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Objective The study aimed to describe the postmortem investigation patterns for perinatal deaths and compare the degree of investigation between stillbirths and early neonatal deaths. Study Design We conducted a single-center retrospective review of all perinatal deaths from 2011 to 2017. Perinatal death was defined as intrauterine fetal death at ≥20 weeks' gestation, plus neonatal deaths within the first 7 days of life. Rates of postmortem investigation were compared. Results There were 97 perinatal deaths, with 54 stillbirths (56%) and 43 neonatal deaths (44%). Stillbirths were significantly more likely to receive autopsy (p = 0.013) and postmortem genetic testing (p = 0.0004) when compared with neonatal deaths. Maternal testing was also more likely in stillbirths than neonatal deaths. A total of 32 deaths (33%) had no postmortem evaluation beyond placental pathology. Conclusion Investigation following perinatal death is more likely in stillbirths than neonatal deaths. Methods to improve postmortem investigation following perinatal death are needed, particularly for neonatal deaths. Key Points

The primary purpose of this study is to recognize the perinatal mortality rate and the vital causes of perinatal mortality to ascertain the significant maternal elements for a safe birth. A retrospective study was carried out in three large tertiary hospitals in Jeddah, Saudi Arabia, in the period from January 1, 2010, through December 31, 2015. All perinatal deaths happening during that time were analyzed. During the six-year review period, a total of 280 infant deaths were recorded with a perinatal mortality rate (PMR) of 6.6 per 1000 births. The principal causes of death among the deceased were low birth weight (LBW) (87%), lethal congenital malformation (CM) (4%), sepsis (3%), and respiratory arrest (3%). The PMR was high in 2010 at 6.8, while it declined to 6.4 at the end of the period studied. The average PMR recorded in this study was 6.6 per 1000 births. This study showed that low birth weight is the main reason for prenatal mortality, although the PMR did decline by the end of the period. A decrease in the perinatal death rate is viable when all females start to attend preconception counselling and are present at antenatal health centres.

The Perinatal mortality rate is an important index of community health condition and quality of health service provided to the mother and their fetus during the 28 weeks of gestation till, after delivery, there are many factors that threaten their life. This study aimed to determine the perinatal mortality rate in Baghdad AL Karkh health directorate and to identify the contributing factors and main causes of perinatal mortality.A study based on a record review of the perinatal mortality in three hospitals in Baghdad Al-karkh for a one year starting from 1st April 2018 and at the end in March 2019.The total deliveries were 27,096, while the total deaths were 1217 deaths during the perinatal period the perinatal mortality rate was 45 /1000, 67% of them with newborn death, 57% of fetal gender was male, 64 % of perinatal deaths were delivered by cesarean section, the most common maternal contributing factors is the complication of labor and delivery was 24% while the fetal causes are Respiratory and cardiovascular disorders specific to the perinatal period was 56%, the study revealed a significant relation or association between gestational age, mode of delivery, place of delivery, a product of delivery and age of the baby when dead and in another side this study revealed a no association between the mother’s age, gender of the baby and the Weight of the baby . The main causes of perinatal mortality deaths occur during the first 2 days and may be modifiable with simple targeted perinatal policies with, quality improvement of the health care providing in labor rooms and neonatal care units.

Objective To analyze the indications for cesarean deliveries and factors associated with adverse perinatal outcomes in Sierra Leone. Methods Between October 2016 and May 2017, patients undergoing cesarean delivery performed by medical doctors and associate clinicians in nine hospitals were included in a prospective observational study. Data were collected perioperatively, at discharge, and during home visits after 30 days. Results In total, 1274 cesarean deliveries were included of which 1099 (86.3%) were performed as emergency surgery. Of the 1376 babies, 261 (19.0%) were perinatal deaths (53 antepartum stillbirths, 155 intrapartum stillbirths, and 53 early neonatal deaths). Indications with the highest perinatal mortality were uterine rupture (45 of 55 [81.8%]), abruptio placentae (61 of 85 [71.8%]), and antepartum hemorrhage (8 of 15 [53.3%]). In the group with cesarean deliveries performed for obstructed and prolonged labor, a partograph was filled out for 212 of 425 (49.9%). However, when completed, babies had 1.81‐fold reduced odds for perinatal death (95% confidence interval 1.03–3.18, P‐value 0.041). Conclusion Cesarean deliveries in Sierra Leone are associated with an exceptionally high perinatal mortality rate of 190 per 1000 births. Late presentation in the facilities and lack of adequate fetal monitoring may be contributing factors. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Objective To describe the characteristics and outcomes of prelabour uterine ruptures. Design Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Sample Maternities with uterine rupture before start of labour in Norway during the period 1967-2008 (8 complete ruptures among 2 334 712 women with unscarred uteri, and 22 complete and 45 partial ruptures among 121 085 women with scarred uteri). Method We measured the rate of perinatal deaths and peripartum hysterectomy following ruptures. In addition, we studied the characteristics of ruptures. Results The eight complete ruptures in women with unscarred uteri were associated with trauma from traffic accidents (n = 3; 37.5%), previous curettage (n = 3; 37.5%) and congenital uterine malformations (n = 2; 25%), resulting in seven perinatal deaths and two hysterectomies. The 22 complete ruptures in scarred uteri were mostly outside the lower uterine segment (n = 17; 72.7%). Abnormally invasive placenta (AIP) and previous rupture were present in four (18.2%) and three women (13.6%), respectively. They resulted in nine perinatal deaths (39.1%) and two hysterectomies (9.1%). The 45 partial ruptures involved mostly scars in the lower uterine segment (n = 39; 86.7%). None of them resulted in perinatal death or hysterectomy. Perinatal deaths have decreased dramatically in recent years, despite increasing prelabour rupture rates. Conclusion Although complete uterine ruptures before labour start were rare, they often resulted in catastrophic outcomes, such as perinatal death. Scars outside the lower segment were associated with a higher percentage of catastrophic prelabour ruptures compared with scars in the lower segment (Video S1). Tweetable abstract Complete prelabour uterine ruptures were rare, but resulted in high perinatal deaths, especially if they were in scars outside the lower segment.

Introduction: The placenta is infrequently examined in developing countries. This study examined the role of placental pathology in perinatal deaths at Chulalongkorn University Hospital, Bangkok. M...

The aim of the study is to estimate the perinatal mortality rate and its determinants. Aretrospective observational study was conducted at a tertiary hospital in Maharashtra, India of the perinatal mortalities born from January 2017 to December 2017 after Ethics Committee approval. Data was acquired from the Delivery register of the Labour room covering the maternal socio-demographic characteristics and the relevant investigations. The causes of perinatal mortality were simplified as per the Tulip Classification (2006). Statistical Analysis: The standard WHO formula for calculating the perinatal mortality rate was applied. Chi- square test followed by P-value were obtained through the Open Epi software, was used for estimating the statistically significant observations amongst the study results. The total births in the study period were 3461 and the perinatal deaths were 132. The Perinatal Mortality Rate computed to 39.65 per 1000 live births. Out of the 132 perinatal deaths, stillbirths were 89 and early neonatal deaths were 43.The perinatal mortalities were found to be highest in the age group of 30-35 years, multigravidae, unbooked and high risk obstetric patients and low birth weight newborns. Lack of antenatal registrations, unoptimised high risk pregnancies entering labour can potentially pose a threat to the delivery outcome.

