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Intrapartum Still Births: Is there a Scope to improve

 
Author(s) Name:

Raheel Sikandar, Nusrat Nisar, Falak Naz

Address of Correspondence

Dr. Raheel Sikandar, Associate Professor ,Obs&Gyn, Liaquat University of Medical & Health Sciences Jamshoro.

Abstract

Objective: To assess the frequency and causes of intrapartum still births in tertiary care hospital and to identify the quality related issues in these intrapartum deaths.
Study Design: Observational Study
Place and Duration of the Study: Study conducted from 1 Febuary 2011 to 29 February 2012 at Obs/Gyn unit IV, Liaquat University of Medical Health Sciences (LUMHS) Jamshoro.
All still born babies of more than 32 weeks gestation with a positive heart beat at the onset of labour were included, antenatal foetal deaths and still borns with congenital anoma-lies were excluded from the study. The medical records of every intrapartum still birth was eva-luated and included in the study after taking informed consent from the mother or family. Infor-mation regarding socio demographic, high risk obstetric conditions ( prematurity, Hypertensive disorders in pregnancy and Antepartum hemorrhage), mode of delivery, delayed decision regard-ing delivery, communication gap between junior and senior staff members and availability of re-sources was recorded on the preformed proforma.
Results: The still birth rate was 24.2/1000(52/2142 births) births among these, 9 (4/1000 birth) were intrapartum still births. Mean maternal age was 28± SD years. Thirty three percent were pri-migaravida and 44.4% were booked for antenatal care. Caesarean section (CS) was the mode of delivery in 2(22.2%) cases, whereas the rest were delivered vaginaly. Prematurity, hypertensive disorders in pregnancy and abruption were 4(44.4%), 2(22.2%) and 2(22.2%) respectively. Risk identification problems were present in 22.2%, poor obstetric management because of lack of unit protocol was responsible in 22.2% of cases and resource unavailability caused delay in care provision in 44.4% of the cases. These women delivered with in a mean time of 4±SD hours at the facility. Mean birth weight of the neonates was 2.7±SD kg and 55.6% of them were at term.
Conclusion: Intrapartum still birth rate of 4/1000 in a university hospital is very high. There is scope to improve intrapartum care even in high-performance settings like university hospitals. Improved quality of intrapartum care and neonatal resuscitation through drills and audits, are promising strategies so is the involvement of hospital administration in quality care issues.
Key Words: Intrapartum stillbirth, Quality care, Emergency Obstetric and Neonatal Care.

 

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