Lack of antenatal care, father’s occupation risk factors for perinatal mortality

Intrapartum perinatal mortality (IPPM)—the rate of infant deaths that occur during perinatal period—is a serious problem in developing countries, including India. The World Health Organization has estimated that IPPM rates in India range from 7.3 to 15 per 1,000 live births of infants weighing at least 1,000 g.


For improvement to occur, physicians and health systems in India need to “improve antenatal care, encourage the use of skilled birth attendants/hospital deliveries, and always keep a skilled neonatologist available for all high-risk deliveries.”
-C.N. Purandare, MD, DOBST, FICOG, Mumbai, India, immediate past president of the Federation of Obstetric & Gynaecological Societies of India and a member of mdCurrent’s India and International Editorial Advisory Boards


In an effort to evaluate the risk factors associated with IPPM, a recent study followed all pregnant women in a teaching hospital in Northern India who gave birth at 35 or more weeks, or who delivered a baby that weighed at least 2,000 g. The researchers analyzed patient records and interviewed mothers to gather information on[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] antenatal care, events surrounding labor and delivery, and facts about the families.

Key Point: Key factors associated with perinatal mortality in the emergency referral environment include the father’s work situation, a lack of antenatal care, and the presence of obstructed labor. Early interventions in these patients could help save lives.

The authors found that among 248 emergency obstetric referrals, 18 fresh stillbirths (defined as death with no evidence of cardiac activity or breathing movements) and 2 deaths in the neonatal period were considered to be due to asphyxia, resulting in an overall IPPM rate of 80 per 1,000 births.

When investigators performed an analysis of the patient data, they found several statistically significant risk factors for IPPM:

  • fathers engaged in unskilled labor (risk factor of 95% vs 59%);
  •  lack of hemoglobin estimation (35% vs 7.9%);
  •  lack of urine examination (35% vs 8.4%);
  •  presence of obstructed labor (10% vs 0.4%).

According to the authors, reducing IPPM rates will not be an easy task. Because of the lack of resources in many parts of India, women in poorer areas often receive inadequate antenatal care and deliver at home. A lack of training of healthcare workers in providing neonatal resuscitation and a dearth of around-the-clock emergency facilities in rural areas also contribute to high mortality.

C.N. Purandare, MD, MA Obst, DGO, DFP, DOBST, RCPI, FICOG, FRSH, FICA, is immediate past president of the Federation of Obstetric & Gynaecological Societies of India and a member of mdCurrent’s India and International Editorial Advisory Boards. He said that while the risk factors for stillbirth are well known, the study is an important one for Indian physicians to read, as it provides important factual data about these factors. He noted that, for improvement to occur, physicians and health systems in India need to “improve antenatal care, encourage the use of skilled birth attendants/hospital deliveries, and always keep a skilled neonatologist available for all high-risk deliveries.”

Source: Rani S, Chawla D, Huria A, et al. Risk factors for perinatal mortality due to asphyxia among emergency obstetric referrals in a tertiary hospital. Indian Pediatr. 2012;49:191-194.

Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ. 2005;83:409-417. Accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626256/pdf/15976891.pdf.

Access the original journal information here:
http://www.indianpediatrics.net/mar2012/191.pdf
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

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