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TEMPLATE DESIGN © A FIVE YEAR REVIEW OF PERINATAL MORTALITY IN PUTRAJAYA HOSPITAL MALAYSIA FROM 2006 T TOWARDS ACHIEVING MILLENIUM DEVELOPMENT GOAL NUMBER FOUR Noraihan MN, Sofia Annaim A. Department of O&G, Putrajaya Hospital, Malaysia Objectives Conclusions 10 years Obstetric record of PJH Annual perinatal census (National Stillbirths and Neonatal forms) of PJH Methods Using the annual perinatal census in for PJH, the data was obtained specifically based on the National Stillbirths and Neonatal forms where the data was collected prospectively. The causes of perinatal mortality were grouped according to the Modified Wigglesworth classification. The data was then organized into the Microsoft Excel files and the results were analyzed descriptively. The total births for the whole five years in PJH ( ) was (Figure 1), while total deliveries were 26874, with total of 116 mothers and 119 babies involved. The Crude PNMR is 6.07, 5.10, 3.76, 4.23 and 2.54 respectively. The corrected PNMR is 5.27, 3.88, 2.90, 3.39 and 1.27 respectively (Figure 2). The five years Stillbirth Rate is 4.66, 4.08, 2.22, 3.22 and 1.82 respectively (Figure 3) with the Early Neonatal Death (ENND) rate of 1.42, 1.02, 1.54, 1.02 and 0.73 respectively. The objectives were to ascertain the perinatal mortality rate (PNMR) in Putrajaya Hospital (PJH) for the past five years ( ), the causes and the associated sociodemographic data. Results The majority is macerated stillbirth (MSB) (55.2%), followed by ENND (26.70%) and fresh stillbirth (FSB) (18.10%). The major cause of mortality is due to prematurity (32.8%) followed by unknown causes (29.31%), lethal congenital malformation (LCM) (23.30%), asphyxia (11.20%) and death due to infection (3.40%). In 2010, there was no death due to asphyxia (Figure 4). In the preterm babies, 31.30% were less than 28 weeks period of amenorrhea (POA) and 31.30% were near term i.e. 34 to 36 weeks. The majority (32.80%) weigh less than 1001 gram followed by 26.70%, which weigh more than 2500 gram. The main cause of death in this near term group was unknown. In cases of LCM, majority is caused by multiple gross abnormalities (7.76%), followed by neural tube defect (6.03%), hydrop feotalis (4.31%), complex cyanotic heart disease (2.59%), Patau Syndrome (1.72%) and Edward’s Syndrome (0.86%) CRUDE AND CORRECTED PERINATAL MORTALITY RATE Male gender fetus accounted for 50.10%, while 44.80% were female and 4.30% were unknown. The mothers were mainly between 28 to 30 years old and 50% were multiparous. Primigravida accounted for 44% and 6% were grandmultiparous. Majority of mothers came with preterm deliveries (57.80%), while others with diabetes mellitus (12.10%), hypertension (11.20%), other associated medical illness (8.60%), per vaginal bleeding (7.80%), anemia (6.90%), unknown illness (3.40%) and prolonged rupture of membrane (2.60%). The cases mainly involved the ethnic Malays (84.50%), followed by other ethnics ( 9.50%), Chinese (5.20%) and Indians (0.86%). Majority of them received antenatal care (ANC) at health clinics (43.10%), followed by hospital centre (29.30%), private maternity center (19.00%) and 8.6% had no ANC. Years Numbers The crude and corrected PNMR in PJH for the past five years ( ) is low and reducing in trend i.e from 6 per 1000 to 2 per 1000 births. There is also a decrease in both the stillbirth and ENND rate. The main cause is prematurity followed by unexplained and LCM. Malay multipara between years old, accounts for majority cases with almost half receiving their ANC from health clinics. Further research needs to be performed to ascertain the causes of the MSB and identify risk factors for prematurity in the PJH population. References
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