Objectives: The goal was to assess the risk factors for emergency cesarean section versus prophylactic caesarean section. Materials and Methods: This was a descriptive analytical cross-sectional study of the Type Cas/Witnesses at the Reference Health Centre of Commune V of the District of Bamako in Mali. The sample consisted of 100 cases for 200 controls (1 case for 2 controls) with retrospective collection of data for the period from January 1 to July 11, 2011 (6 months and 11 days). Results: During the study period, out of a total of 3559 deliveries, we recorded 2,794 vaginal deliveries, 78.50% and 765 caesarean sections or 21.50%. Of the 765ceras, we performed 353 emergency caesarean sections or 46.15% and 412 prophylactic caesarean sections 53.85%. We have selected 100 prophylactic caesarean section files and 200 emergency caesarean section files. The average age of the patients was 27.41 years-5.84 with extreme ages of 14 to 40 years. 100% of our patients (Cas) had performed at least one antenatal consultation compared to 83.5% of the parturients evacuated (Witnesses). The most frequently cited reasons for evacuation were: acute fetal suffering, non-cephalic presentation and excessive uterine height with 30%, 17.5% and 12% respectively. The bulk of the caesarean section indications were dominated by dystocies with 90% in cases compared to 65% in Witnesses, followed by acute fetal suffering with 30% in Witnesses. We recorded 30% perinatal deaths among Witnesses compared to 1% in Cases. We recorded 16 uterine ruptures in the Witnesses among which 2 hysterectomies and 14 hystererraphia. Conclusion: Prophylactic caesarean section improves maternal and perinatal prognosis more than emergency caesarean section.

Most maternal and perinatal deaths could be prevented through timely access to skilled birth attendants. Women should access appropriate obstetric care during pregnancy, labor, and puerperium. Maternity waiting homes (MWHs) permit access to emergency obstetric care when labor starts. This study compared maternal and perinatal outcomes among MWH users and non-users through a retrospective cohort study. Data were collected through obstetric chart reviews and analyzed using STATA version 15. Of the 8144 deliveries reported between 2015 and 2019, 1305 women had high-risk pregnancies and were included in the study. MWH users had more spontaneous vaginal deliveries compared to non-users (38.6% versus 16.8%) and less cesarean sections (57.7% versus 76.7%). Maternal morbidities such as postpartum hemorrhage occurred less frequently among users than non-users (2.13% versus 5.64%). Four women died among non-users while there was no death among users. Non-users had more stillbirths than users (7.68% versus 0.91%). The MWH may have contributed to the observed differences in outcomes. However, many women with high risk pregnancies did not use the MWH, indicating a probable gap in awareness, usefulness, or their inability to stay due to other responsibilities at home. Use of MWHs at scale could improve maternal and perinatal outcomes in Rwanda.

Background: Syphilis is one of the major causes of adverse outcomes in pregnancy in developing countries. Antenatal screening for syphilis aims primarily at timely detecting & treating pregnant women with congenitally transmissible syphilis, there by preventing perinatal deaths. Objective: To study prevalence of syphilis in antenatal women by screening them with the Rapid Plasma Reagin (RPR) & rapid immunochromatographic (ICT) method. Materials and Methods: A total of 2258 pregnant women attending antenatal care from January to December 2018 were tested for Syphilis by RPR & rapid ICT. Results: Out of 2258 women screened during their antenatal visits, 12 (0.53%) were positive by RPR as well as rapid ICT test method. Conclusion(s): Early detection of syphilis in pregnancy is the best tool for prevention of adverse pregnancy outcomes. Antenatal screening of syphilis with Rapid plasma regain (RPR) and Rapid immunochromatography (ICT) is sensitive, specific, rapid and cost-effective method.

Background Globally, 2.6 million stillbirths occur every year. Of these, 98% occur in developing countries. According to the United Nations Children’s Fund, the neonatal mortality rate in Zambia in 2014 was 2.4%. In 2016, the World Health Organization released the International Classification of Diseases - Perinatal Mortality (ICD-PM) as a globally applicable and comparable system for the classification of the causes of perinatal deaths. However, data for developing countries are scarce. The aim of this study was to evaluate the rates and causes of stillbirths and neonatal deaths at a local hospital in Zimba, Zambia to identify opportunities for preventive interventions. Methods All cases of stillbirths and neonatal deaths at Zimba Mission Hospital in Zambia in 2017 were included in this study. Outborn neonates who were transferred to the hospital and later died were also included in the study. Causes of stillbirths and neonatal deaths were analyzed and classified according to ICD-PM. Results In total, 1754 babies were born via 1704 deliveries at the hospital, and 28 neonates were transferred to the hospital after birth. The total number of perinatal deaths was 75 (4.2%), with 7 deaths in the antepartum, 25 deaths in the intrapartum, and 43 deaths in the neonatal period. Most antepartum deaths (n = 5; 71.4%) were classified as fetal deaths of unspecified causes. Intrapartum deaths were due to acute intrapartum events (n = 21; 84.0%) or malformations, deformations, or chromosomal abnormalities (n = 4; 16.0%). Neonatal deaths were related primarily to complications from intrapartum events (n = 19; 44.2%); low birth weight or prematurity (n = 16; 37.2%); or infection (n = 3; 7.0%). Conclusions Perinatal deaths were associated with acute intrapartum events and considered preventable in 40 cases (53.3%). Effective interventions to prevent perinatal deaths are needed.

ObjectiveWhen a formal review of care takes places after the death of a baby, parents are largely unaware it takes place and are often not meaningfully involved in the review process. Parent engagement in the process is likely to be essential for a successful review and to improve patient safety. This study aimed to evaluate an intervention process of parental engagement in perinatal mortality review (PNMR) and to identify barriers and facilitators to its implementation.DesignMixed-methods study of parents’ engagement in PNMR.SettingSingle tertiary maternity unit in the UK.ParticipantsBereaved parents and healthcare professionals (HCPs).InterventionsParent engagement in the PNMR (intervention) was based on principles derived through national consensus and qualitative research with parents, HCPs and stakeholders in the UK.OutcomesRecruitment rates, bereaved parents and HCPs’ perceptions.ResultsEighty-one per cent of bereaved parents approached (13/16) agreed to participate in the study. Two focus groups with bereaved parents (n=11) and HCP (n=7) were carried out postimplementation to investigate their perceptions of the process.Overarching findings were improved dialogue and continuity of care with parents, and improvements in the PNMR process and patient safety. Bereaved parents agreed that engagement in the PNMR process was invaluable and helped them in their grieving. HCP perceived that parent involvement improved the review process and lessons learnt from the deaths; information to understand the impact of aspects of care on the baby’s death were often only found in the parents’ recollections.ConclusionsParental engagement in the PNMR process is achievable and useful for parents and HCP alike, and critically can improve patient safety and future care for mothers and babies. To learn and prevent perinatal deaths effectively, all hospitals should give parents the option to engage with the review of their baby’s death.

