VITAL STATISTICS AIM : To reduce maternal, fetal and neonatal deaths related to pregnancy and labour by evaluating the data and taking measures to prevent the causes. DEFINITIONS : a) Birth: The complete expulsion or extraction from the mother of the fetus irrespective whether the umbilical cord has been cut or the placenta is attached. Fetus should be more than 500grams or 20 weeks of gestation.

Cont … Definitions.. b) Crude Birth Rate: The number of live births per 1,000 population. c) Fertility Rate: Number of live births per 1,000 female population (aged 15-44). d) Live Birth: Any infant who shows any signs of life at birth (i.e. H.b. breathing movement, etc.) e) Still Birth: No signs of life present at or after birth.

Cont … Definitions … f) Neonatal Death: Early NND death at a live born infant during the first 7 days. Late NND. g) Direct Maternal Deaths: Deaths of the mother resulting from obstetrical complications of pregnancy, labour or puerperium.

Cont … Definitions. h) Indirect Maternal Death: An obstetrical death not directly related to obstetrical causes, but resulting from previously existing disease or diseases that developed during pregnancy, labour or puerperium but was aggravated by the physiological adoption of pregnancy, i.e. heart disease (valvular).

Cont … Definitions. i) Still Birth Rate: Number of stillborn infants per 1,000 infant born including live or still births. j) Perinatal Mortality Rate: Number of still births plus neonatal deaths per 1,000 total births. k) Low Birth Weight: Less than 2,500 grams l) Term Infant: Any infant born between 37 (completed menstrual week) to 42 weeks ( days). m) Premature or Preterm Infant: Any infant born between 37 completed menstrual weeks.

Cont … Definitions. n) Post-term: Infant born after 42 completed menstrual week. o) Abortus: A fetus or embryo removed or expelled from the uterus during the first 20 weeks of gestation or weigh less than 500 grams or measures less than 25 cm. in length. p) Maternal Mortality Ratio (Rate): Number of maternal deaths that results from the reproductive process per 100,000 live births.

POST-TERM PREGNANCY DEFINITION INCIDENCE ETIOLOGY CONFIRMATION COMPLICATION MANAGEMENT

POST-TERM PREGNANCY DEFINITION: Post-term: 42 completed weeks of gestation 294 days from LMP 280 days from date of conception Post-mature: Specific clinical syndrome, divided into 3 stages stage 1: clear amniotic fluid stage 2: skin stained green stage 3: skin discoloration yellow-green

Features include: Wrinkled, patchy peeling skin, long thin body, open eyed, unusually alert, old and worried looking, long nails and skin wrinkled in soles and palms.

INCIDENCE:  Overall is 10% Completed 4127 % Completed 4214 % Completed 43 2 – 7 %  Incidence is  Why? Because of accurate dating (U/S).

Incidence vary according to: 1. Population studied 2. Rate of preterm labour 3. Rate of induction 4. Rate of elective caesarean section 5. Rate of ultrasound

ETIOLOGY: 1. Error in determining the time of ovulation and conception according to LMP time (most frequent). 2. Failure to recall accurate LMP and variable length of proliferative phase. 3. When PT actually exist cause is usually unknown. 4. Rarely it is associated with fetal conditions e.g. Placental sulfatase deficiency, anencephaly and fetal adrenal hyperplasia.

CONFIRMATION:  Accurate dating is essential to avoid unnecessary and perhaps harmful intervention.  Establishing gestational age in 1 st antenatal visit (early).  LMP:  certain  regular  normal  no pills in the last 3 months

Other clinical data should be consistent with EDD: 1. quickening at weeks 2. fetal heart by fetal stethoscope by weeks 3. size of uterus consistent with date in first trimester 4. at 20 weeks fundal height should be about 20 cm. (usually corresponds to umbilicus)

Role of Ultrasound  Using Ultrasound early.  CRL in first trimester  BPD, FL in second trimester

COMPLICATIONS: 1. Perinatal mortality and morbidity  risk of perinatal death Antepartum Intrapartum Postpartum Anomalies and asphyxia, Admission to NNU, pneumonia, intrauterine infection, seizure, macrosomia, shoulder dystocia

RISK FACTORS FOR ADVERSE OUTCOME Hypertension Pre-eclampsia Diabetes Abruptio placenta IUGR

MANAGEMENT STRATEGIES 1. Fetal surveillance  kick chart  BPP  CTG  Stress test 2. Induction of labour  ARM  oxytocin  Cervix ripening ± PGE2 gel or pessary Foley catheter (mechanical) Sweeing

COMPARISON BETWEEN INDUCTION OF LABOUR AND EXPECTANT MANAGEMENT WITH SERIAL ULTRASOUND 1. In expectant group 20-30% delivered by caesarean section or induction before spontaneous labour. 2. Induction group at 41 weeks had: a)  caesarean section rate b)  fetal distress rate c)  rate of macrosomia d)  rate of meconium SL

RECOMMENDATIONS: 1. Establish gestational age 2. At weeks and six days: In uncomplicated pregnancy no strong indication for close fetal surveillance or induction.

Cont … Recommendations.. 3. At 41 to 42 In uncomplicated pregnancy after either elective delivery vaginally or caesarean section, if vaginal delivery is C.I. 4. Exceptions (expectant management) some female prefer to wait and see they need close fetal monitoring.