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.

Keywords: perinatal mortalite, ölü doğum hızı, erken neonatal mortalite