Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occuring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified from an estimated population of 54,400 total births giving a perinatal death rate of 38.0 per 1000 total births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many deaths as possible. In the event, 51 por ciento of perinatal deaths received such a postmortem examination, for the most part by 3 specially trained pathologists working in the capital. Postmortem rate was affected by sex, multiplicity of the infant, month of death and area of delivery. Deaths were classified using Wigglesworth scheme. The distribution categories was similar in the months when the postmortem rate was 70 por ciento to the rest of the time period when the post-mortem rate was only 40 por ciento . The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 por ciento of deaths. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.

Perinatal mortality in Jamaica: the role of intrapartum asphyxia and birth trauma

Data from the Jamaican Perinatal Morbidity and Mortality Survey, 1986-1987, were analysed in order to examine the frequency of pathological markers of asphyxia and birth trauma amongst fresh stillbirths and neonatal deaths in babies coming to necropsy. A total number of 1112 necropsies were performed. There were 295 normally formed fresh stillbirths and 463 neonatal deaths, 264 of whom died on the last day of life. One hundred and seventy (57.6 por ciento ) fresh stillbirths showed signs of asphyxia and 64 (21.7 por ciento ) had evidence of birth trauma. Signs of asphyxia were common in all the birth weight groups in 1st day neonatal deaths, being least common in the 0-999g group (19.6 por ciento ) and most common in those weighing 2500-3499g (48.7 por ciento ). Birth trauma was most common in infants with birth weights of over 2500g. It is of great concern that a large proportion of mature fresh stillbirths and neonatal deaths in Jamaica show pathological evidence of intrapartum asphyxia or birth trauma at necropsy. The problems underlying these deaths and the methods of preventing them need urgent attention.

Fatal malformations in Jamaica

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were in 96 (8.6 por ciento ) of 1112 perinatal and neonatal deaths coming to necropsy and in 25 (2.35 por ciento ) of 1085 other deaths. The central nervous system was not most commonly affected, followed by the renal, gastro-intestinal and cardiovascular system in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malfomation syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, its importance will increase as there is a fall in deaths related to perinatal asphyxia, currently the major cause of perinatal mortality in Jamaica. Although many malformations are currently untreatable, it is important to take account of gastro-intestinal defects when planning surgical services for the newborn, since these are the most easily remediable.