Perinatal Mortality and Morbidity

Perinatal Mortality and Morbidity - Setting the Stage

• Perinatal Period:
  • WHO: From 22 completed weeks gestation to 7 completed days after birth.
  • India (National): From 28 completed weeks gestation to 7 completed days after birth.
  • Birth weight criteria: >500g (WHO) or >1000g (India, if gestation unknown).
• Stillbirth (SB): Fetal death at or after 28 weeks gestation (India) or 22 weeks (WHO), before/during birth.
• Neonatal Death (NND): Death of a live-born infant within the first 28 completed days of life.
  • Early NND: Death in the first 7 days.
  • Late NND: Death from 7 up to 28 days.
• Perinatal Mortality Rate (PMR): $PMR = \frac{\text{(Stillbirths + Early Neonatal Deaths)}}{\text{Total Births (Live Births + Stillbirths)}} \times 1000$
• Stillbirth Rate (SBR): $SBR = \frac{\text{Stillbirths}}{\text{Total Births}} \times 1000$
• Neonatal Mortality Rate (NMR): $NMR = \frac{\text{Neonatal Deaths}}{\text{Live Births}} \times 1000$

⭐ India's approximate PMR (SRS 2020) is 20 per 1000 total births. The global target (Every Newborn Action Plan - ENAP) is <12 per 1000 births by 2030.

Perinatal Mortality and Morbidity - The Why Behind Loss

Key etiological factors, especially relevant in India:

• Prematurity & LBW: Leading overall cause.
• Birth Asphyxia: Major preventable factor.
• Infections: Maternal (e.g., TORCH, sepsis) & neonatal.
• Congenital Anomalies: Structural/functional defects.
• Maternal Conditions: Severe anemia, hypertensive disorders, diabetes.

Breakdown of Causes:

⭐ In India, approximately 20-25% of perinatal deaths are attributed to birth asphyxia and trauma, highlighting the critical need for skilled obstetric and neonatal care during delivery and immediately postpartum.

Perinatal Mortality and Morbidity - Surviving with Scars

• Hypoxic-Ischemic Encephalopathy (HIE): Brain injury from perinatal asphyxia.
  • Sarnat Staging: I (mild), II (moderate), III (severe).
  • Therapeutic hypothermia for moderate/severe HIE within 6 hours.
  • Sequelae: Cerebral palsy, epilepsy, cognitive impairment.
• Respiratory Distress Syndrome (RDS): Surfactant deficiency in preterms (<34 weeks).
  • CXR: Ground-glass, air bronchograms.
  • Rx: Antenatal steroids, surfactant, CPAP.
  • Complications: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP).
• Neonatal Sepsis:
  • Early onset (<72h): Maternal Group B Streptococcus (GBS), E. coli.
  • Late onset (>72h): Nosocomial/community.
  • Rx: IV antibiotics.
• Birth Injuries:
  • Brachial plexus: Erb's palsy (C5-C6), Klumpke's palsy (C8-T1).
  • Fractures: Clavicle (most common).
  • Cephalohematoma (subperiosteal, respects sutures).

⭐ Severe HIE (Stage III) is a major predictor of long-term neurodevelopmental disabilities like cerebral palsy and severe cognitive deficits.

Perinatal Mortality and Morbidity - Saving Tiny Lives

Perinatal Mortality Rate (PMR): Deaths from 22 weeks gestation to 7 days post-birth per 1000 total births. Key causes: prematurity, birth asphyxia, infections, congenital anomalies.

Wigglesworth Classification of Perinatal Deaths:

• Antenatal: ≥4 ANC visits, Iron-Folic Acid, Tetanus Toxoid, High-risk screening.
• Intrapartum: Skilled birth attendance, Clean delivery (5 Cs), Essential Newborn Care (ENC).
• Postnatal: Kangaroo Mother Care (KMC), Exclusive breastfeeding, Danger sign recognition.

Perinatal Death Audit Steps:

⭐ Kangaroo Mother Care (KMC) is a high-impact, low-cost intervention proven to reduce mortality by up to 40% in stable preterm infants.

High-Yield Points - ⚡ Biggest Takeaways

• Perinatal period: 22 weeks gestation to 7 days post-birth.
• PMR: Stillbirths (≥28 wks) + Early Neonatal Deaths (≤7 days) per 1000 total births.
• NMR: Deaths in first 28 days of life per 1000 live births.
• Leading causes of PMR: Prematurity, birth asphyxia, infections, congenital anomalies.
• IUGR significantly ↑ perinatal morbidity & mortality.
• Key maternal risk factors: Hypertension, diabetes, anemia, maternal infections.