Causes of perinatal mortality and risk factors in a district of Shanghai after the implementation of universal two-child policy / 上海预防医学

Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy， and then explore effective interventions for preventing perinatal mortality. Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality， causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy. Results In total， there were 153 099 perinatal births from 2011 to 2020 in Changning District， in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births， showing an overall downward trend from 2011 to 2020 （ P <0.05）. Residents with local household registration had lower perinatal mortality， compared to those with non-local household registration， which was observed both before and after the universal two-child policy （ P <0.05）. Furthermore， the perinatal mortality showed an upward trend after the universal two-child policy （ χ 2trend=5.481， P <0.05）. The major causes of perinatal death were fetus and its accessories， fetal malformation， and maternal diseases during pregnancy before the universal two-child policy； in contrast， the causes changed to maternal diseases during pregnancy， fetus and its accessories， and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age， menstrual delivery， and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy （ P <0.05）. The most common pregnancy complication was gestational diabetes mellitus， gestational hypertension， and hypothyroidism during pregnancy after the universal two-child policy. Of them， the proportion of gestational hypertension increased from 6.56% （4/61） to 25.88% （22/85）. Conclusion Before and after the universal two-child policy， the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover， pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore， health education should be strengthened to improve the awareness of self-health care， especially for non-local women. Hierarchical perinatal health service， primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.

Causes of perinatal mortality and risk factors in a district of Shanghai after the implementation of universal two-child policy / 上海预防医学

Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy， and then explore effective interventions for preventing perinatal mortality. Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality， causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy. Results In total， there were 153 099 perinatal births from 2011 to 2020 in Changning District， in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births， showing an overall downward trend from 2011 to 2020 （ P <0.05）. Residents with local household registration had lower perinatal mortality， compared to those with non-local household registration， which was observed both before and after the universal two-child policy （ P <0.05）. Furthermore， the perinatal mortality showed an upward trend after the universal two-child policy （ χ 2trend=5.481， P <0.05）. The major causes of perinatal death were fetus and its accessories， fetal malformation， and maternal diseases during pregnancy before the universal two-child policy； in contrast， the causes changed to maternal diseases during pregnancy， fetus and its accessories， and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age， menstrual delivery， and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy （ P <0.05）. The most common pregnancy complication was gestational diabetes mellitus， gestational hypertension， and hypothyroidism during pregnancy after the universal two-child policy. Of them， the proportion of gestational hypertension increased from 6.56% （4/61） to 25.88% （22/85）. Conclusion Before and after the universal two-child policy， the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover， pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore， health education should be strengthened to improve the awareness of self-health care， especially for non-local women. Hierarchical perinatal health service， primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.

Study of maternal and fetal outcome in eclampsia at Government Medical college, Aurangabad, Maharashtra, India

Background: Eclampsia is an obstetric enigma. Eclampsia as a clinical entity has been known from times immemorial. Even today it is one of the dreaded complications. Today also eclampsia is a life-threatening emergency that continues to be a major cause of serious maternal and perinatal morbidity and it’s still the leading cause of maternal mortality in our country.Methods: Method analysis of case records of all eclampsia cases from study period of October 2013 to September 2015, a observational study.Results: The incidence of eclampsia was found to be 1.06% in GMC, Aurangabad. The number of maternal deaths of eclampsia patients was 7 out of 335 eclampsia cases. Maternal mortality in eclampsia patients was 2.08% in 2-year study, however maternal mortality in hospital was 0.23% in 2 years study and the perinatal mortality rate in eclampsia was 361 per 1000 total births. while it is 84 per 1000 total birth for total deliveries in GMC Aurangabad during study. Majority of patients i.e. 87.75% were in the age group of 16-25 years, 55.82% of total eclampsia were primigravida 57% eclampsia cases were referred from government or private hospitals, 11% booked in GMC and 32% patients were self.  Antepartum eclampsia was the commonest type 82.11%. 80% patients of eclampsia were delivered vaginally and 18% underwent caesarean section ,2% instrumental deliveries. 12% of babies had birth weight 1000gm. 41% babies delivered with weight 2001 gm. Out of 264 live births 92 babies required NICU admission and 45 babies died in early neonatal period.Conclusions: With good antenatal, intranatal and postnatal care with judicious use of anti-hypertensive, anti-convulsant and battery of investigations and judicious obstetric intervention, maternal and perinatal mortality can be reduced.

Implicancias epidemiológicas de la gestación múltiple en la salud pública

En los últimos años la gestación múltiple ha experimentado un aumento en su incidencia, posiblemente en relación a factores sociodemográficos, entre los cuales toma relevancia la postergación de la maternidad y también factores médicos (tratamientos de infertilidad), teniendo como consecuencia el aumento de las complicaciones y riesgos asociados, entre las cuales destaca la prematuridad, el riesgo de parálisis cerebral y complicaciones tales como la enfermedad hipertensiva de la gestación, hiperémesis, diabetes gestacional, entre otras.

