56 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Clinical Audit Kanchan S, et al. Perinatal Mortality Audit Study procedure During the study period, 4177 deliveries were conducted in the hospital, and the neonatal outcomes were noted. Monthly perinatal audit data (from both hardcopies and electronic versions) were collected. Data of the course of treatment to the neonates admitted to the NICU secondary to various morbidities were taken from the NICU admission registers, inpatient charts, and discharge summaries of these neonates. The period and cause of perinatal death were analyzed using the classification of stillbirth by Relevant Condition at Death (ReCoDe). This system helps identify the condition(s) that existed at the time of death in utero and is based on the principle that “Stillbirths are distinct from neonatal deaths and warrant their own classification. There is no need for a sub-classification according to gestation, as ‘prematurity’ is not a relevant cause or condition for stillbirths. There is no sub-classification according to weight, but one related to fetal growth status, based on weight-for-gestation.”6 Results Totally, 101 (37 + 64) deaths were recorded in the perinatal period (Table 1). PMR was calculated as follows: Number of perinatal deaths (stillbirths + early neonatal deaths) / total number of births (stillbirths + live births) x 1000 = 101/4226 x 1000 = 23.9% Among the stillborns, 14 (37.8%) were fresh stillborns, while 23 (62.2%) were macerated. Of the 101 perinatal deaths, 40 (39.6%) were from the booked cases, while 61 (60.4%) were referrals from other hospitals (unbooked cases). • PMR of booked cases: 9.46 per 1000 • PMR of unbooked cases: 14.4 per 1000 The lowest PMR was recorded in the February 2019 and the highest in July 2019. Although there was no substantial difference in the total birth rate during these months, this significant difference in PMR was noted. (Figure 1). Figure 2 shows a slow and steady decline in the trend of stillbirth rate (SBR) between the years 2016 and 2020. Table 1. Outcomes of Deliveries Conducted in Kasturba Hospital Between January 2019 and June 2020 Month Year Total No. of Deliveries Live Births Stillbirths (Booked + Unbooked) Early Neonatal Deaths PMR January 2019 196 199 1 3 20.1 February 2019 236 244 1 2 12.3a March 2019 271 301 5 3 26.5 April 2019 280 282 2 2 14.2 May 2019 266 270 0 8 29.6 June 2019 228 219 2 6 36.5 July 2019 238 251 3 8 43.8a August 2019 220 219 0 6 27.4 September 2019 176 202 0 5 24.8 October 2019 239 239 2 4 25.1 November 2019 233 237 0 4 16.9 December 2019 227 225 2 4 26.6 January 2020 197 191 4 2 30.4 February 2020 212 209 3 0 14.3 March 2020 213 208 3 2 24.0 April 2020 278 272 5 1 22.1 May 2020 237 233 1 3 17.1 June 2020 229 225 3 1 17.7 Total 4177 4226 37 64 23.9 (Average) aPMR was the least in February 2019 and the highest in July 2019. PMR, perinatal mortality rate. Disorders related to fetal growth were found to be the major causes of antepartum fetal deaths (Table 2). A significant association was found between the period of gestation, fetal weight, and the chances of
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