PERINATAL MORBIDITY AND MORTALITY RATE - NURSING ASSIGNMENT

INTRODUCTION

        The sensitive index of the quality of the health care delivery system of a country as a whole or in part is reflected by its maternal and perinatal mortality rates. With 16% of worlds population India accounts for over 20% of worlds maternal deaths. During the last 50 years, there has been marked reduction in the maternal death rates astonishingly in the developed countries and to some extent in the developing world.

PERINATAL MORTALITY

DEFINITION

        Perinatal mortality is defined as deaths among fetases weighing over 1000gms at birth who die before and during delivery or within first 7 days of delivery. The perinatal mortality rate is expressed in terms of such deaths per 1000 total births. OR Perinatal mortality is the sun of the fetal mortality and the neonatal mortality.

PERINATAL MORTALITY RATE

According to WHO

Perinatal Mortality Rate (PMR)

Late foetal deaths (2800ks gestation and more)  + early neonatal deaths (first wk in one year)

=                                                                                  X 1000

Live Births in the same year

·        Perinatal mortality is a problem of serious dimensions in all countries in developed countries perinatal mortality rates have gradually declined the post decades due to improved obstetric and  perinatal technologies.

·        Perinatal mortality rate is lowest when the mothers age at birth is 20-39. It is substantially higher for mothers giving birth at age less than 20 years and at ages 40-49.

·        The interval between the previous pregnancy and the current pregnancy has a strong negative effect on perinatal mortality.

        In the world nearly four million new borns die within the first week of life and another three million are born dead. In developed countries perinatal mortality is less than 10% thousand total births.

CAUSES OF PERINATAL MORTALITY

        About two thirds of all perinatal deaths occur infants with less than 2500 gm birth weight. The causes involves one or more complication in the mother during pregnancy or labour. In the placenta or in the foetus or neonate.

Main Causes:

        The main causes of death are intrauterine and birth asphyxia low birth weight birth trauma and intra uterine or neonatal infections. The various causes of perinatal mortality is grouped as below.

a) Antenatal Causes

1.   Maternal diseases: Hypertension cardio vascular diseases, diabetes tuberculosis anaemia.

2.   Pelvic diseases: Uterine myomas endometrosis, ovarian tumours.

3.   Anatomical defects: Uterine anamalies incompetent cervix

4.   Endocrise imbalance and inadequate uterine preparation

5.   Blood incompatibilities

6.   Malnutrition

7.   Toxemias of pregnancy

8.   Antepartum haemorrhage

9.   Cogenital defects

10.                     Advance maternal age

b) Intranatal Causes

1.   Birth injuries

2.   Asphyxia

3.   Prolonged effort time

4.   Obstetric complications

c) Postnatal Causes

1.   Prematurity

2.   Respiratory distress syndrome

3.   Respiratory and alimentary infections

4.   Congenital anomalies

d) Unknown Causes

        In some cases the causes are not clinically ascertainable.

PERINATAL MORTALITY RATE BY STATE

        Perinatal mortality rates for the 5 years period preceding the survey by state India, 2009-2010.

State	PMR	State	PMR
India North		North East
Delhi	35.0	Arunachal Pradesh	40.2
Haryana	36.7	Manipur	63.3
Himachal Pradesh	30.2	Meghalaya	23.4
Jammu & Kashmir	37.6	Mizoram	26.6
Punjab	33.2	Nagaland	22.5
Rajasthan	49.4	Sikkim	16.0
Uttaranchal	38.1	Tripura	42.0
Central		West
Chattisgarha	63.5	Goa	12.4
Madhya Pradesh	46.1	Gujarath	40.2
Uttar Pradesh	59.5	Maharashtra	35.8
East		South
Bihar	58.7	Andra Pradesh	47.3
Jharkhand	57.6	Karnataka	35.3
Orissa	55.6	Kerala	10.8
West Bengal	46.8	Tamil Nadu	33.0

Late foetal death + early neonatal

            death in one year

        PMR =                                                              X 1000

     Live birth in the same year

PREVENTION OF PERINATAL MORTALITY

        As every mother has the right to conclude her pregnancy safely so also has the baby got a right to be born alive safe and healthy.

