Suchergebnisse

Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs) which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal. Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach) worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.

Through the set hypotheses and presented results of statistical analysis it
was attempted to answer the question of what more could be done in our
country, especially in the health sector, to decrease perinatal mortality,
so as to achieve the level which some northwest European countries already
have. On the basis of data of official statistics, there is still
insufficient cooperation in Belgrade between departments in the same health
institution, as well as between certain levels of health care, without
appropriate transfer of information on the women who have just given birth,
namely the new-born (pregnancy card). A lack of uniformity in the level of
equipment and insufficient usage of genetic counseling offices is present.
About 62% of pregnant women reports to the counseling offices for pregnant
women for the first time in the first trimester, which is not sufficient.
The standardization of the application of doctrinal standpoints should be
achieved, especially in the diagnosis of risk factors and the provision of
adequate medical documentation for transfer of information during pregnancy,
labor and the condition of the newborn. Within that, it is necessary to
continually provide expert advanced training of health workers in the
future, in the organization of the relevant institution. The research
results of biological variables of women who have just given birth, such as
average age, parity, abortion and illness in her reproductive history, as
well as the most common complications during delivery, showed that no
significant deviation as regards this risk factor within control and risk
groups. The stated data indicated that in the risk group there were somewhat
more primipara, which might present an increased factor of risk for the
outcome of the delivery, while there were almost the same percentage less
than in the control group of the women who bore their second child. On the
other hand, there were less women who previously had an abortion in the
sample. Biological variables of newborns showed that in the risk group, out
of the total infant deaths, 41.6% were stillborn, and 57.3% died during the
first week, namely 22.6% during the first day of life. The ratio between
sexes was almost identical: 44.8% of dead newborns were male and 44.4% were
female sex. In the first twentyfour hours, namely in the first five hours
upon birth, the mortality of male newborns was greater by about 10%. The
mortality of female newborns was greater in the second day of life, by about
7% of the mortality of the male newborns of the same age. Upon reception
into the maternity hospital already, normal state of the fetus was noted in
only one third of the cases with these deliveries, while in two thirds death
had already occurred or suffering of the fetus was present. As many as 198
or 71% of newborns were prematurely delivered. Not a single delivery was
noted after term. 3.9% of the newborns had weight upto 499 grams, as many as
29.4% had exceptionally small weight (500-999 g), and another 20.8% small
weight at birth (1000-1499 g). In 19.4% cases, the fetus was completely
immature, while in 60.6% of the cases the delivery came between the 28th and
36th gestation weeks. As early as the first minute of birth, the lives of
over 60% of the liveborn children were endangered (low apgar score). Over
one half of the newborns which received the mark one or two in the first
minute upon birth, died in the first seventy-two hours of life. The most
critical were the first five hours upon birth, as well as the second day of
life. The knowledge of the samples of seminatal mortality in Belgrade also
represents a basis for further programming of health care for the mother and
child on the city level. A dominant mortality sample is severe asphyxia
(60%). In 13.8% of the cases, the cause of death is registered as unmarked
or unknown, so the second place according to intensity is present as
respiratory distress (6.9%). Multiple deliveries with seminatal mortality
were present in 26.9% cases. Most of the deliveries were carried out with
the "normal" position of the fetus, while 15.1% of the deliveries were
pelvic, and 17.3% were carried out by some childbearing operation technique.

Ispitana je perinatalna smrtnost prijevremeno rođenih blizanaca (do 37. tjedna) u Šibeniku, Zadru i Splitu u razdoblju od 1. siječnja 1988. do 31. prosinca 1990. godine (Period A) i od 1. siječnja 1991. do 30. rujna 1993. godine (Period B). Period A je vrijeme društveno političkih previranja u bivšoj Jugoslaviji, a Period B je vrijeme izravne vojne agresije. U Periodu A je bilo 23826 porođaja, od kojih je 234(0,98%) blizanačkih, a u Periodu B na 22292 porođaja 260(1,17%) su porođaji blizanaca. U periodu A nalazimo 140(29,9%), a u Periodu B 198(38,1%) prijevremeno rođenog blizanca (X 2 = 7,28; P0.05). Da je perinatalna smrtnost blizanaca u Periodu B bila kao u Periodu A, tada bi 14 blizanaca prijevremeno rođenih ostalo u životu. Autori zaključuju da je izravna vojna agresija na područje Šibenika, Zadra i Splita u trudnica sa blizancima prouzročila s jedne strane slabu neonatalnu zaštitu, ili je potpuno onemogućila, a s druge strane prouzročila je fizičke i psihičke traume, što je udruženo dovelo do povećanog prijevremenog rađanja blizanaca, posebice blizanaca do 31. tjedna trudnoće, povećanog rađanja blizanaca porođajne težine do 1499 g, s posljedičnim visokim perinatalnim mortalitetom. Izravna vojna agresija je neizravno prouzročila smrt 14 blizanaca, koji su prijevremeno rođeni. ; Perinatal mortality of preterm twins (up to 37 weeks of gestation) is analyzed, born in Šibenik, Zadar and Split in the two examined periods of time. Period A (1st January 1988 - 31st December 1990) is the time of socio-political turmoil in ex-Yugoslavia, whereas Period B (1st January 1991 - 30th September 1993) is the time of the direct military aggression on the area in question. In the Period A there were 23826 births, 234 (0.98%) of which were twins. Out of 22292 births in the Period B, 260 twins (1.17%) were born. In the Period A 140 twins (29-9%) were born prematurely, compared to 198 (38.1%) in the Period B (X2 = 7.28; pcO.Ol). Twin births before 31 weeks of pregnancy occurred less frequently in the Period A than in the Period B (4.3% :10.1%). Similarly, in the Period A there were less twins of the birthhweight under 1500 g (4.3% -14.7%) (p0.05). Had the perinatal mortality in the Period B been the same as in the Period A (and one should have expected even lower mortality rates), 14 premature twins would have lived. The authors draw a conclusion that the direct military aggression on the regions of Šibenik, Zadar and Split caused on the one hand poor or no antenatal care and on the other hand physical and psychological traumas to pregnant women. This led to an increased number of premature twin births, especially before 31st week of gestation, higher number of twins of birth weight under 1500 g and consequently to a high perinatal mortality. Direct military aggression indirectly caused the death of 14 premature twins.

SummaryPerinatal mortality among hospital deliveries in Lucknow city in 1976–77 is compared with the results of earlier studies. The effect of biological and socioeconomic factors is considered. High risk cases, for which special care should be provided, are noted.