An audit and trends of perinatal mortality at the Jinnah Postgraduate Medical Centre, Karachi.

OBJECTIVE To prospectively review the extent and determinants of perinatal mortality (PNM), at a large Government referral teaching hospital in Karachi and to compare the rate with previous data. METHODS One year study from 1st January to 31st December 2001 was carried out in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. A prospective review of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital either in the obstetric ward or in the neonatal nursery was done. The details of each mother and newborn delivered were recorded on standardized proforma. Aberdeen (Obstetric) classification of perinatal deaths was applied in the survey for classification of perinatal causes. RESULTS During the one year period from 1st January to 31st December, 2001, there were 7743 deliveries and 753 perinatal deaths. Five hundred and sixty nine were still born and 184 died within 7-days of birth. The perinatal mortality rate (PNMR) was 97.2/1000 total births and still birth rate 73.4/1000 total births. The leading cause of stillbirth was hypertensive disease of mother in 180 (24%). This included Pregnancy Induced Hypertension (PIH) 106 (14%) and eclampsia 74 (10%). The next common cause was mechanical, accounted for 161 (21.4%). Antepartum haemorrhage (APH) was responsible for 151 (20%) perinatal deaths and low birth weight (LBW) was identified in 108 (14.4%). Congenital malformation caused deaths in 47 (6.2%), maternal medical disorders as jaundice, anaemia and diabetes in 24 (3.2%) and neonatal infections as Respiratory Distress Syndrome (RDS), probable pneumonia, bleeding disorders and septicaemia caused deaths in 35 (4.8%). CONCLUSION Perinatal deaths are largely the result of poor maternal health, low socio-economic status, lack of health awareness and inadequate care during antepartum, intrapartum and postpartum period. Perinatal mortality rate has largely remained unchanged over the last 40 years at the premier referral and teaching institution of Karachi, due to higher patient influx and referral rate.