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  • Title: Perinatal mortality in rural Tanzania.
    Author: van Roosmalen J.
    Journal: Br J Obstet Gynaecol; 1989 Jul; 96(7):827-34. PubMed ID: 2765428.
    Abstract:
    Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH). All case records of stillborn infants (with a birth weight of greater than 1000 g) in Lugarawa Hospital (Tanzania) over the September 1971-September 1976 period were analyzed retrospectively for avoidable factors leading to death. 137 case records were included in the study, giving a stillbirth rate of 48/1000 in 2875 births. Avoidable factors were found to be present in 34 of 137 stillbirths (25%). In the case of 7 stillbirths, the health workers had failed to detect that the woman was "at risk." No appropriate action in a delayed 1st stage was considered to be the cause of death in 7 stillbirths. As a general guideline, progress in cervical dilatation of 1 cm per 1 or 2 hours was considered as the lower limit of normal, and delay was diagnosed when progress was less than this. In the category of no appropriate action taken in a delayed 2nd stage in hospital, 6 primigravida had a mean duration of 2nd stage labor of 159 minutes and 8 multigravida had a mean of 112 minutes. No appropriate action when fetal distress was diagnosed occurred in 6 stillbirths. In a 21% of the 34 cases of avoidable factors, deficiencies beyond the responsible hospital indicated a need for change in midwifery policy in the community. In the other 79%, deficiencies in hospital management were responsible. Consequently, obstetric policy in the hospital was changed with the aim of reducing the occurrence of prolonged labor and thereby perinatal mortality. Following the introduction of the new policy, the perinatal mortality rate was reduced from 71 to 39/1000 births. Prolonged labor as a cause of perinatal death can be minimized by the use of the partogram, which should be included in maternal and child health training.
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