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Intrapartum-related birth asphyxia in South Africa--lessons from the first national perinatal care survey.
S Afr Med J. 2002 Nov; 92(11):897-901.SA

Abstract

BACKGROUND

The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report.

OBJECTIVES

To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of intrapartum-related asphyxia to total perinatal mortality in South African hospitals, and to identify the primary obstetric causes and avoidable factors for these deaths.

METHODS

The amalgamated PPIP data for the year 2000 were obtained from 27 state hospitals (6 metropolitan, 12 town and 9 rural) in South Africa. In PPIP-based audit, all perinatal deaths are assigned primary obstetric causes and avoidable factors, and these elements were obtained for all deaths resulting from intrapartum-related birth asphyxia.

RESULTS

There were 123,508 births in the hospitals surveyed, with 4,142 perinatal deaths among infants > or = 1,000 g, giving a perinatal mortality rate of 33.5/1,000 births. The perinatal mortality rate from intrapartum-related birth asphyxia was 4.8/1,000 births. The most frequent avoidable factors were delay by mothers in seeking attention during labour (36.6%), signs of fetal distress interpreted incorrectly (24.9%), inadequate fetal monitoring (18.0%) and no response to poor progress in labour (7.0%). The perinatal mortality rates for metropolitan, town, and rural areas were 30.0, 39.4 and 30.9/1,000 births respectively. The contribution of intrapartum-related birth asphyxia to perinatal mortality in these areas was 10.8%, 16.7% and 26.4% respectively.

CONCLUSION

The high rates of perinatal death from intrapartum-related birth asphyxia in South Africa are typical of those in underdeveloped countries, with the most serious deficiencies in rural areas. Most of these deaths are avoidable and the reduction of these rates presents an important challenge to providers of perinatal care in this country. Areas worthy of research and action include provision of mothers' waiting facilities in rural regions, improvements in fetal monitoring, partogram-based labour management, and the establishment of midwifery staffing norms for South African labour units.

Authors+Show Affiliations

Buchmann EJ
Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg.
Pattinson RC
No affiliation info available
Nyathikazi N
No affiliation info available

MeSH

Asphyxia NeonatorumFemaleHealth Care SurveysHospitals, StateHumansInfant MortalityInfant, NewbornObstetric Labor ComplicationsPregnancyRisk FactorsRural PopulationSouth AfricaSuburban PopulationUrban Population

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12506592

Citation

Buchmann, E J., et al. "Intrapartum-related Birth Asphyxia in South Africa--lessons From the First National Perinatal Care Survey." South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, vol. 92, no. 11, 2002, pp. 897-901.
Buchmann EJ, Pattinson RC, Nyathikazi N. Intrapartum-related birth asphyxia in South Africa--lessons from the first national perinatal care survey. S Afr Med J. 2002;92(11):897-901.
Buchmann, E. J., Pattinson, R. C., & Nyathikazi, N. (2002). Intrapartum-related birth asphyxia in South Africa--lessons from the first national perinatal care survey. South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 92(11), 897-901.
Buchmann EJ, Pattinson RC, Nyathikazi N. Intrapartum-related Birth Asphyxia in South Africa--lessons From the First National Perinatal Care Survey. S Afr Med J. 2002;92(11):897-901. PubMed PMID: 12506592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrapartum-related birth asphyxia in South Africa--lessons from the first national perinatal care survey. AU - Buchmann,E J, AU - Pattinson,R C, AU - Nyathikazi,N, PY - 2003/1/1/pubmed PY - 2003/1/16/medline PY - 2003/1/1/entrez SP - 897 EP - 901 JF - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde JO - S Afr Med J VL - 92 IS - 11 N2 - BACKGROUND: The recent amalgamation of data by users of the Perinatal Problem Identification Programme (PPIP) throughout South Africa has culminated in the publication of the Saving Babies report. OBJECTIVES: To determine the absolute rate of death from intrapartum-related birth asphyxia, and the contribution of intrapartum-related asphyxia to total perinatal mortality in South African hospitals, and to identify the primary obstetric causes and avoidable factors for these deaths. METHODS: The amalgamated PPIP data for the year 2000 were obtained from 27 state hospitals (6 metropolitan, 12 town and 9 rural) in South Africa. In PPIP-based audit, all perinatal deaths are assigned primary obstetric causes and avoidable factors, and these elements were obtained for all deaths resulting from intrapartum-related birth asphyxia. RESULTS: There were 123,508 births in the hospitals surveyed, with 4,142 perinatal deaths among infants > or = 1,000 g, giving a perinatal mortality rate of 33.5/1,000 births. The perinatal mortality rate from intrapartum-related birth asphyxia was 4.8/1,000 births. The most frequent avoidable factors were delay by mothers in seeking attention during labour (36.6%), signs of fetal distress interpreted incorrectly (24.9%), inadequate fetal monitoring (18.0%) and no response to poor progress in labour (7.0%). The perinatal mortality rates for metropolitan, town, and rural areas were 30.0, 39.4 and 30.9/1,000 births respectively. The contribution of intrapartum-related birth asphyxia to perinatal mortality in these areas was 10.8%, 16.7% and 26.4% respectively. CONCLUSION: The high rates of perinatal death from intrapartum-related birth asphyxia in South Africa are typical of those in underdeveloped countries, with the most serious deficiencies in rural areas. Most of these deaths are avoidable and the reduction of these rates presents an important challenge to providers of perinatal care in this country. Areas worthy of research and action include provision of mothers' waiting facilities in rural regions, improvements in fetal monitoring, partogram-based labour management, and the establishment of midwifery staffing norms for South African labour units. SN - 0256-9574 UR - https://www.unboundmedicine.com/medline/citation/12506592/Intrapartum_related_birth_asphyxia_in_South_Africa__lessons_from_the_first_national_perinatal_care_survey_ DB - PRIME DP - Unbound Medicine ER -