Please wait a minute...
Clinical and Experimental Obstetrics & Gynecology  2021, Vol. 48 Issue (1): 144-150    DOI: 10.31083/j.ceog.2021.01.5466
Original Research Previous articles | Next articles
What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India
Momina Zulfeen1, 2, *(), Rekha Upadhyay1, Sapna V. Amin1, Muralidhar V. Pai1, Leslie Lewis3
1Department of ObGyn, Kasturba medical college, 576104 Manipal, India
2Mount Sinai Hospital, University of Toronto, M5S Toronto, Canada
3Department of Pediatrics, Kasturba medical college, 576104 Manipal, India
Download:  PDF(673KB)  ( 46 ) Full text   ( 19 )
Export:  BibTeX | EndNote (RIS)      
Abstract  
Objective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audit process exists. The aim of this study was to perform a qualitative perinatal audit and devise methods for future audits. Methods: We conducted a one year audit for all perinatal deaths using WHO ICD PM and 3-delay classification. Gestational age(GA) specific mortality was calculated for significant underlying factors using fetuses-at risk approach. Results: We recorded a perinatal mortality rate of 6.1/1000 births among booked cases and 21.32/1000 births among referred cases. Fetal growth restriction was the most common antenatal condition, accounting to 33.3% of antepartum deaths. Prematurity accounted to 52% of neonatal deaths. Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (> 24h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk-factor. GA specific mortalities, calculated using fetuses-at risk approach, show a peak mortality rate at 30 weeks, 37 weeks and 38 weeks in pregnancies with early-onset preeclampsia, severe fetal growth restriction and medically treated gestational diabetes respectively. Conclusion: The audit identified significant contributing factors to the mortality. ICD-PM and 3-delay classification was simpler and easier to apply with wide areas of opportunities for secondary analysis.
Key words:  Perinatal mortality      Clinical audit      ICD-10      Maternal health services     
Submitted:  21 December 2019      Revised:  16 August 2020      Accepted:  20 August 2020      Published:  15 February 2021     
*Corresponding Author(s):  Momina Zulfeen     E-mail:  momina.zulfeen@manipal.edu

Cite this article: 

Momina Zulfeen, Rekha Upadhyay, Sapna V. Amin, Muralidhar V. Pai, Leslie Lewis. What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(1): 144-150.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2021.01.5466     OR     https://ceog.imrpress.com/EN/Y2021/V48/I1/144

[1] A. Simsek, S. Uludag, A. Tuten, A. S. Acikgoz, S. Uludag. Maternal and perinatal outcomes in early onset and late onset preeclampsia[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(6): 837-841.
[2] C. Goudeli, L. Aravantinos, D. Mpotsis, G. Creatsas, A. Kondi-Pafiti. Clinicopathological changes of perinatal mortality during the last 20 years in a tertiary hospital of Greece[J]. Clinical and Experimental Obstetrics & Gynecology, 2017, 44(5): 734-739.
[3] G. Kennady, M.J. Kottarathara, A.J. Kottarathara, R. Ajith, T.M. Anandakesavan, K. Ambujam. Maternal and neonatal outcomes in pregnancy induced hypertension: an observational study[J]. Clinical and Experimental Obstetrics & Gynecology, 2017, 44(1): 110-112.
No Suggested Reading articles found!