Retrospective Analysis of Perinatal Mortality in Belgrade in 1996

Abstract

Through the set hypotheses and presented results of statistical analysis it was attempted to answer the question of what more could be done in our country, especially in the health sector, to decrease perinatal mortality, so as to achieve the level which some northwest European countries already have.

On the basis of data of official statistics, there is still insufficient cooperation in Belgrade between departments in the same health institution, as well as between certain levels of health care, without appropriate transfer of information on the women who have just given birth, namely the new-born (pregnancy card). A lack of uniformity in the level of equipment and insufficient usage of genetic counseling offices is present. About 62% of pregnant women reports to the counseling offices for pregnant women for the first time in the first trimester, which is not sufficient. The standardization of the application of doctrinal standpoints should be achieved, especially in the diagnosis of risk factors and the provision of adequate medical documentation for transfer of information during pregnancy, labor and the condition of the newborn. Within that, it is necessary to continually provide expert advanced training of health workers in the future, in the organization of the relevant institution.

The research results of biological variables of women who have just given birth, such as average age, parity, abortion and illness in her reproductive history, as well as the most common complications during delivery, showed that no significant deviation as regards this risk factor within control and risk groups. The stated data indicated that in the risk group there were somewhat more primipara, which might present an increased factor of risk for the outcome of the delivery, while there were almost the same percentage less than in the control group of the women who bore their second child. On the other hand, there were less women who previously had an abortion in the sample.

Biological variables of newborns showed that in the risk group, out of the total infant deaths, 41.6% were stillborn, and 57.3% died during the first week, namely 22.6% during the first day of life. The ratio between sexes was almost identical: 44.8% of dead newborns were male and 44.4% were female sex. In the first twenty-four hours, namely in the first five hours upon birth, the mortality of male newborns was greater by about 10%. The mortality of female newborns was greater in the second day of life, by about 7% of the mortality of the male newborns of the same age.

Upon reception into the maternity hospital already, normal state of the fetus was noted in only one third of the cases with these deliveries, while in two thirds death had already occurred or suffering of the fetus was present. As many as 198 or 71% of newborns were prematurely delivered. Not a single delivery was noted after term. 3.9% of the newborns had weight upto 499 grams, as many as 29.4% had exceptionally small weight (500-999 g), and another 20.8% small weight at birth (1000-1499 g). In 19.4% cases, the fetus was completely immature, while in 60.6% of the cases the delivery came between the 28^th and 36^th gestation weeks.

As early as the first minute of birth, the lives of over 60% of the liveborn children were endangered (low apgar score). Over one half of the newborns which received the mark one or two in the first minute upon birth, died in the first seventy-two hours of life. The most critical were the first five hours upon birth, as well as the second day of life.

The knowledge of the samples of seminatal mortality in Belgrade also represents a basis for further programming of health care for the mother and child on the city level. A dominant mortality sample is severe asphyxia (60%). In 13.8% of the cases, the cause of death is registered as unmarked or unknown, so the second place according to intensity is present as respiratory distress (6.9%).

Multiple deliveries with seminatal mortality were present in 26.9% cases. Most of the deliveries were carried out with the "normal" position of the fetus, while 15.1% of the deliveries were pelvic, and 17.3% were carried out by some childbearing operation technique.