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  • Title: Reducing perinatal mortality in Vila Central Hospital, Vanuatu.
    Author: Maouris P.
    Journal: P N G Med J; 1994 Sep; 37(3):178-80. PubMed ID: 7668056.
    Abstract:
    This paper provides accurate figures and detailed analysis of the causes of perinatal mortality in the main referral hospital in Vanuatu in 1992, and discusses possible improvements in management. The perinatal mortality rate for the Vila Central Hospital area was 30.4 per 1000 births (with a stillbirth rate of 14 per 1000). These figures include mothers who presented for the first time in labour without any antenatal care, and cases of very low birthweight (less than 1 kg). These results were achieved with very low intervention rates. The commonest cause of death in Vanuatu was birth asphyxia, with prematurity, unexplained stillbirth and major congenital abnormality as the other main causes. Even though there is still scope for improvement, especially in the prevention of birth asphyxia, the perinatal mortality rate in Vanuatu compares favourably with that in other developing countries. Increased family planning uptake will be expected to lead to a reduction in perinatal mortality. A prospective study attempted to establish accurate figures of perinatal mortality (first-week neonatal deaths and stillbirths weighing 500 g or more) occurring in 1992 in patients delivered at Vila, Vanuatu, Central Hospital (VCH). Out of 1445 total births, there were 23 stillbirths and 27 first-week neonatal deaths at VCH during 1992, giving a total perinatal mortality rate of 34.6/1000 births (and a stillbirth rate of 16/1000). If emergency referred cases from other islands are excluded, the perinatal mortality rate for the VCH area was 30.4/1000 births (with a stillbirth rate of 14/1000). These figures include five mothers (with outcomes of four stillbirths and one neonatal death) who presented for the first time in labor without any antenatal care, and eight cases of very low birth weight (1 kg). There were three sets of twins involved in perinatal mortality: one set of twins died because of premature delivery, there was one set of conjoined twins, and an unexplained fetal death in utero of one of a set of twins with a normal outcome of the other twin. The commonest cause of death was birth asphyxia (30% of perinatal deaths or 10.4/1000 births). Careful analysis of the asphyxia deaths identified 10 cases in which more intensive monitoring of the fetal heart rate could have prevented the death. There were two cases of cord prolapse, in which delay in performing caesarean section was the main reason for the fetal death, and a further three cases in which a delay in performing the caesarean section probably contributed to the fetal death. Prematurity accounted for 20% of the perinatal deaths, whereas 10% of the babies born at VCH weighed less than 2.5 kg. The third largest cause of perinatal death was unexplained stillbirth. Major congenital abnormality was the fourth cause of perinatal mortality. Parity over 4, maternal age over 38 years, maternal age under 18 years, and birth spacing of less than 2 years contributed 12.4%, 5.5%, 2.7%, and 13% of the births in VCH, respectively.
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