Trends in perinatal out come at teaching hospital peradeniya during the period of 1986-2004

Abstract

INTRODUCTION: The obstetric care has tremendously improved over the past two decades worldwide, resulting in better maternal and perinatal outcome. To move forward we need to assess whether the standard of care provided at TH Peradeniya has also similarly advanced. Objectives: To analyze the trends in perinatal out come at TH Peradeniya and to refine the tertiary level obstetric care. METHOD: Retrospective descriptive study to analyze monthly perinatal statistics in the hospital during the period of 1" of January 1986 to 31" October 2004. RESULTS AND DISCUSSION: Crude perinatal mortality rate has shown a significant drop, reaching 22.9 per 1000 births in 2004, from 44.87 per 1000 births in!986.This is a reflection of improvement in obstetric and neonatal care. The gradual decline observed in admission to special care baby unit, from 179.9 per 1000 live births in 1986 to 144.2 per 1000 live births in 2004, reflects the improvement in intrapartum care. Intra uterine growth restriction was on the rise from 0.30 per 1000 live births in 1995 to 7.8 per 1000 live births in 2004 indicating, possibly more detection rate with application of advanced radiological technology. A decline found in neonatal septicaemia from 4.4 per 1000 live births in 1986 to 2.1 per 1000 live births in 2004 is because of effective implementation of infection control measures and judicious use of antibiotics. A significant drop noted in birth asphyxia, from 14.7 per 1000 live births in 1986 to 4.1 per 1000 live births in 2004, which can be due to improvement in intrapartum care and steady rise in caesarean section rate. A downward trends was observed in need for ventilatory support can be explained by the wide spread use of antenatal corticosteroids .It has dropped to 4.9 per 1000 live births in2004, from 5.2 per 1000 live births in 1986.Congenital abnormalities have declined from 12.8 per 1000 live births in 1986 to 7.7 per 1000 live births in 2004 possibly due to the pre-conceptual folic acid supplementation -But, the trend is on the rise from 3.1 per 1000 live births in2001 to 7.7 per 1000 live births in2004 indicating probable increase in the incidence. A decline observed in number of preterm deliveries from 49.5 per 1000 live births in!986 to 24-7 per 1000 live births in2004, could possibly due to improvement in facilities of fetal surveillance, which could have allowed obstetricians, to prolong the pregnancies until maturity. Alarmingly, meconium aspiration rate has risen from 7.7 per 1000 live births in!986 to 10.8 per 1000 live births in 2004.Currently an audit is underwayjo find out the possible causes. CONCLUSION: Most of the areas in perinatal outcome reflect improving trends. Increase in meconium aspiration rate needs urgent audit and remedial measures.