Risk factors for Perinatal Mortality Due to Asphyxia Among Emergency Obstetric Referrals in a tTrtiary Hospital
Risk factors for Perinatal Mortality Due to Asphyxia Among Emergency Obstetric Referrals in a tTrtiary Hospital
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DOI：
10.1007/s13312-012-0058-9
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发表时间：
2012-03-01
影响因子：
2.3
通讯作者：
Jain, Suksham
中科院分区：
文献类型：
--
作者：
Rani, Shikha;Chawla, Deepak;Jain, Suksham
目的：评估临床、行为和健康护理相关的危险因素产时围产期死亡率（IPPM）。设计：前瞻性队列研究。设置：北印度一家教学医院的分娩室和产后病房。参与者：如果分娩时妊娠期≥ 35周或婴儿出生时体重至少2000 g，索引妊娠没有预订在产前诊所的研究hospital和胎儿在入院后24 h内交付inhospital.Methods：产前保健和周围的劳动和分娩事件的信息，从产前保健记录，转诊说明，医院的临床记录和采访的母亲。多因素分析采用前向逐步Logistic回归分析。主要结局指标：IPPM定义为窒息特异性死产或窒息特异性早期新生儿死亡。结果：在研究期间的248例产科急诊转诊中，IPPM率为8%（20/248，18例新鲜死产和2例窒息特异性新生儿死亡）。区医院和社区保健中心/第一转诊单位占所有转诊的四分之三。Logistic回归分析显示，发生IPPM的显著危险因素为难产（OR：23，95% CI：1.9-275.8），父亲从事非熟练劳动（OR：10，95% CI：1.3-77.7）和产前未进行尿液检查结论：社会经济地位低、产前保健不足、助产技术水平低、产时保健差是IPPM的危险因素。
Objectives: To evaluate the clinical, behavioral and health-care associated risk factors of intrapartum perinatal mortality (IPPM).Design: Prospective cohort study.Setting: Labor room and postnatal wards of a teaching hospital in North India.Participants: Pregnant women were eligible for enrolment in the study if period of gestation at delivery was 35 weeks or more or baby weighed at least 2000 g at birth, index pregnancy was not booked in antenatal clinic of the study hospital and fetus was delivered within 24 h of admission in the hospital.Methods: Information about antenatal care and events surrounding labor and delivery were retrieved from antenatal care records, referral notes, hospital clinical records and interview of mothers. Multivariate analysis was conducted using forward stepwise logistic regression analysis.Main Outcome Measure: IPPM was defined as asphyxiaspecific stillbirth or asphyxia-specific early neonatal death.Results: Among 248 emergency obstetric referrals during the study period, rate of IPPM was 8% (20/248, 18 fresh stillbirths and 2 asphyxia-specific neonatal deaths). District hospitals and community health-centers/first referral units contributed threefourths of all referrals. On logistic regression analysis significant risk factors for IPPM were presence of obstructed labor (OR: 23, 95% CI: 1.9-275.8), father engaged in unskilled labor (OR: 10, 95% CI: 1.3-77.7) and absence of urine examination during antenatal period (OR: 5.5, 95% CI: 1.8-16.3).Conclusions: Low socioeconomic status, inadequate antenatal care and poor intrapartum care due to unskilled birth attendance are risk factors of IPPM.