance & inadequate uterine preparation.
Blood incompatibilities.
Malnutrition.
Toxemias of pregnancy.
APH.
Congenital defects.
Advanced maternal age.
2) INTRANATAL CAUSES:-
Birth injuries.
Asphyxia.
Prolonged effort time.
Obstetric complication.
3) POSTNATAL CAUSES:-
Prematurity.
Respiratory distress
syndrome.
Infections.
4) UNKNOWN CAUSES. Congenital anomalies.
In some, causes are not
clinically ascertainable.
PREVENTION :-
As every mother has the right to conclude her pregnancy safely,
so also has the baby got a right to be born alive safe and healthy.
Preventive Measures:-
Prepregnancy healthcare & counselling.
Genetic counselling in high risk cases & prenatal diagnosis to detect
genetic, chromosomal or structural abnormalities are essential.
Regular antenatal care, with advice regarding health, diet and rest.
Detection & management of medical disorders in pregnancy.
Screening of High-risk patients & their mandatory hospital visits &
delivery.
Careful monitoring in labour to detect hypoxia early & avoidance of
traumatic vaginal delivery.
Skilled birth attendant - to minimise sepsis, at least three cleans are to be
maintained.
Provision of referral neonatal service, especially to look after preterm and
LBW babies.
Healthcare education of the mother about the care of the newborn.
Early and exclusive breastfeeding, prevention of hypothermia.
INTERVENTIONS:-
Before & During Pregnancy During Pregnancy
Delay child birth Birth & emergency preparedness.
Birth Spacing Early detection & treatment of
maternal complications
Healthy mother
Monitoring of foetal well-being
No drug abuse Timely interventions for fetal
No smoking or Alcohol. complications.
TT and other required Prevention & Treatment of Anemia
immunisation Prevention & Treatment of
Female education. Infections.
Good diet and nutrition.
After delivery In first month of life
Hospital delivery
Early post-natal contact.
Early detection & prompt treatment
Protection, promotion and support
of complications.
of exclusive breast feeding.
Newborn resuscitation
Prompt detection & management of
Newborn care.
diseases in newborn infant.
Early initiation of exclusive breast
feeding. Immunization.
Counseling of homecare, danger Protection of girl child.
signs and care seeking.
THANK
YOU!
