Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study

Abstract

Objective To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. Design Retrospective study. Setting Labour and maternity unit of a tertiary centre in South India. Population or sample Women who gave birth between 2000 and 2018. Methods Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re‐organisation, and minor changes in staffing and infrastructure. Main outcome measures Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. Results Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. Conclusion In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. Tweetable abstract Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.

A multicenter study of incidence, risk factors and outcomes of babies with birth asphyxia in Nepal

“…The overall incidence of BA reported in developed countries ranges from 1.6 to 24% varying by the type of study (single or multicenter or population based) and the operational definition of BA [22][23][24]. Multi-centric study in South India reported incidence of 24% [25] and 36% in a single center study in Nepal [26]. Similar, incidence of BA has been reported from systematic reviews and metaanalysis in Africa range from 15.9 to 22.3% [12,23,27].…”

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

“…Not all studies were focused solely on evaluation of CTG training: Nine studies considered CTG training as a component of much wider organisational changes and restructuring (Appendix S3 ). 37 , 49 , 60 , 62 , 63 , 64 , 70 , 72 , 86 It was not possible to specifically assess the impact of CTG training alone in these studies, and the components and outcomes reported in these organisational interventions varied markedly (Appendix S3 ). We did not identify any studies that evaluated the impact of CTG training on the use of resources.…”

“…We identified 64 studies that met our inclusion criteria (Figure 1) reported across 65 papers (two papers reported different outcomes from the same study) 23–86 . One relevant study protocol was not included because the study is still ongoing 87 .…”

Analysis of the perinatal mortality rate in the metropolitan region of grande Vitória, Espírito Santo, Brazil, between 2008 and 2017

“…and 2015, the perinatal mortality rate changed from 22.3 to 17.4 per thousand births, with the southern region having the lowest rate and the northeast the highest, with values of 15.4 and 21.2, respectively [6][7][8] . Several authors point out risk factors associated with perinatal mortality, evidencing avoidable causes closely related to the quality of care, ranging from situations arising from the quality of prenatal care, delivery and newborn care [6][7][8][9][10] .…”