Factors affecting perinatal mortality in India (perinatal audit)

Objectives To determine the existing perinatal mortality rate in the variou s parts of India, to highlight the factors responsible for it and to make r ecommendations that would assist in improving perinatal survival rates. Methods A total of 43 centers from all over the country were enrolled. The analysis of the data was performed with the program Epilnfo version 5.0 dev eloped by the World Health Organization for epidemiological studies. The su rvey performed was a case-control study. Results A total of 10 715 (5353 perinatal deaths, cases; and 5362 live birt hs, controls) was included. When the number of antenatal visits increased t o more than six during a pregnancy, perinatal deaths decreased threefold (p < 0.0005). The number of antenatal visits increased as the socioeconomic s tatus and education level improved (p < 0.0005). Patients with early regist ration had more antenatal visits and a better perinatal outcome (p < 0.0005 ). The lower socioeconomic group had a 2.27-times higher risk of a perinata l death as compared to the higher socioeconomic group (p < 0.0005). Educati on improved the perinatal mortality by 2.12 (p <0.0005, odds ratio 0.47, 95 % CI: 0.43-0.51). Higher birth weight was associated with better chances of survival, being significant if > 2000 g in both singletons and twins (p <0 .0005). Perinatal mortality rate increased with delivery occurring at decre asing weeks of gestation (p < 0.0005). Twinning increased the odds of havin g a perinatal death by 2.47 (p < 0.0005, 95% CI 2.01-3.05). The second of t wins had 3.77 times the risk of a perinatal death as compared to the first of twins (p < 0.0005, 95% CI 2.35-6.06). There was a 1.57-times higher risk of a perinatal death in those who consumed tobacco as compared to those wh o did not (p <less than> 0.0005, odds ratio 1.51 95% CI 1.33-1.71). With in creasing gravidity or parity, the perinatal outcome worsened (p < 0.0005). There was a 1.22-times higher chance of perinatal death in case of an abort ion in the past (p = 0.001, odds ratio 1.22, 95% CI 1.09-1.36). The ideal s pacing between children seemed to be 4 years in this study. Amongst the var ious maternal medical problems leading to perinatal death, anemia was the c ommonest, followed by hypertensive disorders. Amongst the 10 715 mothers, 4 086 (38.1%) had obstetric problems such as antepartum hemorrhage, previous Cesarean section, intrauterine growth restriction, oligohydramnios, multipl e pregnancy, leading to perinatal death. Neural tube defects were the commo nest congenital malformation seen in our study. Conclusions Early registration for antenatal care, preferably in the first trimester with a minimum of six antenatal visits, preferably 12 visits duri ng pregnancy, is recommended. Tobacco consumption in any form should be avo ided. Periconceptional folate consumption to reduce neural tube defects whi ch constitute almost 50% of congenital defects should be implemented. Activ ely promoting family planning and limiting gravidity and parity, preventing prematurity by good antenatal care and delivering patients with highrisk f actors in well-equipped hospitals with efficient obstetric and neonatal ser vices will go a long way in improving our perinatal statistics.