This study analyzed perinatal mortality trends at Kathmandu Medical College Teaching Hospital from 2002-2007. It found that the perinatal mortality rate decreased from 30.7 in 2002-2003 to 19.1 in 2003-2005 but slightly increased to 25.5 in 2007. The main causes of perinatal deaths were prematurity (33.3%), intrapartum asphyxia (25%), and congenital anomalies (8.3%). Improving antenatal care, preventing preterm births, better monitoring during delivery, and intensive care for low birth weight infants could help reduce the perinatal mortality rate further.

1. PERINATAL MORTALITY TREND AT KATHMANDU MEDICAL COLLEGE TEACHING HOSPITAL Sheelendra Shakya 1 , D.S. Manandhar 1 , S. Padhey 2 1 Department of Pediatrics, 2 Department of Obstetrics and Gynaecology Kathmandu Medical College

8. Distribution of perinatal deaths by weight Weight SB SB % ENND ENND % <1kg 1 6.7 0 0 1-<1.5kgs 3 20 3 33.3 1.5-<2.5kgs 3 20 4 44.4 >2.5kgs 6 40 2 22.2 Not mentioned 2 13.3 0 0 Total 15 100 9 100

9. Relationship of PMR with Birth Weight Weight Total PND PND % Total births PMR <1kg 1 4.2 1 1000 1-<1.5kgs 6 25 15 400 1.5-<2.5kgs 7 29.2 127 55.1 >2.5kgs 8 33.3 758 10.6 Not mentioned 2 8.3 2 Total 24 100 903 26.6

10. Relationship of PMR with birth weight

11. Distribution of perinatal deaths according to gestational age Gestational age SB ENND Total PND No. % No. % No. % <28 weeks 1 6.7 0 0 1 4.2 28 – 36 weeks 8 53.3 6 66.7 14 58.3 37 – 41 weeks 6 40 3 33.3 9 37.5 Total 15 100 9 100 24 100

12. Distribution of Stillbirth Sex No. % Male 6 40 Female 9 60 Total 15 100 Type No. % Fresh 6 40 Macerated 6 40 N/A 3 20 Total 15 100 40% 40% 20% Fresh Macerated N/A

13. CAUSE OF STILLBIRTH 0 2 4 6 8 10 12 No. of cases SB Unknown 66.7% PET 13.3% Congenital Anomalies 6.7% Intrapartum asphyxia 6.7% APH 6.7%

14. ENND by time of death 0% 33% 11% 56% <1 hr 1 – 24 hrs 24 – 72 hrs >72 hrs

15. PRIMARY CAUSE OF ENND 44.4% 22.2% 11.1% 11.1% 11.1% 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Prematurity Birth Asphyxia Congenital Anomalies MAS Septicaemia No. of cases ENND

16. Comparison between the 3 studies Category Oct ‘02 to Sept ‘03 Nov ‘03 to Oct ‘05 Jan ‘07 to Dec ‘07 Total stillbirth rate per 1000 births 30.2 14.5 16.6 Total stillbirth rate (excluding <1kg) 18.1 13.4 15.5 Total ENND rate per 1000 live births 18.3 6.7 10 Total ENND rate (excluding <1kg) 12.9 6.1 10 PMR per 1000 births 30.7 19.1 25.5 Extended PMR per 1000 births 47.9 21.1 26.6 Caesarean section out of total births (in %) 26.4% 29.7% 29.9% Instrumental delivery out of total births (in %) 1.4% 4.2% 4.4% Total Deliveries 563 1517 903

17. PERINATAL MORTALITY TREND AT KMCTH 30.7 47.9 19.1 21.1 25.5 26.6

18. Comparison of cause Wigglesworth’s classification(%) Oct ‘02 to Sept ‘03 Nov ‘03 to Oct ‘05 Jan ‘07 to Dec ‘07 Group I (normally formed macerated stillbirths) 18.5 43.8 25 Group II (SB or NND with congenital anomalies) 14.8 12.5 8.3 Group III (conditions associated with immaturity) 31.3 28.1 33.3 Group IV (asphyxial conditions developing in labour) 40.7 12.5 25 Group V (conditions specific to the neonate) 3.7 3.1 8.3

19. PERINATAL MORTALITY TREND AT KMCTH By Wigglesworth’s Classification

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