Changing trends in perinatal deaths at the Armed Forces Hospital, Riyadh, Saudi Arabia.

A total of 104522 babies were delivered at the Riyadh Armed Forces Hospital between 1979 and 1998, including 807 stillbirths and 658 neonatal deaths. The 20-year period was divided into four 5-yearly intervals for comparative purposes. The overall Perinatal Mortality Rate (PMR) for infants weighing 500 grams or more ranged between 20.2 per 1000 in 1979 and 13 per 1000 in 1998. The lowest PMR of 10.3 per 1000 was recorded in 1985. Thirty-one per cent of the perinatal deaths were unbooked. The corrected neonatal death rate (excluding congenital anomalies) dropped from 10.1 per 1000 in 1979 to 1.7 per 1000 live births in 1998 - The corrected stillbirth rate dropped from 12.1 per 1000 births in 1979 to six per 1000 in 1998. Of the 807 stillbirths, 24.1% had lethal congenital anomalies while 29.5% were unexplained, 4% had hydrops fetalis, 2% died as a consequence of toxaemia of pregnancy, 7.5% were associated with antepartum haemorrhage, 7.9% were mechanical, related to cord accident and ruptured uterus, 9.8% died as a consequence of maternal disease, 5.4% of intrapartum asphyxia and 6.4% placental insufficiency. Of the 658 neonatal deaths, 47.5% had lethal congenital anomalies, 2% had hydrops fetalis, 7.6% died as a result of intrapartum asphyxia, 38% died as a result of prematurity with its complications of severe respiratory dysfunction and intraventricular and pulmonary haemorrhage, 4.1% died in NICU of secondary infection and 0.7% were unclassified. The overall PMR for infants weighing 500 grams or more was 14.1 per thousand. Congenital anomalies and low birth weight/prematurity accounted for 85.5% of the neonatal deaths. Congenital anomalies and unexplained deaths accounted for 53% of total stillbirths while maternal disease was responsible for 9.8% of total stillbirths. Reducing congenital anomalies and preventing prematurity and provision of good antenatal care will help in reducing PMR still further.

Transabdominal cervicoisthmic cerclage.

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Intrapartum rupture of the gravid uterus.

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Transabdominal cervicoisthmic cerclage: the Riyadh Armed Forces Hospital experience.

Between 1985 and 1996, 17 transabdominal cervicoisthmic cerclage procedures were performed and followed up through 28 pregnancies at Riyadh Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Fourteen procedures were carried out during pregnancy and three preconceptionally. Twenty-four pregnancies continued beyond 36 weeks of gestation and three were premature deliveries. The material used was an infant feeding tube size 6 and the knot was tied posteriorly. The sole miscarriage was at 6 weeks' gestation. All deliveries were by caesarean section. Fetal survival was 92%. In conclusion, abdominal cerclage is an effective and safe operation which helped the pattern of pregnancy wastage to be restored to normal in selected patients.