Extended Perinatal Mortality Audit in a Rural Hospital in India

Abstract

Objective The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. Study Design Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following “Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan).” Results The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. Conclusion This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. Key Points

Does provision of antenatal care in Southern Asia improve neonatal survival? A systematic review and meta-analysis

“…Nine studies were based in Bangladesh, 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 5 in India, 28 , 29 , 30 , 31 , 32 5 in Nepal, 33 , 34 , 35 , 36 , 37 1 in Pakistan, 38 and 1 in Afghanistan. 39 Fifteen of 20 studies were cross-sectional, 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 33 , 34 , 35 , 37 , 38 , 39 with data for both exposure and outcome obtained from household questionnaires as part of national demographic and health surveys. Three studies were case–control, 21 , 31 , 36 2 were prospective cohort studies, 22 , 29 and 1 was a retrospective cohort study.…”

“…Three studies were case–control, 21 , 31 , 36 2 were prospective cohort studies, 22 , 29 and 1 was a retrospective cohort study. 28 These also used household questionnaires, and thus both exposure and outcomes were self-reported measures. Included studies were published between 1987 and 2021.…”

“…The remaining 10 were of low risk for selection bias because they included all women who had live-born infants in the time frame and area of the study. 19 , 21 , 22 , 26 , 27 , 28 , 29 , 31 , 33 , 36 …”

“…Only 6 used medical records or interviews during and immediately after pregnancy, and therefore had low risk of performance bias. 21 , 22 , 28 , 29 , 31 , 32 …”

“…An analysis examining neonatal mortality by number of ANC visits was planned a priori but could not be conducted using results adjusted for confounders. We therefore used unadjusted results from 5 studies 20 , 28 , 31 , 33 , 36 and obtained an OR of 0.68 (95% CI, 0.44–1.06; I 2 =76.7%) for women receiving 1 to 3 visits and 0.44 (95% CI, 0.25–0.78; I 2 =85.4%) for women receiving ≥4 visits ( Figure 4 ).

Figure 4 Forest plot for subanalysis by number of visits received A forest plot showing the result of the meta-analysis performed as a subanalysis of number of antenatal care visits received, using unadjusted results.

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