Epidemiological Aspects of Stillbirth and Neonatal Deaths in the Delivery Room at the Libreville Mother-Child University Hospital from 2019 to 2022

Introduction: Stillbirths are estimated at 2 million each year, of which more than 40% occur during labour. Our objective was to study the epidemiological aspects of stillbirth and neonatal deaths in the delivery room in our health facility. Patients and methods: Prospective, descriptive and analytical study, conducted at the Jeanne Ebori Foundation Mother-Child University Hospital over 4 years (January 2019-December 2022). All neonatal deaths in the delivery room or foetal death in utero, were included. Results: Among the 18,346 deliveries performed, 512 newborns were declared dead in the delivery room (27.9‰ live births), divided into in utero foetal death (19.0‰) and immediate neonatal death (8.9‰). The mean age was 34.3 weeks of amenorrhea. The rate of preterm birth was 60.4%. The sex ratio was 1.1. The average weight was 2186.6. The main causes were vascular (46.1%), foetal (20.2%), adnexal (17.1%) and asphyxia per partum (16.6%). Foetal causes were more likely to result in IUFD than other causes (OR = 6.4 [2.4 - 15.7], p < 0.001). After birth, partum asphyxia was more likely to lead to death before 15 minutes of life than other causes (OR = 11 [6.1 - 18.9], p Conclusion: The causes of stillbirth and early neonatal mortality are dominated by maternal vascular pathologies. However, the proportion of childbirth-related causes remains worrying. Better monitoring of pregnancy and labour will minimize this prevalence in our hospital.

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.

ANALYSIS OF CLINICAL CHARACTERISTICS AND DEATH RELATED FACTORS OF SEVERE MECONIUM ASPIRATION SYNDROME

Objective To investigate the factors in relation with the case fatality in severe meconium aspiration syndrome (MAS). Methods Eighty-one severe MAS cases intervened by the mechanical ventilation from 9 childrens hospitals were retrospectively analyzed for the risk factors of fatality with SAS software for non-parametric rank sum test and chi-square test. Results In the 81 cases, 49 were survived (death rate 39%). The gestational age (GA), Apgars score at 1min and other complications with MAS were significantly related to the death (P <0.05). There was no difference of death rate between the patients with or without receiving endotracheal intubation and airway suctioning (P>0.05). Conclusion A higher death rate (close to 40%) of severe MAS in the middle of 1990s in major cities of China suggests that it is important to detect the intrauterine hypoxemia as it may indicated by meconium staining amniotic fluid which should be intervened early by adequate termination of pregnancy before 42 weeks. The effects of delivery room suction and conventional ventilation also need to be reevaluated.

Psychosocial impact of mothers with perinatal loss and its contributing factors:an insight

Objective:To evaluate the psychosocial impact among mothers with perinatal loss and its contributing factors.Methods:A cross sectional study was conducted in University Kebangsaan Malaysia Medical Centre (UKMMC) from April 2008 to May 2009 using Edinburgh Postnatal Depression Scale (EPDS) and self administered questionnaire.Results:Sixty-two respondents were included and most of them were working mothers (77.4%).The mean age of the respondents was (31.0±5.6) years and a majority of the subjects aged between 20-34 years (77.4%).According to the EPDS score,53.2% of the respondents had a psychosocial impact with a total score of >9,out of 30.There was a significant relationship between psychosocial impact after perinatal loss and support from friends (P=0.019).However,there were no significant differences between psychosocial impact and history of previous perinatal loss,ethnicity,occupation,educational level,age or total income.Conclusion:Mothers with perinatal loss should be screened for psychosocial impact and offered support when needed.Family and friends should continue to provide emotional support.People who have experienced similar problem before will be able to provide better support than those who have not.