ObjectivesTo investigate if the implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience reduced perinatal mortality in a South African province. The recommendations were implemented which included increasing the number of contacts and also the content of the contacts.MethodsRetrospective interrupted time-series analysis was conducted for all women accessing a minimum of one antenatal care contact from April 2014 to September 2019 in Mpumalanga province, South Africa. Retrospective interrupted time-series analysis of province level perinatal mortality and birth data comparing the pre-implementation period (April 2014–March 2017) and post-implementation period (April 2018–September 2019). The main outcome measure was unadjusted prevalence ratio (PR) for perinatal deaths before and after implementation; interrupted time-series analyses for trends in perinatal mortality before and after implementation; stillbirth risk by gestational age; primary cause of deaths (and maternal condition) before and after implementation.ResultsOverall, there was a 5.8% absolute decrease in stillbirths after implementation of the recommendations, however this was not statistically significant (PR 0.95, 95% CI 0.90% to 1.05%; p=0.073). Fresh stillbirths decreased by 16.6% (PR 0.86, 95% CI 0.77% to 0.95%; p=0.003) while macerated stillbirths (p=0.899) and early neonatal deaths remained unchanged (p=0.499). When stratified by weight fresh stillbirths >2500 g decreased by 17.2% (PR 0.81, 95% CI 0.70% to 0.94%; p=0.007) and early neonatal deaths decreased by 12.8% (PR 0.88, 95% CI 0.77% to 0.99%; p=0.041). The interrupted time-series analysis confirmed a trend for decreasing stillbirths at 0.09/1000 births per month (−0.09, 95% CI −1.18 to 0.01; p=0.059), early neonatal deaths (−0.09, 95% CI −0.14 to 0.04; p=ConclusionThe implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience may be an effective public health strategy to reduce stillbirths in South African provinces.

Premature birth is a large-scale medical issue by being the cause of most of the perinatal deaths and a risk factor for other medical issues affecting the health and life quality of both mother and infant. Early diagnosis of such cases may prove to be very helpful in improving the health quality of society overall. So, in this study, such early diagnostic methodology is proposed by employing the non-invasive technique of uterine electromyography, which is also called electrohysterography (EHG). The raw EHG signals from three recording channels are first filtered using a 4-pole band-pass Butterworth filter of 0.8Hz-4Hz of each channel. Algorithm of Empirical Mode Decomposition (EMD) is applied as a pre-processing approach and for segmentation purposes. Then using nine statistical features, EHG signals are very accurately classified as ones leading to term or preterm labors under the Quadratic Discriminant at 25% holdout validation. The proposed framework is 98.5% accurate for classification of term and preterm deliveries with 98.48% sensitivity and 98.48% specificity. This technique will help obstetricians in their clinical practices by providing an early assessment of pregnancies and for saving the life of infants and improving the infant and maternal health status.

Background: Around 70% of all pregnancies (Including 15% of clinically-recognized ones) are lost due to various fetal or maternal disorders. Chromosomal aneuploidies are among the most common causes of pregnancy loss. Standard chromosome analysis using G-banding technique (Karyotype) is the technique of choice in studying such abnormalities; however, this technique is time-consuming and sensitive, and limited by vulnerabilities such as cell culture failure. The use of molecular cytogenetic techniques, including array-based techniques and Multiplex Ligation-Dependent Probe Amplification (MLPA), has been proposed to overcome the limitations of this method to study the products of conception. This study has been designed to investigate the feasibility of using MLPA technique as a standalone genetic testing, with histopathologic examinations and genetic counseling to detect aneuploidies in products of conception and neonatal deaths. Methods: Forty-two verified fetal and neonatal samples were studies and genetic counseling was scheduled for all parents. Histopathologic examinations were carried out on the products of conception, and appropriate fetal tissues were separated for genetic studies. Following DNA extraction and purification, MLPA was carried out to investigate chromosomal aneuploidies. Results: Nine samples (21.42%) were diagnosed to be affected with aneuploidy. Detected aneuploidies were trisomy 22 (n=3), trisomy 21(n=1), trisomy 18 (n=2), trisomy 16 (n=1), trisomy 13 (n=1), and monosomy of chromosome X (n=1). The MLPA analysis results were conclusive for all of the fetal samples (Success rate: 100%). Conclusion: These results suggest that MLPA, as a standalone genetic testing, is an accurate, rapid, and reliable method in overcoming the limitations of standard cytogenetic techniques in genetic investigation of products of conception.

Background Stillbirths and neonatal deaths have long been imperfectly classified and recorded worldwide. In Hong Kong, the current code system is deficient (>90% cases with unknown causes) in providing the diagnoses of perinatal mortality cases. Objective The objective of this study was to apply the International Classification of Diseases for Perinatal Mortality (ICD-PM) system to existing perinatal death data. Further, the aim was to assess whether there was any change in the classifications of perinatal deaths compared with the existing classification system and identify any areas in which future interventions can be made. Methods We applied the ICD-PM (with International Statistical Classification of Diseases and Related Health Problems, 10th Revision) code system to existing perinatal death data in Kwong Wah Hospital, Hong Kong, to improve diagnostic classification. The study included stillbirths (after 24 weeks gestation) and neonatal deaths (from birth to 28 days). The retrospective data (5 years) from May 1, 2012, to April 30, 2017, were recoded by the principal investigator (HML) applying the ICD-PM, then validated by an overseas expert (EA) after she reviewed the detailed case summaries. The prospective application of ICD-PM from May 1, 2017, to April 30, 2019, was performed during the monthly multidisciplinary perinatal meetings and then also validated by EA for agreement. Results We analyzed the data of 34,920 deliveries, and 119 cases were included for analysis (92 stillbirths and 27 neonatal deaths). The overall agreement with EA of our codes using the ICD-PM was 93.2% (111/119); 92% (78/85) for the 5 years of retrospective codes and 97% (33/34) for the 2 years of prospective codes (P=.44). After the application of the ICD-PM, the overall proportion of unknown causes of perinatal mortality dropped from 34.5% (41/119) to 10.1% (12/119) of cases (P Conclusions Using the ICD-PM would lead to a better classification of perinatal deaths, reduce the proportion of unknown diagnoses, and clearly link the maternal conditions with these perinatal deaths.

Evaluate the impact of third trimester ultrasound in identifying ,small for gestational age (SGA) growth restricted (FGR) and appropriately grown fetuses (AGA).Analyse their outcomes ,ascertain the main causes of perinatal death and lastly compare ultrasound intervention to standard antenatal care . Design Prospective observational study Setting Secondary care, government hospital Population Antenatal women Methods Based on estimated fetal weight by scan , patients were categorized into FGR 3 and 10 centile. Perinatal outcomes and deaths were analysed by category. Health Ministry data was extracted for standard care outcomes and compared to study group. Main Outcomes Perinatal deaths and causes,composite neonatal morbidity ,severe adverse outcomes Results Number of births in study and standard care was 1817 and 15,427 respectively. Detection rate by ultrasound for FGR/SGA fetuses was 28.5%.This contained 44.8% (13/29) of all perinatal deaths. Neonatal deaths, composite neonatal morbidity, serious adverse perinatal outcomes were significantly more in FGR compared to AGA. Standard care group had twice as many stillbirths RR 2.32(1.3-4.1)and early neonatal deaths (RR2.5 (1.18-5.34) . Majority of perinatal deaths (17/29; 58.6%) in study group were the direct result of failure to recognize antepartum/ intrapartum risk factors, leading to delayed delivery. In addition (3/12 ; 25%), women reported late after decreased fetal movements and ( 3/12 25%)were post dated. Ill-equipped nursery contributed to neonatal mortality in (10/17 ; 58.8%) cases. Conclusion Perinatal outcomes will not improve by ultrasound identification of small fetuses unless concomitantly, obstetric protocols and patient awareness programmes are not improved.

