60 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Clinical Audit Kanchan S, et al. Perinatal Mortality Audit Overall, a downward trend was observed in PMR and SBR, while an upward trend was observed in NMR in Kasturba Hospital. With respect to the causes of perinatal deaths, congenital anomalies accounted for 7.9% of stillbirths. Fetal growth restriction (FGR) accounted for > 50% of the perinatal deaths. FGR was found to be strongly associated with hypertensive disorders of pregnancy. However, FGR was also noted as an isolated finding or was found to be associated with the other maternal conditions such as autoimmune disorders. Maternal medical conditions were associated with up to 40.6% of stillbirths. Prematurity accounted for 45.3% of neonatal deaths, and sepsis accounted for 20.31%. Delayed referrals for severe preeclampsia, eclampsia, and uncontrolled hypertension were the most common causes of perinatal deaths. Intrapartum deaths were mostly because of acute intrapartum events that eventually lead to hypoxia. Conclusion Several measures can be taken to improve mother and child health care such as registration of all pregnancies, early identification of at-risk cases, and administration of timely intervention. Further, ensuring adequate ANC visits, providing nutritional supplementation, promoting institutional deliveries, and providing advanced life support for sick neonates can also help improve mother and child outcomes. References 1. Robalo R, et al. Late stillbirth: a ten year cohort study. Acta Med Port. 2013;26(1):39–42. 2. Flenady V, et al. Major risk factors for stillbirth in high income countries: a systematic review and meta-analysis. Lancet. 2011;377:1331–1140. 3. World Health Organization. Making every baby count: audit and review of stillbirths and neonatal deaths. https://www. who.int/publications/i/item/9789241511223. Published September 19, 2023. Accessed June 13, 2020. 4. Allanson ER, et al. The WHO application of ICD-10 to deaths during the perinatal period (ICD-PM): results from pilot database testing in South Africa and United Kingdom. BJOG. 2016;123(12):2019–2028. Figure 3. Comparison of Trends in PMR in Kasturba Hospital With That in India and Karnataka KH, Kasturba Hospital; NMR, neonatal mortality rate; PMR, perinatal mortality rate; SBR, stillbirth rate. compared with that of other South Asian countries like Pakistan (30.63), Afghanistan (28.38), Nepal (17.46), Bangladesh (24.28), and Myanmar (14.13), but is more than that in Bhutan (9.66) and China (5.54).7 In 2019, the NMR was 21.66 in India, while it was 41.22 in Pakistan, 37.1 in Afghanistan, 22.45 in Myanmar, 16.57 in Bhutan, 3.86 in China, 19.78 in Nepal, and 19.06 in Bangladesh.7 In 2010, the NMR was 66.6 in India. This downward trend in NMR in India can be attributed to the effective implementation of health care policies. Hence, assessing the factors responsible for the reduction in NMR and the hurdles encountered in achieving the same must be assessed. Currently, one of the sustainable development goals is to bring NMR to < 12 deaths per 1000 births by 2030. Based on the current rate, the NMR is expected to decrease to 15.7 at least and subsequently reach the global target of 9.9. In 2019, the PMR was 25.3, and for the first 6 months of 2020, it was 24.3, in Kasturba Hospital. The PMR was lower compared with the overall statistics of the state of Karnataka (30), but higher compared with the national PMR (25). The NMR for 2019 in Kasturba Hospital (19.04) was lower than that of both Karnataka (22) and India (21.6). The SBR for 2019 in Kasturba Hospital (6.23) was significantly lower compared with that of Karnataka (12) and slightly lower compared with that of India (7) (Figure 3).8 National (2019) 13.93 21.16 12 6.5 19.04 9.71 7.1 25.3 24.33 30 25 Karnataka (2015) KH (2019) KH (2020) 0 5 10 15 20 25 30 35 NMR SBR PMR 22
RkJQdWJsaXNoZXIy MjAwNDg=