        The following measures are helpful in reducing the perinatal mortality.

·        Pre-pregnancy health care and counseling

·        Genetic counselling in high risk cases and the role of prenatal diagnosis to detect genetic chromosomal or structural abnormalities.

·        Regular antenatal care with advice regarding health diet and rest

·        Improvement of maternal nutrition

·        Detection and correction of anaemia and prevention of pre-eclampsia, eclampsia, expectant management of placenta previa and early hospitalization in multiple pregnancy. Immunization against tetanus should done as a routine.

·        Screening of high risk patients

·        Careful monitoring in labour and avoidance of traumatic vaginal delivery.

·        Providing an efficient neonatal service specially to look after the pre-term babies

·        Health care education of the mother about the care of the new born.

PERINATAL MORBIDITY

DEFINITION

Perinatal morbidity is the major illness of the neonate from birth to first four weeks of life.

CAUSES OF PERINATAL MORBIDITY

·        Low birth weight

·        Birth injuries

·        Birth asphgxia

·        Infections

·        Prematurity

Low Birth Weight

        Low birth weight is defined as the one who birth weight is less than 2500 gm irrespective of the gestational age. The main factors influencing the low birth weight of the baby are

1.   Socio-economic status

2.   Nutritional and intrauterine environment

3.   Genetic control

PREVENTION

·        Regular antenatal check up

·        Advice the mother to have iron and folic acid tablets along with Vit C

·        Advice the mother to have caloric rich food and green leafy vegetables

BIRTH INJURIES

        Birth injuries remains as important cause of perinatal mortality and morbidity. Birth injuries is defined as injury to the infant resulting from mechanical forces such as compression or traction during child birth.

PREVENTION

·        Antenatal check up to find out the adequancy of pelvis

·        Care must be given during instrumental delivery

BIRTH ASPHYXIA

        Birth asphyxia or perinatal asphyxia is the state of the decreases oxygen delivery (hypoxia) to the fetus or neonate resulting in adequate tissue perfusion (ischaemia)

PREVENTION

·        Regular antenatal check up

·        Fetal monitoring

·        Advice the mother to avoid heavy exercise

INFECTIONS

        Infections are mainly classified into three

1.   Antenatal

2.   Intranatal

3.   Postnatal

        In antenatal period infections that can affect through the transplacental route are predominantly viruses. They are rubella, HIV, chicken pox and hepatitis B viruses. Other infections are syphilis and tuberculosis.

        In intranatal period aspiration of infected liquor or meconium following early rupture of the membranes. This may lead to neonatal sepsis, pneumonia and meningitis.

        In postnatal period in transmuron due to human contact infected mother, relatives or staff of the nursery.

        Cross infection from an infected baby on the nursery.

        Infection through feeding, bathing clothing and air borne.

PREVENTION OF PERINATAL MORBIDITY

·        Should not handle the baby with bare hands

·        Avoid infective visitors

·        Should wash the hands before handling the baby

·        Aspectic technique should be maintained during delivery

·        Advice the mother to wash the breast before and after feeding

·        The baby should be wrapped in sterile cloth

CONCLUSION

        Perinatal mortality is a serious problem of all countries. In developed countries perinatal mortality rate is gradually declined during the past decades due to improved obstetric and perinatal technologies. Perinatal morbidity is the major illness of the neonate from birth to first four weeks of life.

BIBLIOGRAPHY

·        A Text Book of D.C.Dutta, 5^th Edition, Page No.648-650.

·        A Text Book of Myles, 14^th Edition, Page No.1022.

·        A Text Book of Community Health Nursing, K.Park, Page No.390.