ABSTRACT
The Wigglesworth pathophysiological classification was used to analyse perinatal deaths occurring in 5 health centres in Bangladesh. The aims were to assess the feasibility of this classification, to determine the causes of perinatal deaths and thereby to identify the areas in need of intervention. A total of 8058 births were recorded at 5 centres during the period of 11 months from mid-January to mid-December 2001. There were 1069 deaths in the perinatal period. Stillbirths were slightly more frequent (53.5%) than early neonatal deaths (46.5%). Among the stillbirths, fresh stillbirths predominated over normally formed macerated ones at all centers except BIRDEM, where the majority (52.5%) was macerated. The majority (71.6%) of perinatal deaths were in the groups comprising asphyxial conditions (46.8%), conditions associated with immaturity (13.3%), and normally formed macerated stillbirths (NFMSB, 11.5%). In the group, 'other specific conditions' which was responsible for 9.3% of perinatal deaths, all but one case was attributed to sepsis. When the cases were subdivided by birth groups, asphyxia predominated in all but the <1000g group, in whom immaturity was responsible. Conditions associated with immaturity were second highest in number. The majority of the perinatal deaths (83.4%) was in babies less than 2500g. The study has shown that the Wigglesworth classification can be used in different types of health facilities in Bangladesh by doctors, nurses and midwives. The areas which need intervention are antepartum care, obstetric and newborn care practices, and environmental factors responsible for the high prevalence of prematurity and low birth weight.
Subject(s)
Asphyxia Neonatorum/mortality , Bangladesh/epidemiology , Birth Injuries/mortality , Cause of Death , Congenital Abnormalities/classification , Female , Fetal Diseases/classification , Fetal Hypoxia/mortality , Humans , Infant, Newborn , Infant, Newborn, Diseases/classification , Male , Pregnancy , Pregnancy Outcome/epidemiology , Prospective StudiesSubject(s)
Humans , Female , Pregnancy , Umbilical Cord/anatomy & histology , Cardiac Output/genetics , Diastole , Fetal Diseases/classification , Fetal Diseases/diagnosis , Regional Blood Flow/physiology , Regional Blood Flow/genetics , Laser-Doppler Flowmetry , Umbilical Veins , Blood Flow Velocity/physiology , Pregnancy Complications/diagnosis , Placenta , Prenatal Diagnosis , Ultrasonography, Prenatal , Uterus/blood supplySubject(s)
Humans , Female , Pregnancy , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular , Fetal Heart/abnormalities , Fetal Diseases/classification , Fetal Diseases/diagnosis , Fetal Diseases/physiopathology , Echocardiography , Ultrasonography, Prenatal , Fetus , Pregnancy Trimester, First , Risk FactorsABSTRACT
Fetal echocardiography was undertaken in 350 high risk pregnant females between 14 to 36 weeks of gestation at our institution. Significant fetal arrhythmias were diagnosed with the help of M-mode and pulsed Doppler echocardiography in 24 pregnant females. Three categories of arrhythmias were observed: (i) atrial or ventricular extrasystoles in 17, (ii) supraventricular tachycardia in 4, and (iii) congenital complete atrioventricular block in 3. The first category of arrhythmia was benign in 100 percent of cases with complete resolution before or just after birth. The second category was completely treatable with antiarrhythmic drugs given to the mother, thus preventing complications of heart failure and hydrops. In the third category, one fetus who had associated severe structural cardiac malformation, died in utero. The other two are doing well postnatally and are on medical follow up. Recognition of arrhythmias and appropriate prenatal treatment will prevent intrauterine death and also help avoid unnecessary operative or premature deliveries.