Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low-incomeurban population

We describe a prospective cross-sectional survey over a 12-month period in the principal maternity hospital of Kathmandu, Nepal, where over 50% of the local population deliver. The study aim was to estimate the contribution o f birth asphyxia to perinatal mortality in this setting. During 1995, there were 14 371 livebirths and 400 stillbirths, a total stillbirth rate of 27 per 1000 total births. The fresh term (2000 g or more) stillbirth rate was 8.5 per 1000 total births [95% CI 7.1, 10.1]. Ninety-two cases of neonatal encephalopathy (NE) affecting term infants were detected (excluding those d ue to congenital malformations, hypoglycaemia and early neonatal sepsis). T he birth prevalence of NE was 6.4 per 1000 livebirths [95% CI 5.2, 7.8]. Th ere was evidence of intrapartum compromise in 63 (68%) of the cases of NE a nd 65 (76%) of the stillbirths, but only in 12 (12%) of controls. The cause -specific early neonatal mortality rate for NE was 2.1 per 1000 livebirths [95% CI 1.4, 3.0]. Combining the NE deaths and fresh stillbirths gives an u pper estimate for term birth asphyxia perinatal mortality rate of 10.8 per 1000 total births [95% CI 9.2, 12.6], 24% of all perinatal deaths before ho spital discharge. This study suggests that birth asphyxia remains an import ant cause of perinatal mortality in developing countries. The paper discuss es the pros and cons of different strategies to reduce birth asphyxia in lo w-income countries.