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THREE YEARS STUDY OF PERINATAL MORTALITY IN A DISTRICT GENERAL HOSPITAL, UK

THREE YEARS STUDY OF PERINATAL MORTALITY IN A DISTRICT GENERAL HOSPITAL, UK Momena J A, Rao C Anita. Mid –Essex Hospital NHS Trust, Court Road, Broomfield, Chelmsford, Essex, CM1 4ED, UK . Results. Objectives. Conclusions.

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THREE YEARS STUDY OF PERINATAL MORTALITY IN A DISTRICT GENERAL HOSPITAL, UK

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  1. THREE YEARS STUDY OF PERINATAL MORTALITY IN A DISTRICT GENERAL HOSPITAL, UK Momena J A, Rao C Anita.Mid –Essex Hospital NHS Trust, Court Road, Broomfield, Chelmsford, Essex, CM1 4ED, UK. Results Objectives Conclusions To analyse the main causes and associated conditions in perinatalmortality and to identify the avoidable factors and areas of improvement. Our perinatal mortality rate was 4.3 per 1,000 total births against United Kingdom average of 7.6 per 1,000 total births. Antenatal education regarding normal and reduced fetal movements have been implemented. Women reporting reduced fetal movements have a care pathway of management. Intrapartumstillbirths due to poor cardiotocography interpretation has been rectified by regular teaching and correct classification using national guidelines. Post-mortem study identified causes of deaths in 10 cases. Antenatal identification of growth restricted fetus, monitoring and timely intervention are essential to prevent stillbirth.  During the study period, total births were 12,535 with 54 perinatal deaths; Stillbirths 44 cases (antepartum 39 and intrapartum 5); Early Neonatal Deaths, 10 cases. The perinatal mortality rate was 4.3 per 1,000 total births. Adjusted perinatal mortality was 3.27 per 1,000 total births corrected for lethal congenital anomalies in 13 cases. Each group of maternal age below 20 years and above 40 years had 5 cases (9.26%). Post-mortems were performed in 18 cases (34%). Causes of deaths were analyzed according to ReCoDe classification system. Group A:Fetus, 31 cases (57.4%), Fetalgrowth restriction in 25 cases (46.3%) that includes 13 cases of lethal congenital anomalies. Group B: Umbilical Cord, 4 cases (7.4%), consisting of 2 cases of cord prolapse and 2 cases of constricting knots. Group C; Placenta, 4 cases (7.4%), Placental abruption in 2 cases and placental insufficiency in 2 cases. Group D: Amniotic fluid, 2 cases of chorioamnionitis. Group F: Mother, 4 cases (7.4%), diabetic in 3, and one case of essential hypertension. Group G: Intrapartum, 5 cases (9.25%). Group I: Unclassified, 7 cases (12.96%). Reduced fetal movements reported in 19 cases (35%).  Methods A retrospective audit of perinatal deaths between January 2009 to December 2011. Inclusion criteria were stillbirths and early neonatal deaths after 24 weeks of completed gestation (birth weight >500 gramme). Data collection was from obstetrics risk management register. Data analyzed includes maternal and gestational age, maternal risk factors, antenatal and intrapartum care, weight and sex of baby and post-mortem reports. The causes of deaths were ascertained using Relevant Condition at Death System (ReCoDe). This classification reduces the category of unexplained still births. References • GardosiJ, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ 2005;331:1113-17. • Centre for Maternal and Child Enquiries (CMACE). Perinatal Mortality 2009: United Kingdom, CMACE: London, 2011.

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