Incidence and causes of perinatal mortality in Hyderabad, Andhra Pradesh, India
Mehdi, Z.; Naidu, P.M.; Rao, V.G.
Indian Journal of Medical Research 49: 897-936
1961
ISSN/ISBN: 0019-5340 PMID: 14472124 Document Number: 477299
In the course of a 4 1/2 year study at Hyderabad there were 1,747 perinatal deaths among 26,230 single and twin viable births at the Osmania General Hospital and later at the Government Maternity Hospital. The incidence of perinatal mortality was 79.8 per 1,000 viable births for the first 2 years and 9 months, followed by a rapid fall to 61.0 per 1,000 during the last 1 year and 9 months. The probable factors for this rapid fall have been discussed. Perinatal mortality in relation to birth weight has been analysed for 784 deaths out of 13,642 viable births at the Government Maternity Hospital. Analysis of perinatal mortality in relation to birth weight showed that it was minimum for the weight group of 7.6 to 8.5 lb. But it increased amongst fetuses and infants weighing 8.6 lb. and above. It was of course highest in the case of infants and fetuses weighing 2.5 to 4.1 lb. It has been shown that the rate was lowest for mothers of age group 20 to 24 years for the first parity as well as all parities, while more than double that rate was observed in mothers less than 20 years of age. It rose progressively with each succeeding age group. If only parity was to be considered, perinatal mortality was the highest for the first, declined for the group of 2nd to 4th parity, and rose progressively with the successive parity groups of 5th to 7th, and 8th and above. Nine hundred clinically studied cases and 400 autopsied cases were analysed for causes of perinatal deaths. It was found that trauma and stress of labor accounted for 31.4 and 41.5%, toxemia of pregnancy 16.4% and 16% antepartum hemorrhage 6.6% and 6.5%, maternal disease 16.6% and 13.25%, congenital deformity 8.8% and 12%, infection and others 4.3% and 6.4%, etythroblastosis fetalis 0.2% and 0.5%, and undefined 15.6% and 3.75%, respectively, in the clinically studied and autopsied series. Perinatal mortality has also been analysed according to the method of delivery and the results presented. Perinatal mortality was lowest, 4% in the group of spontaneous cephalic deliveries and showed a higher rate in cases of instrumental or operative delivery. Morbid anatomical and histological investigations have revealed that in perinatal deaths the principal lesions observed were tissue changes attributable to anoxia in 26.7% of the cases, pulmonary lesions in 19.2%, congenital anomalies in 12%, birth injuries in 10%, syphilis in 4.5%, miscellaneous conditions of the new born in 1.5% and erythroblastosis fetalis in 0.5%. In 106 cases (25%), the fetuses were macerated, though in 38 of these fetuses signs of anoxia were seen on naked-eye examination. All these were screened for spirochetes and were found to be negative. In a majority of these a careful study of maternal and obstetric condition revealed some cause to account for fetal death. Only in 15(3.75%) of cases the precise cause of death could not be ascertained even after autopsy. The socio-economic conditions and the nutritional status of the affected families have been surveyed on a limited scale and the results presented. These showed that a large majority of obstetric deaths have occurred in families of low income groups living in over-crowded houses and subsisting on inadequate and ill-balanced diets.