Factors affecting perinatal mortality in India (perinatal audit)

Objectives To determine the existing perinatal mortality rate in the various parts of India, to highlight the factors responsible for it and to make recommendations 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 developed by the World Health Organization for epidemiological studies. The survey performed was a case-control study. Results A total of 10 715 (5353 perinatal deaths, cases; and 5362 live births, controls) was included. When the number of antenatal visits increased to more than six during a pregnancy, perinatal deaths decreased threefold (p < 0.0005). The number of antenatal visits increased as the socioeconomic status and education level improved (p < 0.0005). Patients with early registration 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 perinatal death as compared to the higher socioeconomic group (p < 0.0005). Education 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 decreasing weeks of gestation (p < 0.0005). Twinning increased the odds of having a perinatal death by 2.47 (p < 0.0005, 95% CI 2.01-3.05). The second of twins 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 who did not (p <less than> 0.0005, odds ratio 1.51 95% CI 1.33-1.71). With increasing 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 abortion in the past (p = 0.001, odds ratio 1.22, 95% CI 1.09-1.36). The ideal spacing between children seemed to be 4 years in this study. Amongst the various maternal medical problems leading to perinatal death, anemia was the commonest, followed by hypertensive disorders. Amongst the 10 715 mothers, 4086 (38.1%) had obstetric problems such as antepartum hemorrhage, previous Cesarean section, intrauterine growth restriction, oligohydramnios, multiple pregnancy, leading to perinatal death. Neural tube defects were the commonest 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 during pregnancy, is recommended. Tobacco consumption in any form should be avoided. Periconceptional folate consumption to reduce neural tube defects which constitute almost 50% of congenital defects should be implemented. Actively promoting family planning and limiting gravidity and parity, preventing prematurity by good antenatal care and delivering patients with highrisk factors in well-equipped hospitals with efficient obstetric and neonatal services will go a long way in improving our perinatal statistics.