Fairbrother P, Connolly M D
S Afr Med J. 1975 Feb 1;49(5):158-62.
The perinatal deaths which occurred during 1973 in the Harare perinatal service were analysed in relation to their obstetric associations. Seventy-one per cent of all the deaths were associated with just five obstetric complications, namely asphyxia in laubour, preterm delivery, minor antepartum haemorrhage, unexplained intra-uterine death and disproportion. It is suggested that asphyxial deaths occurring labour will only be eliminated when continous cardiotocographic monitoring becomes standard practice for all patients. Until then, selected cardiotocography will remain as the main diagnostic aid. Its value will be improved by reviewing the principles of selection. The potential exists to eliminate preterm delivery by the use of beta-adrenergic stimulant drugs. It is suggested that the rational application of this potential would reduce perinatal mortality from preterm delivery. The unexplained intra-uterine deaths and those associated with a minor antepartum haemorrhage presented major problems of understanding and therefore management. These are discussed. Deaths associated with disproportion occurred in 0,10% of booked patients and 3,22% of unbooked patients. The management of the booked patient is satisfactory, and improvement in perinatal mortality will only be achieved by decreasing the number of unbooked patients.
对1973年哈拉雷围产期服务期间发生的围产期死亡病例，就其产科相关因素进行了分析。所有死亡病例中有71%仅与五种产科并发症相关，即分娩时窒息、早产、产前少量出血、不明原因的宫内死亡和头盆不称。有人认为，只有当连续胎心监护成为所有患者的标准做法时，分娩时发生的窒息性死亡才能消除。在此之前，选择性胎心监护仍将是主要的诊断辅助手段。通过回顾选择原则，其价值将得到提高。使用β-肾上腺素能刺激药物有可能消除早产。有人认为，合理应用这一可能性将降低早产导致的围产期死亡率。不明原因的宫内死亡以及与产前少量出血相关的死亡病例，在理解和处理方面存在重大问题。对此进行了讨论。与头盆不称相关的死亡病例在已登记患者中占0.10%，在未登记患者中占3.22%。已登记患者的处理情况令人满意，只有减少未登记患者的数量，才能实现围产期死亡率的改善。
