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Quality of Services Need All Round Critical Appraisal for Decreasing Perinatal Deaths

Shakuntala Chhabra, Varma Shivkumar P, Thakre P and Dhawade K

Background: Perinatal mortality rates (PMR), index of quality of maternity, neonatal services, are still high in developing countries with regional variability. Material and Methods: Present study was done by analysis of case records of mothers who had perinatal deaths (PD). During period of analysis, there were 81051 births, 5235 PD, [3923 stillbirths (SB) 1312 neonatal deaths (NND)] with decreasing trends of PMR, from 95.18 to 34.93. For analysis, cases were divided into 10 blocks. Objective: Study was done to know trends of factors responsible for PD at rural referral hospital in Central India, so as to look into possible preventive strategies. Results: More teenagers had more often PD in each block, 1203 (22.97%) mothers were severely anemic, problem persisted over years, 20.15% in Block A, 20.96% in Block J. Cases with hypertensive disorders with PD increased from 19.62% in Block A to 21.14% in Block J, with preterm births decreased from 52.52% to 41.26%, with antepartum haemorrhage (APH), mostly placental abruption, increased from 1.31% to 1.59%. Nine hundred twenty one (17.59%) women who had PD delivered between of 28 to < 34 weeks, 1274 (24.33%) between >34 to <37 weeks gestation, but 3040 (58.78%) were term births, Overall 41.92%. PD was preterm, significantly higher than over all 14% preterm births. Of all cases with PD, 3753 (71.69%), were after vaginal birth [2274 (60.60%) term, 1479 (39.40%) preterm], 500 (9.55%) after elective caesarean sections (CS), 982 (18.7%) emergency CS. Overall 1482 (28.3%) babies lost were after CS. Analysis revealed that 218 (43.6%) PD were due to respiratory distress syndrome (RDS), 123 (24.6%) prematurity with low birth weight (LBW) with septicemia, 104 (20.8%) meconium aspiration, 30 (0.6%) sudden infant death syndrome, 25 (5.0%) congenital heart disease. Overall 89% babies were LBW. Major factors which lead to PD and were persisting over years were anemia, hypertensive disorders in mother, sepsis, prematurity with LBW. Of all cases of PD, 8% were after elective, 18% emergency CS, majority done in fetal interest. Conclusion: PMR continues to be very high. Anemia, hypertensive disorders, preterm births, sepsis were major factors, persisting over years, almost all preventable. Of PD, 8% births were after elective CS, 18% emergency CS, majority CS done for fetal interest, a matter of real concern.