Background: Research indicated the prevalence of perinatal deaths of infants immediately or up to a week after birth and includes fresh and macerated stillbirths and neonatal deaths. Worldwide, there is a decline in perinatal deaths. However, in South Africa, it is not the case. Often the quality of maternity care is considered as the most important contributing factor for these deaths. However, maternal and neonatal factors can also contribute. Aim: The aim of the study was to determine the maternal and neonatal factors associated with perinatal deaths in a single selected district hospital within the Free State Province of South Africa. Setting: The maternity unit of the largest district hospital in the specific district in the Free State Province of South Africa. Method: A clinical audit design was used. Units of analysis comprised the Perinatal Problem Identification Programme (PPIP) database of neonates born during 2015, and their mothers. A random sample of 384 alive neonates and an all-inclusive sample of 43 deceased neonates were taken from a total of 2319. Descriptive statistics were reported and Cohen’s effect sizes, d , were calculated to identify practically significant differences between the neonates in the alive and the deceased group, respectively. Results: Cohen’s effect sizes and logistical regression analyses indicate that the Apgar score recorded 10 min after birth, gestational age, birth weight of neonate and the parity of the mother were the most practically significant factors influencing a neonate’s chances of survival. Conclusion: Quality maternity care is not the only cause of perinatal mortality rates; maternal and neonatal factors are also contributors.

Objective: Electronic fetal monitoring (EFM) using cardiotocograph (CTG) is commonly used both to assess fetal wellbeing in late antepartum and for intervention during intrapartum period. We validated the performance of indigenously developed mobile cardiotocograph (CTG) device with wireless probes compared to standard CTG device. Materials and methods: We sequentially used mobile and standard CTG devices in 495 pregnant women in labour and 359 pregnant women with gestation > 32 weeks. The CTG interpreted by two independent obstetricians in a blinded manner were compared to estimate the agreement by kappa (k) statistic. Results: High level of agreements between mobile and standard CTG devices for both intrapartum (87.9%; kappa 0.61) and antepartum monitoring (91.2%; kappa 0.60) were observed. Most of the pregnant women (80% in intrapartum and 70% in antepartum groups) and all nurses and obstetricians preferred the mobile CTG device over standard CTG device. Conclusion: The mobile CTG device can reliably be used for both intrapartum and antepartum monitoring instead of the standard CTG devices. The smaller size, portability and ability to transmit the recordings for second opinion make it suitable for use by midwives for appropriate triaging and referral. Wider availability of CTG and interpretation support at the peripheral facilities would assist identifying at-risk pregnancies and foetuses for timely referral and appropriate action to reduce perinatal deaths, stillbirths and birth asphyxi.

Background: Perinatal mortality rate indicates quality of care provided during pregnancy and delivery to the mother and to the neonate in its early neonatal period. The objective of this study was to determine the frequency and causes of perinatal mortality in a tertiary care hospital in Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted at Department of Gynaecology & Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 1st January 2016 to 31st December 2016. The inclusion criteria was all singleton gestation with gestational age of at least 24 weeks presenting with perinatal mortality. Data was collected for the following variables; age groups (up to 20 years, 21-30 years, 31-40 years and > 40 years), booking status (yes/ no), period of gestation (24-31+6, 32-36+6, 37-39+6 and > 40 weeks), Foetal weight ( 3.5 kg) and cause of perinatal mortality. Results: Out of 4508 deliveries there were 288 perinatal deaths, including 228 stillbirths and 60 neonatal deaths, so perinatal mortality rate was 63.8/1000 births. 90.28% women were unbooked. Most common cause was hypertensive disorders of pregnancy (27.78%) followed by antepartum haemorrhage (25.71%) and then mechanical causes (13.88%). Congenital anomalies comprised 11.8% cases, neonatal problems 10.07% and maternal medical disorders for 4.16% cases. Cause of 4.16% cases remained unexplained. Conclusion: Appropriate strategies like control of identifiable causes, proper antenatal and postnatal care, healthy delivery practices and availability of emergency neonatal care facilities can bring down perinatal mortality rates.

Babies born to women who live in the most deprived areas of the UK are twice as likely to be stillborn and are at a 73% excess risk of neonatal death when compared with babies born in the most affluent areas, and the poverty gap is widening, a surveillance report has found.1 The report produced by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) looked at perinatal deaths (including late fetal losses, stillbirths, and neonatal deaths) from gestational age of 22 weeks among babies born in the UK between 1 January and 31 December 2019. The results showed that perinatal deaths are declining overall. Between 2013 and 2019 numbers of stillbirths across the UK fell by more than 20%, representing around 610 fewer stillbirths in 2019, and neonatal mortality by 12%, representing around 160 fewer neonatal deaths in 2019. However, stillbirth rates among babies of black ethnicity were more than …

In the 21st century, the incidence of preterm birth has continued to increase. According to statistics, preterm birth accounts for 5%–18% of all births worldwide, and 70%–75% of perinatal deaths are related to preterm birth. Preterm birth is not only a cardiopulmonary defect for the baby, but also has a negative impact on the mother's health. Many studies have shown that vaginal microecological dysbiosis-related diseases are the most common causes of preterm birth, such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), group B streptococcal (GBS) infections and other infectious diseases. Therefore, we have a review of the deeper understanding of the links and mechanisms between vaginal microecological dysbiosis-related diseases and preterm birth. In addition, timely restoration of vaginal microecology through microbial therapy become the key to prevent and reduce the incidence of preterm birth.

Aim A cohort study was performed to clarify the influence of risk factors on perinatal events (obstetric complications and/or perinatal deaths). Methods This cohort study reviewed 395 785 births from 2011 to 2013. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The OR were determined on multivariate analysis. The perinatal event score (PES) for risk factors, which is the product of the OR of risk factors for obstetric complications, OR of risk factors for perinatal death, and OR of obstetric complications for perinatal death, was introduced to clarify the impact of each risk combination. Results There were 20 risk factors such as maternal age and medical complications relating to the 11 obstetric complications, including pregnancy-induced hypertension and preterm labor. As a result, 77 combinations of risk factors and obstetric complications were found to be significant. Six obstetric complications such as preterm labor and cervical insufficiency were found to be related to perinatal death. Two factors were found to be directly related to perinatal death: age >40 years old (OR, 1.24; 95%CI: 1.11–1.39) and essential hypertension (OR, 1.56; 95%CI: 1.19–2.05). As a result, PES ranged from 1.07 (primipara for premature rupture of membrane) to 40.1 (essential hypertension for placental abruption), and high PES (≥8) was identified in 21 combinations of risk factors and obstetric complications. Conclusion This newly created score for perinatal events, PES, can be used as an indicator of the impact of risk factors on perinatal events.

