Malik S J, Mir N A
Department of Neonatal Medicine, Institute of Medical Sciences, Srinagar, Kashmir.
Asia Oceania J Obstet Gynaecol. 1992 Mar;18(1):45-8. doi: 10.1111/j.1447-0756.1992.tb00298.x.
The present study was undertaken to identify the preventable factors operative in high fetal and neonatal losses. Over a period of one year, of total of 1,600 consecutive deliveries, 1,107 were considered to be at-risk: there were 33 fetal and 31 early neonatal deaths with an overall perinatal mortality rate of 40/1,000 births. Perinatal mortality was higher in mothers who had received inadequate antenatal care and/or with bad obstetric history. Major maternal and obstetric factors associated with a high PMR were: advancing maternal age and parity, antepartum hemorrhage, diabetes, anemia, instrument and vaginal breech delivery. Overall cesarean section rate was 16.9%. Infants with a gestational age of less than 37 weeks and/or of birth weight of less than 2,500 g contributed for 56.2% and 68.7% of the total perinatal losses respectively. PMR was three fold higher among twins compared with singleton births. Identifiable causes of perinatal deaths observed were: asphyxia (31%), congenital anomalies (18.7%), sepsis (18.7%) and low birth weight (25%). It would appear that preventable factors are operative in over two third of the cases of perinatal loss and better maternal health, obstetric and neonatal care can improve the perinatal outcome in majority of the cases.
本研究旨在确定导致高胎儿及新生儿死亡率的可预防因素。在一年的时间里，连续1600例分娩中，1107例被视为高危：有33例胎儿死亡和31例早期新生儿死亡，围产期总死亡率为40‰。产前护理不足和/或有不良产科病史的母亲围产期死亡率更高。与高围产期死亡率相关的主要孕产妇和产科因素包括：产妇年龄和胎次增加、产前出血、糖尿病、贫血、器械助产和阴道臀位分娩。总体剖宫产率为16.9%。孕周小于37周和/或出生体重小于2500g的婴儿分别占围产期总死亡数的56.2%和68.7%。双胞胎的围产期死亡率是单胎分娩的三倍。观察到的围产期死亡的可识别原因包括：窒息（31%）、先天性异常（18.7%）、败血症（18.7%）和低出生体重（25%）。看来，在超过三分之二的围产期死亡病例中存在可预防因素，改善孕产妇健康、产科和新生儿护理可在大多数病例中改善围产期结局。
