Perinatal mortality for 4th year med.students

Educational Materials

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Associate Clinical Prof. Dr. Aisha M. El-Bareg, MD, PhD
Senior Consultant in (Obs & Gyn)/Reproductive Medicine
Faculty of Medicine, Misurata University, LIBYA

2. The perinatal period commenced at
28 completed weeks of gestation
(time when birth weight is normally
1000g), and ends seven completed
days after birth.

3. The neonatal period commences at birth
and ends 28 completed days after birth.

Early neonatal period: first 7 days
Late neonatal period : 7-27 days of life

4. Includes:
Late Fetal death ≥ 28
weeks gestation.


Early neonatal deaths:
≥ 7 days old baby



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5. Perinatal mortality: all fetal & early
neonatal deaths weighing 1000g or
more between 28 weeks of gestation to
first week of neonatal life(WHO).
Perinatal mortality rate: expressed in
terms of perinatal deaths per 1000 total
births.
•Perinatal mortality in developed nations
:<10 per 1000 births


• Developing countries: high,32-35 per
1000 in India

6. Fetal and Early Neonatal Deaths

Total births (live, dead)
X 1000
Perinatal Mortality Rate (PMR)
 Perinatal Mortality Ratio

Fetal and Early Neonatal Deaths

live births
X 1000

7. •Maternal age
–Teenage pregnancies, elderly gravida
•Parity
–Anemia, inadequate antenatal care,
inadequate rest,

•Socioeconomic factors: LSE
•Obstetric factors
–Placental insufficiency, APH, intrapartum
care, malpresentation ,multiple births

8. Idiopathic: about 50 % cases
Maternal:
◦Hypertension, PET, DM, thyroid disorders
◦Placenta previa, Abruption & cord
accidents
◦Chorioamnionitis & other infections
◦APS, Isoimmunization
Fetal: Genetic Anomaly

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9. Prematurity
IUGR (SGA)
Hypoxia
Birth Trauma
Neonatal Infections
Congenital anomalies
Aspiration pneumonitis
Isoimmunization
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10. Antenatal Causes: Maternal diseases -
hypertension, cardiovascular diseases,
diabetes, infections, anemia, pelvic
diseases, anatomical defects.

Intranatal Causes: Birth injuries, asphyxia,
prolonged effort time, obstetric
complications;


Postnatal Causes: Prematurity, respiratory
distress syndrome, respiratory and
alimentary infections, congenital
anomalies

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Prevention:

12. Preconception counseling
Proper Antenatal Care & PND s.o.s
Good Maternal hygiene & control of
genital infections
Early recognition & effective treatment of
maternal factors
Prevent PTL

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13. Judicious use of interventions:
◦Fetal Blood transfusion
◦Fetal Therapy
◦Fetal Operations
Timely Delivery:
◦Prolonged pregnancy
◦DM, Preeclampsia
◦IUGR, Oligohydroamnios, PROM
◦Poor BPP (≤ 6 ) / nonreactive CTG
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14. Prompt management of fetal distress
Prevention of infection.
Amnioinfusion to prevent Meconium
aspiration.
Avoid:
◦Traumatic delivery
◦Prolonged labor

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15. Proper resuscitation &
suction
Prevention of
hypothermia & neonatal
infections
Emphasize Breast feeding
Education of Proper
feeding technique

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16. Prompt treatment of
Acidosis, Anemia,
Infections etc.
Good Neonatal Care
(NICU)

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17. Proper antenatal care
Prevention of preterm births, which is
very difficult
Providing better care and monitoring
during the Intranatal period
Regular use of partograph and timely
intervention.
Intensive care of very low birth weight
and sick neonates.

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