Today pre-eclampsia remains one of the most urgent problems in obstetrics. This condition is associated with a high incidence of maternal and perinatal deaths, which ranges from 12.1 to 23.2%. This pathological condition occurs in 7-23% of pregnancies and it does not tend to decrease. In this review article, we present and analyze the current concepts on the etiology and pathogenesis of pre-eclampsia. The issues concerning functional disorders of the hepatobiliary system in pregnant women are also discussed.

Objectives: to identify the determinants of stillbirths in Zambezia province, Mozambique. Methods: a retrospective cross-sectional ecological study was carried out in 2013-2014 by using perinatal indicators captured by the health information system in Zambezia. Sequentially perinatal care indicators, bivariate analysis and multiple adjusted regression at a 5% significance level with possible explainable variables of stillbirths were described. Results: a median proportion of stillbirths was 1.6%, low birth weight and preterm birth and obstetric complications were 4.9%, 1.9% and 4.1%, respectively. The bivariate analysis demonstrated association of stillbirths with anemia (p=0.043), antepartum hemorrhage (p=0.009), dystocic delivery (p

Introduction: Perinatal mortality indicates quality of maternal and neonatal care and is high inNepal. This study was conducted to find out the prevalence of perinatal deaths in a tertiary carecenter. Methods: This descriptive cross-sectional study was conducted from July 2017 to June 2018 at KISTMedical College and Teaching Hospital. Details of each perinatal death were filled in predesignedproforma from hospital in-patient records within 24 hours of perinatal death. The total of 1088 caseswere selected for the study and convenience sampling was done. Statistical analysis was done withStatistical Package for Social Sciences (SPSS 17.0). Results: Out of 1088 births selected for the study, there were 16 cases of perinatal deaths. Hence,the prevalence of the perinatal deaths in KIST Medical College and Teaching Hospital is found to be1.47%. In the same way, perinatal mortality rate, stillbirth rate and early neonatal mortality rate werecalculated and found to be 14.61 per 1000 births, 8.21 per 1000 births and 6.44 per 1000 live birthsrespectively. Preterm neonates constituted of 71.4% of early neonatal deaths. Conclusions: Perinatal mortality rate was 50% lower than that of national survey, however comparablewith study at another tertiary care center at Kathmandu. Stillbirth and prematurity contributedsignificantly to perinatal mortality. Provision of good antenatal surveillance, identification of highrisk pregnancies and good neonatal care to preterm neonates would be required to reduce perinatalmortality.

Background Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low‐ and middle‐income countries (LMIC) can save lives. Objective To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities. Search strategy PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring. Selection criteria Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC settings. Data collection and analysis Two team members independently screened and collected data. Risk of bias was assessed by Cochrane EPOC criteria. Results Eleven studies from eight countries were included. Doppler was superior at detecting abnormal intrapartum FHR as compared with Pinard stethoscope, but was not associated with improved perinatal outcomes. Using Doppler on admission helped to accurately measure perinatal deaths occurring after facility admission. Conclusion Studies and program learning are needed to translate improved detection of FHR abnormalities to improved case management in LMICs. Doppler should be used to calculate a facility indicator of intrapartum care quality. PROSPERO registration: CRD42019121924., Doppler is superior to Pinard stethoscope for detecting fetal heart rate abnormalities. Without a focus on prompt clinical management, improving perinatal outcomes will be difficult.

Preeclampsia is a progressive and irreversible disease that affects multiple organs and because it will harm the mother and fetus, is responsible for a considerable proportion of maternal and perinatal deaths. Complicates 3 to 22% of pregnancies and is the second leading cause of maternal death in Peru 2013 with 38%, and the leading cause of maternal death in the National Maternal Perinatal Institute with 43%. The clinical spectrum of preeclampsia ranges from mild to severe forms. The diagnostic criteria of preeclampsia are hypertension and proteinuria, however most Proteinuria 5 g no longer considered as a criterion of severe preeclampsia. Carried out a review of the new contributions in the management of severe preeclampsia and eclampsia and the management of one of its most serious complications sucha as the liver rupture. La preeclampsia es una enfermedad de carácter progresiva e irreversible que afecta múltiples órganos y debido a que lesiona a la madre y al feto, es responsable de una proporción considerable de muertes maternas y perinatales. Complica el 3 al 22% de los embarazos y es la segunda causa de muerte materna en el Perú en el 2014 con el 38%, y la primera causa de muerte materna en el Instituto Nacional Materno Perinatal con el 43%. El espectro clínico de la preeclampsia varía desde formas leves a severas. Los criterios de diagnóstico de preeclampsia son hipertensión y proteinuria, sin embargo la proteínuria mayor de 5 grs ya no se considera como un criterio de preeclampsia severa. Se hace una revisión de los nuevos aportes en el manejo de la preeclampsia severa y eclampsia y en el manejo de una de sus complicaciones más graves como es la rotura hepática.

Background: Preeclampsia and chronic hypertension are associated with a large number of cases of small infants during pregnancy (SIP) and perinatal deaths. There are conflicting inconsistencies between research on the effect of preeclampsia and chronic hypertension on KMK. The data showed that preeclampsia had a very significant effect on the occurrence of KMK, but in reality not all infants of preeclampsia mothers gave birth to babies with KMK. This raises the assumption that there are other factors that inhibit the influence of preeclampsia and chronic hypertension on birth weight. Objective: to determine the effect of preeclampsia and chronic hypertension on KMK in Dr. Sardjito Yogyakarta. Method: Retrospective cohort. Data of maternity patients with preeclampsia, maternity patients with chronic hypertension, and weight data of babies born at RSUP Dr. Sardjito were recorded. Also noted parity, maternal age, employment and education. Data were taken from medical records and classified into normotension, preeclampsia, and chronic hypertension using consecutive sampling methods. Result and Discussion: There were 81 samples for each normotension group, preeclampsia, and chronic hypertension. Preeclampsia is significantly at risk of experiencing SIP 7,43 times (95% IK 3,13-17,66). Chronic hypertension is significantly at risk of experiencing 5,15 times SIP% IK 2,15-12,36). Multigravida subjects were at risk of experiencing SIP 1,92 times (IK 95% 1,04-3,55) There was no significant difference in the proportion of SIP in subjects based on age, occupation, and education. Conclusion: Preeclampsia, chronic hypertension, and multigravida parity significantly provide a higher risk of the incidence of SIP. If the three factors work together, they will reinforce the effect on increasing the risk of SIP. Keywords: Small gestational period; preeclampsia; chronic hypertension

Introduction: This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome. Methods: This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded. Results: Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies. Conclusions: The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.

