The Causes Of Perinatal Deaths During 2006-2011 In One District Of Shanghai

Objectives(i) To describe the perinatal mortality and its trends in one District Confinements’ Hospital during 2006 to 2011;(ii) To discuss the health and social factors related to the death cases in the same period;(iii) To understand the changes in health system and health policy in one District;(iv) To make recommendations for action to reduce perinatal deaths in one District Confinements’ Hospital.Methodology(1) Quantitative research Existing data analysis:Information of all the perinatal death cases reported in the four delivery agencies (485 cases in total) in one District from 2006 to 2011 was collected. A retrospective analysis was then conducted based on the information recorded in the perinatal death registration form.(2) Qualitative researchCase studiesA sum of 31 cases of perinatal deaths (including both Type I and Type II), which could have been avoided from 2006 to 2011 according to the evaluation from the District-level health service, were reviewed in this study. The administrators and service providers who were involved in these cases were questioned for more details. Data analysisData were collected in a Microsoft EXCEL spreadsheet. The factors influencing perinatal deaths were....by a SPSS software (SPSS 17.0, SPSS Inc.)ResultsGenerally, the perinatal mortality rate decreased from 2006 to 2011, with an average 6-year death rate of 5.59‰ and that of immigrants accounting for 67.22%. The leading causes of death were birth trauma, acute/sub-acute placental pathology, umbilical cord factors and other unknown factors. Placental factors of perinatal mortality is given priority to with placental abruption [22(70.97%)], a downward trend;Neonatal diseases caused by perinatal deaths is on the decline, the umbilical cord factors, mother’s maternal disease cause of perinatal mortality rate fluctuations.Mainly in the 28tto 37 weeks of gestation, weight below 2500 g of perinatal, ending are given priority to with stillbirth.2006-2011,485 cases of perinatal death in death constitute a significant differences on the city and floating population, outsiders perinatal deaths [326(67.22%)],the city’s household register perinatal deaths [159(32.78%)],perinatal mortality compared with foreign personnel in the city difference was statistically significant (x2= 146.327, p< 0.01).Among the 31 cases of avoidable morality, neonatal deaths were the most common, which mainly occurred with the migrant groups who were either lack of early pregnancy registration or regular prenatal inspection.The lack of skills and knowledge of the health care agents was the most common causes of perinatal mortality, followed by the poor knowledge of the pregnant women and their family and, the negative attitudes of the health care services and the family of the pregnant family.Conclusion1. Foreign perinatal mortality were significantly higher than those of the floating population of this city household registration, and more Older mothers, cultural level is low, more maternal, no antenatal examination.2. The top five cause of death among perinatal, birth defects, respectively, the umbilical cord factors, gestational hypertension (medium, heavy), unknown reasons, other reasons.3. In 2006-2011 mother maternal disease cause of perinatal mortality rate fluctuations. Neonatal diseases and placental factors of perinatal death is on the decline.4. Perinatal deaths is given priority to with stillbirth, mainly in pregnancy 28～ 37 w, weight with< 2500 g, mainly as a diagnostic basis for clinical diagnosis, autopsy rate is low.5.The health care system lacks knowledge and skills include (disease management is not in place, observed closely enough about the disease changes and lack of experience deal with unusual circumstances).6.Health care system in the national holidays, night and weekend management is not strict, high-risk pregnant women weren’t positive enough observation processing, management of pregnant women fail to prenatal follow-up does not reach the designated position, as well as the bad cooperation between different departments and so on.7.Among other causes of perinatal deaths, rather than those mentioned above, cases giving up further medical care by the family accounted for 36%.SuggestionsIn order to reduce perinatal deaths in one District Confinements’ Hospital, some recommendations are presented as follows.1.Trengthen the flow of maternal health education,Increase the rate of pregnancy to build copies,the rate of System management,the rate of hospital births, and strive to improve their consciousness of self health care consciousness and self care consciousness, be included in the category of maternal health care system management as soon as possible is one of the important measures to reduce perinatal mortality.2.Do premarital pregnancy checks and inspection work to strengthen pre-pregnancy health promotion and guidance. Minimized due to birth defects or genetic disorders caused by perinatal death.3.Enhance liquidity in maternal age, maternal management and education, for the low education level of people to do something simple and easy to receive promotional materials and public lectures. 4. The medical institutions should as far as possible for family members to resin solution, in order to make clear the cause of death, in order to further reduce perinatal mortality.5.Strengthen the mission to the Women of childbearing age, such as to avoid repeated cesarean induced abortion or abnormal placental factors; strengthen maternal fetal movement counting missionary, while medical institutions to do fetal monitoring, abnormal timely manner, as far as possible to avoid the umbilical cord factors perinatal death. 6.Strengthen the holidays, succession and obstetric quality management in the night, improve the ability of handling emergency obstetric care and medical quality, to ensure medical safety, selective cesarean delivery should not be arranged during the holidays, succession and night time. 7.For those who called on the government department for cannot afford medical costs, and give up treatment of neonatal families offer certain financial aid.