Perinatal mortality and associated risk factors in LUTH
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Perinatal mortality and associated risk factors in LUTH Dr. Gabriel Onyeka Ekekwe, Prof. Rose .I. Anorlu Lagos University Teaching Hospital (LUTH) Idi-araba, Lagos, Nigeria. OPTIONAL LOGO HERE. OPTIONAL LOGO HERE.

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Perinatal mortality and associated risk factors in LUTHDr. Gabriel Onyeka Ekekwe, Prof. Rose .I. AnorluLagos University Teaching Hospital (LUTH) Idi-araba, Lagos, Nigeria

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  • Data collected includes age, parity, booking status, maternal height, ante-natal complications, labour complications, mode of delivery, fetal sex, birth weight, fetal outcome, placental weight, duration of rupture of membrane and other relevant information

  • The information obtained was collated and entered into a database and analysed with a statistical software package, Epi 6

  • Statistical associations were evaluated using 2 by 2 tables, the odds ratios and statistical significance using 95% confidence interval and p-values

  • Results

  • Perinatal mortality was significantly higher in the unbooked group (Odds ratio (OR), 28.47, 95% confidence interval 19.88-40.84, p< 0.05 and grandmultiparas (OR, 5.92, 95% C.I. 3.24-10.58, p< 0.05)

  • Perinatal mortality was significantly higher in fetuses with birth weight <2.5kg or >4.0kg (OR, 11.91 95% C.I. 8.45-16.92, p<0.05) and (OR 1.94, 95% C.I. 1.12-2.99, p<0.05) respectively

  • It was higher in pregnancies complicated with Preeclampsia (OR, 31.30, 95% C.I. 11.73-65.07, p<0.05), Ante-partum haemorrhage (OR, 18.25, 95% C.I. 8.92-37.23, p<0.05), Obstructed labour (OR, 24.33, 95% C.I. 11.82-50.22, p<0.05), Prolonged rupture of membrane (OR, 11.33, 95% C.I. 5.64-22.54, p<0.05)

  • Intrauterine growth restriction (OR, 11.41, 95% C.I. 4.82-58.73, p<0.05), Sickle cell disease (OR, 6.10, 95% C.I. 1.66-20.34, p<0.05), and Gestational diabetes (OR, 7.08, 95% C.I. 2.46-19.37, p<0.05) were also associated with increased perinatal death

  • Conclusion

  • The high Perinatal mortality in LUTH reflects the prevailing situation in the country in general

  • However, most perinatal mortality were among mothers referred to LUTH from peripheral centres or those that never had any formal care prior to presentation in LUTH

  • Leading causes of high perinatal death were related to prematurity and birth asphyxia which was similar to the findings of other studies and reports regarding perinatal and neonatal deaths in Nigeria and other regions (1,3,6)

  • There is need to make ANC available and accessible(8)

  • There is also urgent need for relevant bodies/groups like SOGON or National Postgraduate Medical College to make available management protocols that will guide practice at peripheral health care centres

  • Facilities and skills for the management of premature babies should be enhanced

  • References

  • 1. Neonatal and Perinatal Mortality: country, regional and global estimates 2004. Ahman, E. and Zupan, J. (eds.) Gevena, Switzerland: WHO.

  • 2. Onadeko, M.O., and Lawoyin, T.O. (2003) ‘The pattern of stillbirth in a secondary and a tertiary hospital in hospital in Ibadan, Nigeria’, Afr. Jour. Med. Sci. vol. 32; pp. 349-352.

  • 3. Opportunities for Africa’s Newborns: practical data, policy and programmatic support for newborn care in Africa, 2006. Lawn, J. and Kerber, K. (eds.) Cape Town: PMNCH, Save the Children, UNFPA, UNICEF, USAID, WHO.

  • 4. Lawn, J., Shibuya, K., and Stein, C. (2005) ‘No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths’, BullWorld Health Organ 83; pp. 409-417.

  • 5. MacFarlane, A., Cahalmers, I., and Adelstem, A.M. (1980) The role of standardization in the interpretation of perinatal mortality rate’, Health Trends, 12; pp. 45-50.

  • 6. Lawn, J.E, Cousens, S, Zupan, J. Four million neonatal deaths: when? Where? Why? Lancet 2005; 365:891-900

  • 7. Ahmed, E. Zupan, J. Neonatal and perinatal mortality: country, regional and gobal estimates in 2004. Geneva: WHO; 2007

  • 8. Lawn, J. Shibuya, K. Stein, C. No cry at birth:global estimates of intrapartum stillbirths rates and intrapartum-related neonatal deaths. BullWorld Health Organ 2005; 83:409-17

  • Summary

  • This study aimed at determining the associated risk factors for high perinatal mortality using data from Lagos University Teaching Hospital

  • LUTH is the major referral centre in the Lagos area

  • Four thousand of all the deliveries in LUTH between 01/01/2002 and 31/12/2006 was randomly selected and reviewed

  • 3497 singleton deliveries were available for final analysis

  • There were 171 perinatal deaths of which 66 are macerated stillbirth(MSB), 43 are Fresh stillbirth(FSB) and 62 are Early neonatal death(END)

  • This gave a PMR 48.9 per 1000 births which is high compared single digit in many developed countries (1,7)

  • Leading causes are antenatal and intrapartum complications resulting in premature, low birth weight or asphyxiated babies; pre-eclampsia, APH, PROM and prolonged obstructed labour (2,3,4,6)

  • Perinatal death was 28 times more among women not registered for antenatal in LUTH but were referred from peripheral centres

  • There is urgent need for relevant professional bodies like Society of Obgyn of Nigeria(SOGON) or National Postgraduate Medical College to make available management protocols to guide ante partum and intra partum management especially in peripheral centres

  • Methods

  • Case records of randomly selected 4000 of 5904 deliveries in LUTH between 01/01/2002 and 31/12/2006 were randomly selected and reviewed

  • Multiple deliveries were excluded to conform with international standardization recommendation as multiple birth constitute a special risk factor for perinatal death(5)

  • Deliveries with incomplete records were excluded

  • 3497 singleton deliveries were available for final analysis

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