What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India
Objective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audi...
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IMR Press
2021-02-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
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| Online Access: | https://www.imrpress.com/journal/CEOG/48/1/10.31083/j.ceog.2021.01.5466 |
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| author | Momina Zulfeen Rekha Upadhyay Sapna V. Amin Muralidhar V. Pai Leslie Lewis |
| author_facet | Momina Zulfeen Rekha Upadhyay Sapna V. Amin Muralidhar V. Pai Leslie Lewis |
| author_sort | Momina Zulfeen |
| collection | DOAJ |
| description | Objective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audit process exists. The aim of this study was to perform a qualitative perinatal audit and devise methods for future audits. Methods: We conducted a one year audit for all perinatal deaths using WHO ICD PM and 3-delay classification. Gestational age (GA) specific mortality was calculated for significant underlying factors using fetuses-at risk approach. Results: We recorded a perinatal mortality rate of 6.1/1000 births among booked cases and 21.32/1000 births among referred cases. Fetal growth restriction was the most common antenatal condition, accounting to 33.3% of antepartum deaths. Prematurity accounted to 52% of neonatal deaths. Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (> 24 h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk-factor. GA specific mortalities, calculated using fetuses-at risk approach, show a peak mortality rate at 30 weeks, 37 weeks and 38 weeks in pregnancies with early-onset preeclampsia, severe fetal growth restriction and medically treated gestational diabetes respectively. Conclusion: The audit identified significant contributing factors to the mortality. ICD-PM and 3-delay classification was simpler and easier to apply with wide areas of opportunities for secondary analysis. |
| format | Article |
| id | doaj-art-269f240b01ea4d79aa5f4183b14c5446 |
| institution | OA Journals |
| issn | 0390-6663 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Clinical and Experimental Obstetrics & Gynecology |
| spelling | doaj-art-269f240b01ea4d79aa5f4183b14c54462025-08-20T02:01:30ZengIMR PressClinical and Experimental Obstetrics & Gynecology0390-66632021-02-0148114415010.31083/j.ceog.2021.01.5466S0390-6663(21)00059-2What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South IndiaMomina Zulfeen0Rekha Upadhyay1Sapna V. Amin2Muralidhar V. Pai3Leslie Lewis4Department of ObGyn, Kasturba medical college, 576104 Manipal, IndiaDepartment of ObGyn, Kasturba medical college, 576104 Manipal, IndiaDepartment of ObGyn, Kasturba medical college, 576104 Manipal, IndiaDepartment of ObGyn, Kasturba medical college, 576104 Manipal, IndiaDepartment of Pediatrics, Kasturba medical college, 576104 Manipal, IndiaObjective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audit process exists. The aim of this study was to perform a qualitative perinatal audit and devise methods for future audits. Methods: We conducted a one year audit for all perinatal deaths using WHO ICD PM and 3-delay classification. Gestational age (GA) specific mortality was calculated for significant underlying factors using fetuses-at risk approach. Results: We recorded a perinatal mortality rate of 6.1/1000 births among booked cases and 21.32/1000 births among referred cases. Fetal growth restriction was the most common antenatal condition, accounting to 33.3% of antepartum deaths. Prematurity accounted to 52% of neonatal deaths. Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (> 24 h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk-factor. GA specific mortalities, calculated using fetuses-at risk approach, show a peak mortality rate at 30 weeks, 37 weeks and 38 weeks in pregnancies with early-onset preeclampsia, severe fetal growth restriction and medically treated gestational diabetes respectively. Conclusion: The audit identified significant contributing factors to the mortality. ICD-PM and 3-delay classification was simpler and easier to apply with wide areas of opportunities for secondary analysis.https://www.imrpress.com/journal/CEOG/48/1/10.31083/j.ceog.2021.01.5466perinatal mortalityclinical auditicd-10maternal health services |
| spellingShingle | Momina Zulfeen Rekha Upadhyay Sapna V. Amin Muralidhar V. Pai Leslie Lewis What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India Clinical and Experimental Obstetrics & Gynecology perinatal mortality clinical audit icd-10 maternal health services |
| title | What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India |
| title_full | What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India |
| title_fullStr | What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India |
| title_full_unstemmed | What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India |
| title_short | What do the numbers say? - Introduction of the WHO ICD-PM classification and fetuses-at risk approach in perinatal audit, South India |
| title_sort | what do the numbers say introduction of the who icd pm classification and fetuses at risk approach in perinatal audit south india |
| topic | perinatal mortality clinical audit icd-10 maternal health services |
| url | https://www.imrpress.com/journal/CEOG/48/1/10.31083/j.ceog.2021.01.5466 |
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