Objective To assess the feasibility of the application of International Classification of Diseases-10—to perinatal mortality (ICD-PM) in a busy low-income referral hospital and determine the timing and causes of perinatal deaths, and associated maternal conditions. Design Prospective application of ICD-PM. Setting Referral hospital of Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania. Population Stillbirths and neonatal deaths with a birth weight above 1000 grams born between October 16th 2017 to May 31st 2018. Methods Clinical information and an adapted WHO ICD-PM interactive excel-based system were used to capture and classify the deaths according to timing, causes and associated maternal complications. Descriptive analysis was performed. Main outcome measures Timing and causes of perinatal mortality and their associated maternal conditions. Results There were 661 perinatal deaths of which 248 (37.5%) were neonatal deaths and 413 (62.5%) stillbirths. Of the stillbirths, 128 (31%) occurred antepartum, 129 (31%) intrapartum and for 156 (38%) the timing was unknown. Half (n = 64/128) of the antepartum stillbirths were unexplained. Two-thirds (67%, n = 87/129) of intrapartum stillbirths followed acute intrapartum events, and 30% (39/129) were unexplained. Of the neonatal deaths, 40% died after complications of intrapartum events. Conclusion Problems of documentation, lack of perinatal death audits, capacity for investigations, and guidelines for the unambiguous objective assignment of timing and primary causes of death are major threats for accurate determination of timing and specific primary causes of perinatal deaths.

Extended perinatal mortality (stillbirths and neonatal deaths) decreased by 15% between 2013 and 2018, but women in the most deprived areas, and Black and Asian babies, remained the most at risk over the period, a surveillance report has found.1 The report, produced by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), looked at perinatal deaths from 22 weeks gestational age (including late fetal losses, stillbirths, and neonatal deaths) of babies born in the UK between 1 January …

Background: Congenital heart diseases are the commonest fetal congenital defects and until nowadays most of them are bypassed without prenatal diagnosis to be still considered as unexplained stillbirths or perinatal deaths. In this study, we tried to prove the importance of routine fetal cardiac screening in the ANC visits and also confirming its high accuracy. Methods: This study was prospective longitudinal one, including doing ISUOG extended fetal cardiac screening for one hundred foetuses scheduled at certain gestational age visits, whom their half were at risks for CHDs and the other were not, with comparing the results to antenatal and postnatal detailed fetal echocardiography. Results: The best gestational age for the fetal cardiac screening was at 18-22 weeks gestation. The accuracy of the screening to the antenatal echocardiogram was 96%-100% and to the postnatal one was 96%-98%. Conclusions: CHDs are still the commonest congenital fetal defects and the antenatal fetal cardiac screening by extended basic views has high accuracy. Making this screening a routine in ANC visits will be of great help in improving the fetal outcome.

Context: Eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in developing countries. This is the result of poor health-seeking behavior of pregnant women and inadequate comprehensive emergency obstetric services. This study reviewed the presentation and management of eclampsia in Sagamu over a 5-year period. Aims: This study aims to determine the prevalence, pattern of clinical presentation and fetomaternal outcomes of eclampsia. Settings and Design: This was a retrospective study conducted in Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun state. Subjects and Methods: Relevant information was retrieved from case notes of all patients who presented with eclampsia from January 2014 to December 2018. Data were analyzed using SPSS version 21. Results: Out of the 4656 deliveries, there were 45 cases of eclampsia giving a prevalence of 0.97%. The modal age was 20–24 years. Majority were unbooked 41 (91.1%) and 29 (64.4%) of the women were nulliparas. Antepartum eclampsia was commonest occurring in 36 women (80%). The most common premonitory symptom was headache occurring in as high as 37 women (82.2%). Most of the patients 37 (84.4%) had an abdominal delivery. There were two maternal mortalities (4.4%) and four perinatal deaths (8.9%). There was no statistically significant association between factors such as booking status, type of eclampsia, mode of delivery and parity, and the fetal outcome (APGAR score at 1 min). Conclusions: Eclampsia is still one of the preventable causes of maternal and perinatal mortality in our environment. The prevalence of eclampsia in sagamu was 0.97%. Improved health-seeking behavior, antenatal care monitoring, and prompt diagnosis and management of preeclampsia will invariably reduce the prevalence of eclampsia.

Objective: Foetal growth retardation (FGR) is a leading cause of perinatal death and long-term harms at survivors. Placental infarction plays a role in FGR, yet, no trials have evaluated whether low molecular weight heparins increase birth weight in ongoing FGR pregnancies. Methods: An open-labelled randomized trial in Denmark during 2011–2016, including singleton pregnant women with FGR (estimated foetal weight < 2.3 percentile) diagnosed before gestational weeks 32. Participants were randomly assigned using sealed, blinded envelopes 1:1 to tinzaparin (4500 IU daily until 37 gestational weeks) or no tinzaparin. The primary outcomes were the observed birthweight relative to the expected for gestational age and gender, and foetal growth rates in the two trial groups evaluated by an intention to treat analysis. Results: We enrolled 53 women. The mean gestational age was 261 days in the tinzaparin group and 246 days in the no treatment group. The mean birth weight was 2229 g in the tinzaparin group compared to 1968 g in the no treatment group. However, the birth weight relative to the expected from gestational age and gender was only 2.5 percentage points higher in the tinzaparin group [−5.1 to 10.0] (p = 0.51). The foetal growth rate during follow-up was 124 g/week in the tinzaparin group and 119 g/week in the no treatment group, a difference of 5 g/week [−19 to 29] (p = 0.67). Two perinatal deaths both occurred in the no treatment group. Conclusion: We found no evidence of a tinzaparin effect on the foetal growth rate or the birth weight after adjustment for gestational age.

On June 15th this year, MBRRACE published its report1 focusing on perinatal deaths in the UK in 2016. While disappointing that the rate of stillbirths in singletons remained static, the report described a significant fall in the rate of stillbirths and neonatal deaths in twin pregnancies. In fact, the stillbirth rate was almost halved from 11.07 (95% CI, 9.78 to 12.47) per 1,000 births in 2014 to 6.16 (95% CI, 5.20 to 7.24) in 2016 (Table 1, Figure 1). The neonatal mortality rate in twins also fell significantly from 7.81 (95% CI, 6.73 to 9.01) to 5.34 (95% CI, 4.47 to 6.36) per 1,000 live births (Table 1, Figure 2). This article is protected by copyright. All rights reserved.

