Çocuk Sağlığı ve Hastalıkları Dergisi
2010 , Vol 53 , Num 3
Hacettepe Üniversitesi Hastanesi 2001-2006 dönemi perinatal mortalite analizi
Hacettepe Üniversitesi Tıp Fakültesi Perinatal Mortalite Çalışma Grubu: Hacettepe Üniversitesi Tıp Fakültesi 1Pediatri
Doçenti, 2Kadın Hastalıkları ve Doğum Öğretim Görevlisi, 3Pediatri Profesörü, 4Kadın Hastalıkları ve Doğum Profesörü,
5Pediatri Yardımcı Doçenti, 6Patoloji Profesörü ,7Pediatrik Cerrahi Profesörü, 8Pediatri Uzmanı
Perinatal mortality statistics are important indicators of the quality of the
perinatal health care system on an institutional or national basis and are
necessary for the identification of the problems and implementation of
preventive measures in the perinatal health care system. However, perinatal
mortality statistics on an institutional or national basis are inadequate in
Turkey. In this study, we aimed to make a comprehensive perinatal mortality
analysis of the 2001-2006 period in our tertiary care university hospital and
to compare results with previous reports of our institution. The Perinatal
Mortality Study Group prospectively analyzed the perinatal mortality cases
regularly each month. The study group was composed of stillbirths including
intrauterine and intrapartum deaths, pregnancy terminations and early neonatal
deaths occuring after 22 completed weeks of gestation until the end of the
7th day of postnatal life or in cases with a birth weight of at least 500 g. The
definitions of the World Health Organization were used for the calculation
of perinatal, stillbirth and early neonatal mortality rates. Wigglesworth and
de Galan-Roosen “fundamental” perinatal mortality classifications were used
for the distribution of the cases. During the study period, 353 perinatal
mortality cases were identified. Of these, 219 (62%) were stillbirth (28.3%
intrauterine death, 7.4% intrapartum death and 26.3% pregnancy terminations)
and 134 (38%) were early neonatal deaths. The distribution of cases according
to Wigglesworth classification was as follows: intrauterine deaths 10.8%,
congenital malformations 35.5%, prematurity 25.2%, perinatal asphyxia 12.5%,
and special causes 15.9%. According to de Galan-Roosen “fundamental”
classification, 0.6% trauma, 2.8% infection, 9.0% placenta-cord pathology,
3.1% maternal immune system pathology, 36.3% congenital malformations,
25.2% prematurity, and 13.0% unclassified cases were identified. Mean
stillbirth rate was 21.9‰, while early neonatal mortality rate was 13.7‰ and
perinatal mortality rate was 35.3‰ for the whole study period. In spite of a
progressive decline in all mortality rates from 2001-2004, an approximately
1.5-2.8-fold increase was detected from 2005-2006. The ratio of stillbirths
to total births increased from 1.6% in 2004 to 2.9% in 2006, and the ratio
of early neonatal deaths to live births increased from 0.7% in 2004 to 1.8%
in 2006. The analysis of the causes of early neonatal mortality showed a
four-fold increase in prematurity from 0.3% in 2004 to 1.2% in 2005-2006
but similar rates of congenital malformations, perinatal asphyxia and special
causes between the two periods. In our hospital, prematurity rate ranged
between 19.2-24.6% during the 2001-2006 period.However, the ratio of very premature infants (gestational age <28 weeks) increased approximately
two-fold from 4.4% in 2004 to 8.2-9.6% in 2005-2006. It is concluded that
the perinatal mortality rate, which declined during from 2001-2004, showed
an increase due mostly to increased early neonatal mortality rate and then
stillbirth rate. The increased ratios of high-risk very premature infants among
live births and of intrauterine deaths and pregnancy terminations among total
births due to late referral seem to be the most important factors contributing
to increased early neonatal mortality and stillbirth rates.
Anahtar Kelimeler :
perinatal mortalite, ölü doğum hızı, erken neonatal mortalite