Perinatal Morbidity and Mortality Flashcards
Why do we monitor perinatal morbidity and mortality?
- To improve the health of mothers, babies and children
- By carrying out confidential enquiries and related work on an nationwide basis
- By widely disseminating the findings and recommendations
Where is the information on perinatal morbidity and mortality?
Perinatal Mortality Report from the National Perinatal Epidemiology Centre (NPEC)
Define stillbirth
Baby delivered without signs of life from 24wks gestation or with a birth weight >/=500g
Define neonatal death
Death of a live born baby occurring before 28 completed days after birth
Early = <7 completed days
Late = 7-27 completed days
Define perinatal death
Stillbirths + early neonatal deaths
Define live birth
Delivery of an infant, which, after complete separation from its mother, shows signs of life
Define overall perinatal mortality rate (PMR)
Number of stillbirths and early neonatal deaths per 1000 births (live births and stillbirths from 24wks gestation or weighing >/=500g )
Define adjusted PMR
Perinatal mortality rate excluding perinatal deaths associated with or due to a congenital malformation
Define Parity
The number of completed pregnancies, whether live birth or stillbirth, of at least 24wks gestation or with a birth weight >/=500g
Define Gravida
The number of times the mother has been pregnant, irrespective of duration
Define intrauterine growth restriction (IUGR)
This is a situation where growth is good initially in pregnancy but the drops later in pregnancy (e.g. fetus on 97th centile dropping to 50th centile)
Define small for gestational age (SGA)
A baby that has a birthweight less than the 10th percentile of all babies with the same gender and gestational age
What was the PMR in 2015?
- 7 deaths per 1000 births
- Adjusted PMR (for congenital abnormalities) = 4.3 deaths per 1000 births
What was the stillbirth rate in 2015?
- 4.5 per 1000 births
What was the early neonatal death rate in 2015?
- 2.5 per 1000 live births
List the risk factors for stillbirths and neonatal deaths
- Lower socioeconomic class
- <17 or >40 years
- Smokers and drug abusers
- Obesity
- Pre-existing medical conditions (HTN, psychiatric disorder, renal disease, diabetes, cardiac disease, epilepsy)
- Poor nutrition
- Multiple pregnancies
- High parity
- Ethnicity (Irish traveller, Asian or Black)
- Previous pregnancy related problems
- Carriers of genetic disorders
- Previous stillbirth or preterm birth
- Infertility treatments
How can the sex of the infant affect perinatal mortality?
- Female infant at greater risk of stillbirth
- Male infant at greater risk of early neonatal death
What is the PMR like for multiple pregnancies?
PMR is 3.9 times that of singleton pregnancies
How does gestation affect perinatal mortality?
Almost 70% of perinatal deaths in 2015 were associated with delivery before 37wks gestation
How does birthweight impact on perinatal mortality?
The most represented birthweight in cases of perinatal death was in the range 500-999g
List the primary causes of stillbirth
- Major congenital anomaly (27%)
- Specific placental conditions (maternal vascular malperfusion) (24%)
- Unexplained (15%)
- Infection (chorioamnionitis) (8%)
- Specific fetal condition (TTTS, hydrops) (8%)
- Ante/intrapartum haemorrhage (praevia, abruption) (7%)
- Mechanical factors (cord around neck/entanglement/prolapse) (6%)
- IUGR (3%)
What are the most common congenital anomalies that cause stillbirth?
- Chromosomal disorders (65.8%)
- Other (16.5%)
- Central nervous system (3.8%)
- CVS (3.8%)
- Musculo-skeletal system (3.8%)
- Multiple anomalies (3.8%)
- Urinary tract (2.5%)
List the primary causes of neonatal deaths
- Major congenital anomaly (59%)
- Respiratory (25%)
- Neuro (HIE/IVH) (10%)
- Infection (Sepsis, RTI, Meningitis) (2%)
- Unexplained (2%)
- Other specific causes (tumours) (1%)
- Pre-viable (<22/40) (0.6%)