The “premonitory symptoms” of eclampsia can be interpreted as actual symptoms of cerebral involvement within the posterior reversible leukoencephalopathy syndrome, and eclampsia as a severe symptom of the same syndrome. Objective: To review the characteristics of women with eclampsia in a national hospital, with emphasis on the associated neurological manifestations. Design: Case series. Institution: Hospital Nacional Daniel Alcides Carrion (HNDAC), Lima, Peru. Patients: Women with eclampsia. Methodology: Study of all patients with eclampsia over a period of 5 years and 6 months. Eclampsia cases that occurred outside the institution or with insufficient data were excluded. Main outcome measures: General characteristics, associated symptoms, complications and laboratory values in eclamptic patients. Results: Thirty-nine cases were reported. The incidence of eclampsia in pregnant women was 0.19%. The mean age was 21 years; 75.8% of the women were primiparous and 44.4% were less than 34 weeks pregnant. 69.7% of them were diagnosed before delivery; 51.5% had blood pressure above 160/110 mmHg and 12.1% had no hypertension. 93.9% presented symptoms, mainly headache (87.9%), as well as visual (27.2%) and auditory (12.1%) disturbances. Two patients had headache and normal blood pressure, and 2 cases were asymptomatic. Complications were: sensory alterations, abruptio placentae (15.2%), HELLP syndrome (15.2%) and difficult-to-control hypertension (39.4%). There were neither maternal nor perinatal deaths. Conclusions: The neurological manifestations that precede eclampsia are variable and do not have a constant correlation with the severity of maternal hypertension. Los ‘síntomas premonitorios’ de la eclampsia se pueden ver englobados como verdaderos síntomas de afectación cerebral dentro del síndrome de leucoencefalopatía posterior reversible, y la eclampsia como un síntoma severo. Objetivo. Revisar las características epidemiológicas de los casos con eclampsia, enfatizando el análisis de las manifestaciones neurológicas asociadas, en un hospital nacional. Diseño. Serie de casos. Institución. Hospital Nacional Daniel A. Carrión (HNDAC), Lima, Perú. Pacientes. Mujeres con eclampsia. Metodología. Estudio de todas las pacientes con eclampsia en un periodo de 5 años y 6 meses. Se excluyó aquellas con eclampsia extrainstitucional o con datos insuficientes. Principales medidas de resultados. Características generales, síntomas asociados, complicaciones y valores laboratoriales en pacientes eclámpticas. Resultados. Se halló 39 casos. La incidencia fue 0,19% del total de gestantes. La edad media fue 21 años, 75,8% fueron primíparas, 44,4% por debajo de las 34 semanas y en 69,7% ocurrió antes del parto; 51,5% tuvo presión arterial mayor a 160/110 mmHg y 12,1% no presentó hipertensión arterial; 93,9% tuvo síntomas, siendo los más frecuentes cefalea (87,9%), alteraciones visuales (27,2%) y auditivas (12,1%). Hubo dos casos de pacientes con cefalea y presión arterial normal, y 2 casos sin sintomatología. Las complicaciones fueron trastorno de sensorio, desprendimiento prematuro de placenta (15,2%), síndrome HELLP (15,2%) e HTA de difícil control (39,4%). No hubo casos de mortalidad materno perinatal. Conclusiones. La sintomatología neurológica que antecede a la eclampsia en la gestante con preeclampsia es muy variable y su correlación con la severidad de la hipertensión arterial materna no es constante.

Fetal growth restriction (FGR) is defined as a failure to achieve the endorsed growth potential. The diagnosis of fetal "smallness" is currently performed on the basis of an estimated fetal weight below a given threshold, most commonly the 10th centile. The chapter presents to aims in the clinical management of FGR, which should be to distinguish "true" FGR from constitutional small for gestational age and to establish whether there is an indication for elective delivery and if not how often monitoring should be performed. Umbilical artery (UA) Doppler is the only measure that provides both diagnostic and prognostic information for the management of FGR. There is compelling evidence that using UA Doppler in high-risk pregnancies improves perinatal outcomes, with a 29% reduction in perinatal deaths. Early studies on high-risk pregnancies showed that, though highly sensitive, cardiotocography has a 50% rate of false positives for the prediction of adverse outcome.

Placenta, a fascinating multifunctional organ, of fetal origin, plays a pivotal conciliatory role during pregnancy by being intimately connected to the mother and her baby. The importance of placenta is irrefutable, being an exceptional (and easily-accessible) source of information which echoes the intrauterine environment. Placental examination can shed light upon factors pertaining to the current pregnancy and its outcome, guide postpartum management, provide insight into clinical problems (such as seizures, pulmonary hypertension, renal failure) that become evident hours or days after delivery, be predictive of future pregnancies, and even play a role in medico-legal situations. The rhetoric that since most babies are normal so are the placentas, therefore an examination of all placentas may not be warranted, has fallen in disfavor and currently placental examination even for ‘routine’ deliveries is being advocated. Until such time, this becomes an established practice examination of the placenta should certainly be performed in any maternal or fetal complications and stillbirths. The placenta can provide exceedingly-useful information relating to perinatal morbidity and mortality. Furthermore, it has been shown repeatedly that a placental examination is needed to understand the causes of perinatal deaths. In order to derive clinically-useful information from the placenta, meticulous macroscopic examination is the first step. The present article describes indications whereby placental examination is warranted, mentions stepwise gross description of the placental cord, membranes, and the disk and the usefulness of placental examination in perinatal death; a figurative narration and a template for placental grossing are included.

OBJETIVO. Presentar las tasas de mortalidad perinatal bruta y corregida en el HNGAI. DISEÑO. Estudio retrospectivo, de revisión de historias clínicas de los neonatimuertos y óbitos fetales ocurridos en el Servicio de Obstétrica del HNGAI del 19 de enero de 1990 al 31 de mayo de 1997. Los resultados han sido evaluados y presentados mediante las técnicas estadísticas. LUGAR. Hospital Nacional Guillermo Almenara Irigoyen-Servicio de Obstetricia. RESULTADOS. Revisamos 561 HC correspondientes a las muertes perinatales, seleccionamos 330 casos correspondientes a las muertes de 28 semanas para adelante. La tasa de mortalidad perinatal (TMP) general fue de 10,6x 1000 n.v. y la TMP corregida de 5,6 x 1000 n.v. Durante los años 94y95 hubo un incremento en las tasas por año. El porcentaje de RN con malformaciones congénitas llegó aproximadamente al 18%. Correlacionamos la muerte perinatal con la EG, peso y características del líquido amniótico. CONCLUSION. La introducción de la vigilancia fetal en el Servicio de Obstetricia de riesgo alto ha llevado a una disminución de la tasa de mortalidad perinatal general, a pesar que desde el año 1994, el Servicio de Obstetricia se convirtió en un servicio casi exclusivo de referencia; por lo tanto, más del 70% de gestantes recibidas tiene un factor de riesgo identificado y por lo tanto la morbimotalidad es más elevada que en un hospital general.

Pre-eclampsia is a major underlying cause of late fetal and early neonatal death, accounting for somewhere between 1 in 10 and 1 in 4 perinatal deaths; it warrants greater efforts from the maternal-newborn community.

The first description of ultrasound to estimate fetal weight was published in 1975.1 More than 40 years later, we still do not know whether universal use of this method prevents perinatal deaths. Multiple lines of evidence suggest that it should work: (i) stillbirth is strongly associated with fetal growth restriction (FGR),2 (ii) current methods using targeted ultrasound have low detection rates for FGR,3 (iii) there is strong evidence that induction of labour at term reduces perinatal mortality. This article is protected by copyright. All rights reserved.

BackgroundOver 80% of deliveries in Sudan occur in rural areas, attended by village midwives (VMWs).ObjectiveTo determine the impact of Helping Babies Breathe training and regular peer–peer skills practice (HBBT+RPPSP) on VMW resuscitation practices and outcomes.MethodsIn a prospective community-based intervention study, 71/82 VMWs, reporting to six East Nile rural medical centres, with previous experience in community health research, consented to HBBT+RPPSP. Outcomes included changes in the resuscitation practices, fresh stillbirths (FSB) and early neonatal deaths ResultsThere were 1350 and 3040 deliveries before and after HBBT+RPPSP, respectively, with no significant differences between the two cohorts regarding maternal age, education or area of birth. Drying of the newborn increased almost tenfold (8.4%, n=113 to 74.9%, n=1011) while suctioning of the mouth/nose decreased fivefold (80.3%, n=2442 to 14.4%, n=437) following HBBT+RPPSP. Pre-HBBT+RPPSP9/18 (50%) newborns who had mouth-to-mouth ventilation died, compared with 13/119 (11%) who received bag-mask ventilation post-HBBT+RPPSP. Excluding 11 macerated fetuses, there were 55 perinatal deaths: 14 FSB/18 ENND (6 months pre-HBBT+RPPSP) and 10 FSB/13 ENND (18 months post-HBBT+RPPSP). FSB rates decreased from 10.5 to 3.3 per 1000 births ((χ2)=8.6209, p=0.003), while ENND rates decreased from 13.5 to 4.3 per 1000 live births ((χ2)=10.9369, p=0.001) pre-HBBT+RPPSP and post-HBBT+RPPSP, respectively.ConclusionIn a selected group of VMWs, HBBT+RPPSP was associated with improvements in newborn resuscitation and perinatal outcomes. HBBT+RPPSP could have immense benefits if propagated nationally to all 17 000 VMWs in Sudan.

