Transcript Factors associated with perinatal deaths in women delivering in a
Factors associated with perinatal deaths in women delivering in a health facility in Malawi
Lily C. Kumbani, Johanne Sundby and Jon Øyvind Odland
Outline
• Introduction • Study Purpose • Methodology • Results • Implications 1
Introduction
• Newborn deaths account for 40% of under- five mortality (MDG- 4).
• Reducing early neonatal mortality is necessary to achieve MDG- 4.
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Introduction ctd…
• Two-thirds of child deaths occur in the first month of life. Of these, more than two thirds die in their first week. Among those in the first week, two-thirds die in the first 24 hours of life. • Unless neonatal mortality is greatly reduced it is not possible to achieve millennium development goal 4 .
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Introduction ctd…
• In Malawi, an increase in perinatal mortality estimated at 40/1000 (MDHS 2010) • Few studies done.
• These data are essential to effectively plan how to reduce perinatal mortality.
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Objectives
• To establish an estimate of perinatal mortality at Chiradzulu District Hospital.
• To identify associated risk factors, and to determine causes of perinatal deaths. 5
Methodology
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Design:
A cross sectional prospective review of records.
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Setting:
Chiradzulu district hospital, labor ward and postnatal ward.
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Inclusion criteria:
Records of mothers who received antenatal care at any health facility but delivered at the district hospital from 28 weeks to term. 6
Methodology ctd…
•
Data collection: A data record form:
was used to collect maternal and neonatal information
Data analysis
• Stata version 11.0 was used • Univariate analysis was computed to determine the association between outcome (perinatal death) and independent variables.
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Methodology ctd… Ethical consideration:
• Study approval - Norway Regional Committee for Medical Research Ethics & College of Medicine Research and Ethics Committee, Malawi. • Written permission from the District Health Officer - Chiradzulu District Hospital 8
Results No. of records - 606
Type of deliveries SVD C/S VE/ Breech Term Gestation Skilled attendant
n Percentage
419 69 165 27.2
21 3.5 534 89 581 95.9
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Results Mothers’ characteristics n Percentage
Age group 14- 18 19- 35 36- 46 Parity 1 2- 4 ≥ 5 115 19 437 72.3
53 8.8
211 34.8
310 51.2
85 14 10
Results Mothers’ characteristics ctd… n Percentage
No. of antenatal visits 1 2 3-4 ≥ 5 34 5.7
119 19.8
389 64.8
58 9.7
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Results - Frequency of perinatal deaths
Total Deliveries
n Percentage
685 Number of fresh still births Number of macerated still births Number of early neonatal deaths Perinatal deaths 18 2.6
7 1 16 2.4
41 5.9
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Results - Frequency of perinatal deaths ctd…
Perinatal mortality rate
Rate
59.9/ 1000 births Still birth rate Early neonatal death rate 36/ 1000 births 24/1000 live births 13
Distribution of perinatal deaths Perinatal deaths (N = 41) Neonatal death outcomes (N = 16) Neonatal death; 39% Fresh stillbirth; 44% Died after 24 hours; 38% Died within 24 hours; 63% Macerated stillbirth; 17%
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Causes of early neonatal deaths
Birth asphyxia Severe prematurity (28 30 weeks) Severe prematurity & sepsis
Percentage
75 12.5
12.5
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Results- univariate analysis (Pregnancy)
Characteristic Perinatal deaths No Yes No. of antenatal visits n 1 2 % 24 70.6
110 92 3 4 ≥5 197 97 177 95 51 88 n % 10 29.4
9 8 6 3 9 5 7 12 P-value † <0.001 Maternal age, parity, HIV, syphilis, preeclampsia, anemia, malaria and APH had no effect on perinatal deaths (p >0.05). 16
Results- univariate analysis (Labor/Delivery)
Characteristic Gestation n Perinatal deaths No Yes % ≤31 32-36 10 140 53 93 ≥37 405 Labor &Delivery complication 95 No Yes Preterm labour No Yes 351 206 165 11 97 88 90 69 n 9 11 21 10 27 19 5 3 12 10 31 % 47 7 5 P-value † <0.001 <0.001 0.029
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Results- univariate analysis (Labor/Delivery) ctd…
Characteristic Presentation n Perinatal deaths P-value † No Yes % Cephalic Breech 533 94 23 79 Compound 4 67 Prolonged 2 nd stage of labor No Yes 525 39 95 78 n % 33 6 6 21 2 33 30 11 5 22 <0.001 <0.001 18
Results- univariate analysis (Labor/Delivery) ctd…
Characteristic Delivery type SVD C/S VE/Breech/ Breech extraction Perinatal deaths P-value † No Yes n % 396 95 152 16 92 76 n % 23 5 13 5 7.8
24 0.012
Anemia, obstetric complications (preeclampsia, eclampsia, rupture of membranes > 24 hours, fetal distress, CPD, obstructed labor), and skilled attendant were not associated with perinatal deaths (p >0.05). 19
Results- univariate analysis (Postpartum)
Characteristic Asphyxia No Yes Apgar score 1-3 4-6 7-10 Preterm No Yes Perinatal deaths P-value † No Yes n % 502 99 63 85 n % 5 1 11 15 <0.001
<0.001
7 60 498 54 91 99.2
6 6 4 46 9 0.8
<0.001
514 50 96 76 20 16 4 24 20
Results- univariate analysis (Postpartum) ctd..
Characteristic Birth weight 700g-1499g 1500g-2499g ≥2500g Sepsis No Yes n 7 93 463 Perinatal deaths P-value † No Yes % n % <0.001 39 91 96 11 9 20 61 9 4 0.009
444 99.6
17 89.5
2 2 0.4
10.5
Meconium aspiration and hypothermia were not associated with perinatal deaths (p >0.05). 21
Implications
• Reinforce and improve health workers’ abilities to properly monitor women in labor at all levels of care for early identification and management of complications.
• Encourage women to start antenatal care early for them to adhere to the four recommended antenatal visits.
• Improve health workers ability in basic resuscitation, as well as care of low birth weight babies. 22
Implications ctd…
• Referral of women with very preterm labor (28 to 32 weeks) to deliver in a facility with neonatal intensive care. • Pregnant women and communities should have sufficient information on obstetric complications to seek health care in time. 23