Department of Forensic Medicine, Gandaki Medical College Teaching Hospital and Research Center, Gandaki Province, Pokhara, Nepal.
Green Pastures Hospital - International Nepal Fellowship, Gandaki Province, Pokhara, Nepal.
BMC Pregnancy Childbirth. 2022 Mar 24;22(1):245. doi: 10.1186/s12884-022-04596-0.
Perinatal and neonatal death rates have decreased recently but it still poses a major challenge to the health system of Nepal. The study was conducted to explore the pattern and causes of perinatal deaths.
This was a descriptive cross-sectional study conducted from September 2020 to June 2021 using the data of perinatal mortality of three years from June 15, 2017, to June 14, 2020. The demographic parameters of the mother consisted of maternal age, place of residence, ethnicity, antenatal care, the number of antenatal visits, gravida, gestational weeks, and the mode of delivery. The causes of death were categorized into fetal and early neonatal deaths. Fetal deaths were further classified as macerated stillbirth and fresh stillbirth. The attribution of the causes of deaths to fetal/neonatal and maternal conditions was done as per the guidelines of the WHO application of ICD-10 to deaths during the perinatal period.
There were a total of 145 perinatal deaths from 144 mothers among which 92 (63.5%) were males. Ten mothers (6.9%) had not sought even single antenatal care, whereas 32 (22.9%) had visited for antenatal care one to three times. At least one cause of death was identified in 114 (78.6%) and remained unknown in 31(21.4%) cases. Among the 28 cases of macerated stillbirths, the cause of death was not identified in 14 (50%), whereas preterm labor was attributed to the cause of death in four (14.3%). In 53 of the fresh stillbirths, intrapartum hypoxia was identified as the cause of death in 20 (37.7%) cases, preterm labor in nine (17%), and was left unknown in 15 (28.3%) cases. Among the 64 early neonatal deaths, prematurity was attributed as the cause of death in 32 (50%) cases, birth asphyxia, and infections each in 11 (17.2%).
The perinatal mortality surveillance system identified the causes of death in most of the cases in our observation. Prematurity was identified as the commonest cause of early neonatal deaths and preterm labor was the commonest cause responsible for perinatal deaths overall. The perinatal deaths should be investigated to establish exact causes of deaths which can be useful to develop prevention strategies.
最近，围产儿和新生儿死亡率有所下降，但这仍然是尼泊尔卫生系统面临的主要挑战。本研究旨在探讨围产儿死亡的模式和原因。
这是一项描述性的横断面研究，于 2020 年 9 月至 2021 年 6 月期间进行，使用了 2017 年 6 月 15 日至 2020 年 6 月 14 日三年的围产儿死亡数据。母亲的人口统计学参数包括母亲年龄、居住地、种族、产前护理、产前检查次数、孕次、孕周和分娩方式。死亡原因分为胎儿和早期新生儿死亡。胎儿死亡进一步分为木乃伊化死产和新鲜死产。根据世卫组织《应用 ICD-10 对围产期死亡的指导原则》，对胎儿/新生儿和产妇状况导致的死亡原因进行了分类。
从 144 位母亲中共有 145 例围产儿死亡，其中 92 例（63.5%）为男性。有 10 位母亲（6.9%）甚至没有接受过一次产前检查，而 32 位母亲（22.9%）接受过 1-3 次产前检查。至少确定了 114 例（78.6%）的死因，31 例（21.4%）死因不明。在 28 例木乃伊化死产中，14 例（50%）死因不明，4 例（14.3%）早产。在 53 例新鲜死产中，产时缺氧被确定为 20 例（37.7%）的死亡原因，早产 9 例（17%），15 例（28.3%）死因不明。在 64 例早期新生儿死亡中，早产被确定为 32 例（50%）的死亡原因，出生窒息和感染各 11 例（17.2%）。
围产儿死亡率监测系统在我们的观察中确定了大多数病例的死亡原因。早产是导致早期新生儿死亡的最常见原因，早产是导致围产儿死亡的最常见原因。应调查围产儿死亡原因，以确定确切死因，这有助于制定预防策略。