En 2011, les décès périnatals représentent 41% des décès avant cinq ans. Notre objectif principal était d"étudier les déterminants de la mortalité périnatale chez les femmes présentant des complications obstétricales au CSRéf (Centre de Santé de Référence) de Kéniéba, Kayes. Nous avons mené une étude transversale, descriptive et analytique du 1er janvier 2008 au 31 décembre 2011. La taille de l"échantillon était égale à 213 obtenu à partir d"Epi6. L"analyse statistique a été faite avec SPSS. Les mesures ont été comparées par des analyses croisées simples et la régression logistique. Les valeurs de X2, des rapports de côte (RC) et du p ont été utilisées pour interpréter les résultats. La fréquence de la mortalité périnatale était de 41,5%. L"analyse uni-variée a été attestée par la multi-variée dont les résultats sont les suivants : la classe de moins de 18 ans a un effet protecteur de 0,19 l"IC à 95% (0,065-0,57) par rapport à la classe d"âge>30,5 ans p=0,003. Les référées ou évacuées ont 4,42 fois plus de risque d"avoir des décès périnatals par rapport aux venues d"elles-mêmes, l"IC égal (1,6-8,75).Les hémorragies étaient à 3,55 fois de risque de décès périnatals, l"IC égal (1,09-12,7). Au terme de cette étude, il apparait que les décès périnatals (41,5%) constituent un problème de santé publique dans le district sanitaire de Kéniéba. Ainsi la classe de moins de 18 ans a un effet protecteur de 0,19 l"IC à 95% (0,065-0,57). Les référées ou évacuées ont un risque de 4,42 d"avoir des décès périnatals ainsi que l"hémorragie dont le risque est aussi de 3,55.

Background: Placental abruption, common disorder in obstetric practice, enigma too, is uniquely fraught with dangers to mother baby. Objectives of study were to study trends of placental abruption, risk factors, management strategies to learn more for reduction in morbidity-mortality of mother-baby, even with low resources, also get insight for future research. Methods: Records of cases of placental abruption managed over 27 years (between 1985 to 2011) were divided into three yearly blocks, A to I and analysed. Details including operative procedures like dilatation-curettage, Caesarean Section (CS) or Ante-Partum Haemorrhage (APH) in past, disorders like chronic hypertension, threatened abortion, pregnancy specific hypertension, diabetes, anaemia in index pregnancy, management done maternal-neonatal outcome were analysed using stata 6 software. Results: There were 66,459 births during analysis period with 667 cases of placental abruption, 1% births, increasing trends from, 0.73% between 1985-1987 to, 1.11% in 2009-2011. In these 667 cases of placental abruption, 211 (32.5%) perinatal deaths occurred. Ratio of perinatal deaths due to placental abruption to overall perinatal deaths increased from 2.12% (8 cases) between 1985-1987 (Block A) to 5.12% (37 cases) between 2009-2011 (Block I). Case fatality in cases of placental abruption has been fluctuating between 3 to 5% till 2004, contributing to around 12-15%, maternal mortality, with no fatality in last 7 years. Conclusions: Cases of placental abruption have been increasing with no obvious reason. In recent past maternal deaths could be prevented but perinatal deaths, have been persisting actually more in last decade.

A total of 12,234 patients were treated in the Lagos University Teaching Hospital (LUTH) for various obstetric conditions between January 1, 1996 and December 31, 2005. Of these, 165 (1.35%) were eclamptics. 148 (89.7%) of these were pre-delivery eclamptics and 17 (10.3%) were post-delivery eclamptics. Unbooked eclamptics remained a dominant group comprising 149 (90.3%) of all eclamptics. Mean maternal age was 26.59±0.44 years. Most of these patients were of low parity; primiparae constituting 76.8% and multiparae 23.2%. Mean gestational amenorrhoea at onset of eclampsia being 34.64±0.44 weeks. There were 22 maternal deaths due to eclampsia and its complications with a maternal mortality rate of 133.3 per 1000 eclamptics. The commonest causes of maternal deaths were septicaemia (13.64%), acute renal failure (9.09%) and respiratory failure (9.09%). There were 54 perinatal deaths, with a perinatal mortality rate of 346.2 per 1000. A comparison of the data obtained from this recent decade (1996 - 2005) to those of the previous three decades (1967 - 1976, 1977 - 1986 and 1986 - 1995) showed that there had been a progressive decline in the number of eclamptics managed in LUTH in the last three decades (572 eclamptics in 1977 - 1986, 299 eclamptics in 1986 - 1995, and 165 in 1996 - 2005). This study also showed a rise in the mean caesarean section rate for pre- delivery eclamptics and all eclamptics (55.41% and 49.70% respectively) compared to findings in the previous decades. There was a significant increase in the maternal mortality and perinatal mortality rates in recent decade. There was a decline in post mortem rate (40.9% in recent decade compared with 60% in previous decades).

Background. Caesarean section (CS) rates are rising worldwide. There is growing concern regarding the possible negative impacts on maternal and fetal health. Objective. To assess birth outcomes of CS v. normal vaginal deliveries (NVD) using the Robson 10-group classification system at a tertiary hospital in Gauteng Province, South Africa. Primary postpartum haemorrhage (PPH), neonatal Apgar scores, neonatal intensive care unit admissions and perinatal deaths were recorded. Methods. A retrospective review of all deliveries for neonates ≥500 g during September and October 2016 was undertaken. A total of 1 443 deliveries were assessed. The data were analysed using Statistical Package for the Social Sciences version 23. Results. There were 730 (50.6%) CSs and 713 (49.4%) NVDs. The greatest contributor to the CS rate was group 5 (15.8%). PPH occurred in 8.3% of women delivered by CS, with an odds ratio (OR) of 1.86 (95% confidence interval (CI) 1.194 - 2.900). Additionally, three hysterectomies were performed in the CS group. A significant difference in Apgar scores was found only at 1 minute, with higher scores in the NVD group (CS mean (standard deviation) 7.74 (2.25), and NVD 8.10 (2.11); p =0.002). Eighty-nine (11.6%) neonates delivered by CS required high care admission, with an OR 1.865 (95% CI 1.292 - 2.692) for neonates delivered by CS. Conclusion. The CS rate was 50.6%. Performing a CS should be weighed against the risks of the procedure. Although an understanding of some influences on the rate can be obtained, further research into indications, and protocol generation to optimise this rate, are needed to limit maternal and neonatal birth complications.