Multiple gestation pregnancy rates have increased in recent years possibly related to socio-demographic factors including deferral of motherhood and some medical factors like fertility treatments. Associated complications including prematurity, cerebral palsy, hypertensive disease of pregnancy, hyperemesis, gestational diabetes have also increased.

Decreasing Pattern in Perinatal Mortality Rates in Korea: In Comparison with OECD Nations / 대한주산의학회잡지

PURPOSE: In Korea before 1996, the perinatal mortality rates (PMRs) were reported by individual studies, but the Korea Ministry of Health and Welfare started official reports of PMRs from 1996, and Statistics Korea provides the annual official data since 2007. The present study observed the decreasing trends of PMR and compared the PMRs between OECD nations. Thereby, we surveyed the terminology of PMR and the international trends in the usage of the calculation methods and intended to provide uniformity in calculating PMR in Korea. Also, the authors speculated some perinatal problems to be improved in the future in order to decrease PMR further. METHODS: Data before 1996 were gathered from individual reports, and after 1996 were utilized from Ministry of Health and Welfare, and Statistics Korea. Data of OECD nations were analyzed from OECD Health Data 2010. The changes in annual PMR of Korea was reviewed, which is helpful to recognize the current state of Korea, and was compared to that of OECD nations. RESULTS: During the past 50 years, the PMRs of Korea were remarkably improved (PMRs: 60 in 1960s, 35 in 1970s, 30 in 1980s, approximately, respectively). The official PMR values of Korea are as following: 6.0 in 1996, 5.2 in 1999, 4.6 in 2002, 4.2 in 2005, 3.6 in 2006, 3.7 in 2007, 3.6 in 2008, and 3.4 in 2009. The decreasing pattern of the annual PMR value was observed and the most recent value reflected the excellent situation in PMR compared to other OECD nations. CONCLUSION: Accordingly, we could observe the encouraging levels of PMR in Korea. We speculate that following efforts should be accompanied to achieve further improvement in PMR, such as improvements in neonatal and maternity transfer system, establishment in perinatal care centers, and establishment in perinatal research network system in Korea.

Trends in modes of delivery in Siriraj Hospital.

Objective: To determine the changing of trend in methods of delivery in a university hospital, the correlation among each method of delivery as well as the correlation of the cesarean section rates and the perinatal mortality rates. Methods: The medical records of birth in Siriraj Hospital during 1979-2006 were collected and analyzed. The methods of delivery from these data were grouped and categorizes as following : vaginal delivery, cesarean section, forceps extraction, vacuum extraction, vaginal breech delivery and others. Each method of delivery was studied separately in detail for time and accordingly trend and comparatively to the others to find interaction among them. The changing of trend of perinatal mortality rates were also demonstrated to identify the correlation with the cesarean section rate. Results: There were totally 442,635 births for this study. It was found that the percentage of vaginal delivery was decreased from 82.35 % in 1979 to 58.44 % in 2006 while the cesarean section rates was increased steadily from 7.06% in 1979 to 37.77 % in 2006. The other methods of delivery such as forceps extraction, vacuum extraction and vaginal breech delivery do not play significant roles in this changing trend since they have only small proportions ranging from about 2-5% of all deliveries. In the view of perinatal mortality rate , it continuously declined and has been less than 10% in the last 10 years. Conclusion: Regarding to 28-year review, it is clearly established that methods of delivery are now changing. Cesarean section rate rises steadily with unpromising sign of stabilization and is now far beyond the rate suggested by WHO. It directly effects the downward trend of vaginal delivery and also may be to the other methods of delivery such as vaginal breech delivery, forceps extraction and vacuum extraction, approaching the extinction. This study found no significant correlation between the increasing cesarean rates and the perinatal mortality rates.

Cesarean section rate and perinatal mortality rate at Siriraj Hospital during 1980-1990.

Cesarean section rates have increased markedly in many centers all over the world in the past 20 years. A retrospective analysis was made using the obstetrics data from one teaching hospital in Bangkok in order to see trends in cesarean section and perinatal mortality during the years 1980-1990. We analysed the annual cesarean section rate, the perinatal mortality rate, and the major indications for cesarean section. Z-test was used to investigate statistical significance. There was a significant increase in the primary cesarean section rate, the repeated cesarean section rate and the total cesarean section rate in the year 1980-1987. After 1987, the rates reached a plateau until December, 1990. Cephalo-pelvic disproportion, breech presentation and fetal distress were the three leading causes of cesarean section in this study. There were significant increase in cephalopelvic disproportion and fetal distress in the second half of the decade compared with the first half. Breech presentation at the time of delivery slightly increased during this time without statistical significance. Perinatal mortality rate decreased significantly from an average of 13.53 between 1980-1984 to 11.12 between 1985-1990. Increasing vaginal birth after cesarean section may be an important means to reduce the cesarean section rate by decreasing the repeated cesarean section rate. This practice has been reposted to lower cesarean section rates in many centers.