Perinatal mortality

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Every morning we have a handover where the last 24 hrs statistics are reviewed for every ward and special cases discussed both as a learning point and also to help in patient management.  I am always surprised by the postnatal ward summary- it normally goes something like this:  on the postnatal ward we have 70 mothers 40 of whom have their babies with them.  My immediate thought is -what happened to the other 30 babies, they go on to say 15 babies are in the nursery/ nicu- and run threw the stats e.g 3 for birth asphyxia, 4 for prematurity etc. but there is still always a percentage unaccounted.  These are the babies that have died fresh still birth, macerated still birth and early neonatal deaths and its easy to see why these occur.

 It is too late to do anything about the macerated still births once they reach the hospital, the mum presents and already there is no fetal heartbeat detectable and hasn’t been for a few days, sometimes this is because of the distance the woman has to travel to reach the health facility by which point it is too late, but it is also due to poor patient education and the women not knowing to be vigilant for reduction or changes in fetal movements which could indicate problems and lack of attending for antenatal care so early problems aren’t detected and addressed . 

The bigger problem however and one that we can do something about are those babies who die within labour.  Imagine carrying your baby for 9 months coming to hospital, going through a long labour only to deliver a stillborn baby and be told that your baby has died- it must be heartbreaking!   The guidelines are that the fetal heart should be listened to every 30 minutes in the first stage of labour and every 15 minutes in the second stage of labour- this is often not feasible with the large patient load and staff shortages and sometimes the fetal heart is only listened to once or twice in labour, and so fetal distress is missed and poor outcomes common! 

If anyone has any suggestions as to how to improve this with limited resources please comment below.  I have been using the student to help, which has worked a little but they aren’t always around.  I also bought a CTG machine with me which I thought could be used for high risk patients after some training and excitedly tried to use it once but came to plug it in only to realise the sockets were broken and didn’t work. I also need to think of ways to motivate the midwives as i'm sure more can be done within the same system, it must be difficult when you are over worked and payed so little and poor outcomes are so common to not get complacent and just take it as the status quo especially as there are almost no repercussions. 

Malawi is actually doing quite well at reducing its child mortality rates but   neonatal mortality still makes up 32% of the under 5 deaths and may hinder in achieving the millennium development goals.   A high Perinatal death rate is actually an indicator for poor obstetric care within a country and this is clearly seen here.