perinatal mortality

Question 1

What is the AUS and NZ
perinatal mortality rate

Fetal death rate

Neonatal death rate

Answer 1

PMR
Aus 10.3 / 1000
NZ 11.2/1000
(aboriginal woman PMR 21/1000)

fetal death rate
AUS 7.4/1000
NZ 8.5:1000

neonatal death rate - death within 28 days
AUS 3/1000
NZ 3.4/1000

Question 2

how has the PMR changed over time

Answer 2

from 1970s to 2000
Reduction by 2/3rds
23/1000 to 8/1000
more so neonatal component but really both

Reduction in peripartum asphyxia, birth trauma, and isoimmunisation

Question 3

What is the leading cause of PMR

Answer 3

Congenital abnormality
Unexplained 20-30%
PTB

Question 4

What are the core investigations for all still births

Answer 4

Maternal and FHx
USS for fetal abnormalities and to assess amniotic fluid volume
Amniocentesis
Low vagina and perianal swabs for aerobic and anaerobic organisms 
Bloods (12) 
FBC
Kleihaurer
G+H

Serology for CMV Toxo Parovirus B19
Rubella and syph

Cr, Uric acid, LFT and bile acids
TFT
HbA1c

Anticardiolipid AB, lupus anticoagulant
APC resistance

Following birth
External examination +photos
post mortem
Swabs ear and throat
Bloods for chromosomal analysis + Guthrie
Bloods for infection (cord or cardiac puncture)

Placental macroscopic exam
cultures
biopsy for chromosome analysis
histopathology

Question 5

Who should get further testing for thrombophilia?

Answer 5

IUGR, PET, maternal thrombosis and or maternal FHx of thrombosis, death still unexplained following core investigations, thrombophilia testing in core Ix were positive

Question 6

What does further thrombophilia testing include?

Answer 6

If previously positive repeat anticardiolipin and lupus anticoagulant
any of the autoimmune screen if not previously done

If APC resistance +ve then Factor V Leiden

Fasting homocystine
Protein C and S deficiency
Prothrombin gene mutation 20210A
Antithrombin III

Question 7

When is testing for MTHFR mutation appropriate/?

Answer 7

NTD
Cleft lip or palate
Congenital cardiac defects

Question 8

What is a confidence interval

Answer 8

a range of values where there is 95% chance that in includes the true value

Question 9

what is the definition of PMR

perinatal mortality rate

Answer 9

Number of still births and neonatal deaths per 1000

Question 10

What is a neonatal death? and what is the neonatal date rate definition

Answer 10

Neonatal death is a death in the first 28 days of life

Neonatal death rate is per 1000

Question 11

What is a IUFD / still birth

Answer 11

death in utero at least 20 weeks or at birth 400 g

Question 12

risk factors for peinatal mortality

Answer 12

extremes of age
Maori and pacific and Indian 
Low SES
Half occur in overweight and obese woman
Smoking 33%
vaginal bleeding in pregnancy 31% (primary cause in 15%)

Question 13

How often does a post mortem have an answer and change counselling

Answer 13

Postmortem changed dx 24% of the time changing counselling and follow up

Question 14

Excluding congential abnormalities what is the most common cause for neonatal deaths?

What is the biggest risk factor for this?

Answer 14

preterm birth
half of neonatal deaths are <24 weeks
70% are <28%

Highest rate of neonatal death from PTB is in the <20s (likely confounded)