Buchmann E J, Pattinson R C, Nyathikazi N
Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg.
S Afr Med J. 2002 Nov;92(11):897-901.
The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report.
To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of intrapartum-related asphyxia to total perinatal mortality in South African hospitals, and to identify the primary obstetric causes and avoidable factors for these deaths.
The amalgamated PPIP data for the year 2000 were obtained from 27 state hospitals (6 metropolitan, 12 town and 9 rural) in South Africa. In PPIP-based audit, all perinatal deaths are assigned primary obstetric causes and avoidable factors, and these elements were obtained for all deaths resulting from intrapartum-related birth asphyxia.
There were 123,508 births in the hospitals surveyed, with 4,142 perinatal deaths among infants > or = 1,000 g, giving a perinatal mortality rate of 33.5/1,000 births. The perinatal mortality rate from intrapartum-related birth asphyxia was 4.8/1,000 births. The most frequent avoidable factors were delay by mothers in seeking attention during labour (36.6%), signs of fetal distress interpreted incorrectly (24.9%), inadequate fetal monitoring (18.0%) and no response to poor progress in labour (7.0%). The perinatal mortality rates for metropolitan, town, and rural areas were 30.0, 39.4 and 30.9/1,000 births respectively. The contribution of intrapartum-related birth asphyxia to perinatal mortality in these areas was 10.8%, 16.7% and 26.4% respectively.
The high rates of perinatal death from intrapartum-related birth asphyxia in South Africa are typical of those in underdeveloped countries, with the most serious deficiencies in rural areas. Most of these deaths are avoidable and the reduction of these rates presents an important challenge to providers of perinatal care in this country. Areas worthy of research and action include provision of mothers' waiting facilities in rural regions, improvements in fetal monitoring, partogram-based labour management, and the establishment of midwifery staffing norms for South African labour units.
南非围产期问题识别计划（PPIP）的用户近期整合了相关数据，最终形成了《拯救婴儿报告》。
确定南非医院中与产时相关的出生窒息导致的绝对死亡率，以及与产时相关的窒息在总围产期死亡率中的占比，并找出这些死亡的主要产科原因和可避免因素。
从南非27家国立医院（6家大都市医院、12家城镇医院和9家农村医院）获取了2000年PPIP整合后的数据。在基于PPIP的审计中，所有围产期死亡都被指定了主要产科原因和可避免因素，这些信息是从所有与产时相关的出生窒息导致的死亡案例中获取的。
在所调查的医院中有123,508例分娩，体重≥1000克的婴儿中有4142例围产期死亡，围产期死亡率为33.5‰。与产时相关的出生窒息导致的围产期死亡率为4.8‰。最常见的可避免因素是母亲在分娩时延迟寻求医疗帮助（36.6%）、对胎儿窘迫迹象的错误解读（24.9%）、胎儿监测不足（18.0%）以及对产程进展不佳无应对措施（7.0%）。大都市、城镇和农村地区的围产期死亡率分别为30.0‰、39.4‰和30.9‰。与产时相关的出生窒息在这些地区围产期死亡率中的占比分别为10.8%、16.7%和26.4%。
南非因与产时相关的出生窒息导致的高围产期死亡率是不发达国家的典型情况，农村地区问题最为严重。这些死亡大多是可避免的，降低这些死亡率对该国围产期护理提供者构成了重大挑战。值得研究和采取行动的领域包括在农村地区提供母亲候产设施、改善胎儿监测、基于产程图的分娩管理以及为南非分娩单位制定助产士人员配备标准。
