TEMPLATE DESIGN © 2008

www.PosterPresentations.com

Perinatal mortality and associated risk factors in LUTHDr. Gabriel Onyeka Ekekwe, Prof. Rose .I. Anorlu

Lagos University Teaching Hospital (LUTH) Idi-araba, Lagos, Nigeria

Content goes here…

SummaryThis study aimed at determining the associated risk factors for high perinatal mortality using data from Lagos University Teaching HospitalLUTH is the major referral centre in the Lagos areaFour thousand of all the deliveries in LUTH between 01/01/2002 and 31/12/2006 was randomly selected and reviewed3497 singleton deliveries were available for final analysisThere 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 centresThere 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

MethodsCase records of randomly selected 4000 of 5904 deliveries in LUTH between 01/01/2002 and 31/12/2006 were randomly selected and reviewedMultiple 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 excluded3497 singleton deliveries were available for final analysis

ConclusionThe high Perinatal mortality in LUTH reflects the prevailing situation in the country in generalHowever, most perinatal mortality were among mothers referred to LUTH from peripheral centres or those that never had any formal care prior to presentation in LUTHLeading 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 centresFacilities and skills for the management of premature babies should be enhancedReferences1. 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; 365:891-9007. Ahmed, E. Zupan, J. Neonatal and perinatal mortality: country, regional and gobal estimates in 2004. Geneva: WHO; 20078. 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

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 informationThe information obtained was collated and entered into a database and analysed with a statistical software package, Epi 6Statistical associations were evaluated using 2 by 2 tables, the odds ratios and statistical significance using 95% confidence interval and p-values

ResultsPerinatal 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) respectivelyIt 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

OPTIONALLOGO HERE

OPTIONALLOGO HERE

TABLE 1: DISTRIBUTION OF DIRECT OBSTETRIC RISK FACTORS

AND CRUDE RELATIONS TO PERINATAL MORTALITY

RISK FACTOR

PERINATAL

DEATH (N-

(171)

LIVE BIRTH

(N-3326)

ODDS

RATIO

95%

CONFIDENCE

INTERVAL

P-

VALUE

Pregnancy induced

hypertension

Yes 3 (1.8%) 11 (3.3%) 0.50 0.13-1.64 0.22900

No 168(98.2%) 3315(96.7%)

Pre-eclampsia

Yes 12 (7%) 8 (0.2%) 31.30 11.73-65.07 0.00001

No 159 (83%) 3318

Ante-partum

Haemorrhage

Yes 17 (9.9%) 20 (0.6%) 18.25 8.92-37.23 0.00001

No 154 (90.1%) 3306(99.4%)

Prolonged/ obstructed

labour

Yes 19 (11.1%) 17 (0.5%) 24.33 11.82-50.20 0.00001

No 152 (99.5%) 3309(99.5%)

Prolonged rupture of

membrane

Yes 15 (8.8%) 28 (0.8%) 11.33 5.64-22.54 0.00001

No 156 (91.2%) 3298(99.2%)

Intrauterine growth

restriction

Yes 10 (5.9%) 18 (0.5%) 11.41 4.82-26.58

No 161(94.1%) 3308(99.5% 0.00001

Non-cephalic

presentation

Yes 26 (15.2%) 62 (1.9%) 9.44 5.63-15.73

No 145(84.8%) 3264(98.1%) 0.00001

TABLE 2: DISTRIBUTION OF INDIRECT OBSTETRIC RISK FACTORS

AND CRUDE RELATIONS TO PERINATAL MORTALITY

Primiparity

Yes 69 (40.4%) 1399(42.1%) 1.07 0.78-1.49 0.65820

No 102(59.6%) 1927(57.9%)

Grandmultiparity

Yes 17 (9.9%) 61 (1.8%) 5.92 3.24-10.58

No 154(90.1%) 3265(98.2%) 0.00001

Maternal height

1.55metres

Yes 13 (7%) 175(5.3%) 2.54 1.22-3.62

No 84(92.4%) 2874(94.7%) 0.00124

Birth weight

<2.5kg

Yes 75(46.0%) 204(6.2%) 11.91 8.45-16.92

No 88(54.0%) 3110(93.8%) 0.00001

Birth weight

>4.0kg

Yes 22(13.5%) 247 (7.5%) 1.94 1.12-2.99

No 141(86.5%) 3067(92.5%) 0.00432

Maternal age 20

years

Yes 11 (6.4%) 64 (1.9%) 3.50 1.71-7.01 0.00007

No 160 (93.6%) 3262(88.1%)

Maternal age >35

years

Yes 29(17%) 261(7.9%) 2.40 1.54-3.71 0.00035

No 142(83%) 3065(92.1%)

Booking status

Yes 113 (66.1%) 213 (6.4%) 28.47 19.88-40.84

No 58 (33.9%) 3113(93.6%) 0.00001

TABLE 3: DISTRIBUTION OF MEDICAL COMPLICATIONS AND CRUDE

RELATIONS TO PERINATAL MORTALITY

RISK FACTOR

PERINATAL

DEATH

LIVE BIRTH

ODDS

RATIO

95%

CONFIDENCE

INTERVAL

P-

VALUE

Sickle cell disease

Yes 4 (2.3%) 13 (0.4%) 6.10 1.66-20.34 0.00003

No 167(97.7%) 3313(99.6%)

Gestational diabetes

mellitus

Yes 6 (3.5%) 17 (0.5%) 7.08 2.46-19.37

No 165(96.5%) 3309(99.5%) 0.00002

HIV/ AIDS

Yes 8 (4.7%) 12 (0.4%) 13.55 4.99-36.15

No 163(95.3%) 3314(99.5%) 0.00001