The Analysis Of The Causes Of Perinatal Death In Zhejiang Province, 2006-2007

The perinatal mortality could be as the mark of regional social economic development and health care level.It also refflects maternal and child health care,perinatal medicine quality and neonatology technical development.Although the perinatal medicine began in 1970s,the perinatal mortality has already decreased greatly comparing with the rate in the early years of liberation of China.At the same time, Perinatology as a new medical field,mainly studied some diseases around the period before and after delivery.It is a new academics with multi-crossed disciplines,it should combine many scientific aspects like obstetrics,neology and ultrasound etc.This new science establishment made the decrease of pregnant incidence and perinatal mortality.It is not good for women and also for babies.With the contribution of government and related medical personnels,the perinatal health care ranked in the excellent range in countrywide.The perinatal mortality in Zhejiang province has descended to a lower level. But on the other hand,it is still higher than Shanghai number as well as.So it is necessary to keep working in improving perinatal health care and promoting the development of prenatal screening.We have already established 30 maternal and child health surveillance sites to represente the whole Zhejiang province situation.Evaluate the development of perinatal-care work in Zhejiang province through investigating the situation of perinatal infants in 30 monitors in detail.There are totally 444212 perinatal infants in 30 monitors districts from 2006 to 2007,and 5215 perinatal death are found.Related information of death was investigated according the regulation of Zhejiang Maternal and Child Care Protocol.After entering each case information in computer the staff in Zhejiang Women Hospital would clean the data and analysis these data.Objective1.Collect each perinatal death case information in 30 minitoring sites from year 2006 to 2007 in Zhejiang Province;2.Analysis the data and find the main causes ofperinatal deaths.3.Give the suggestion for further prevention and decreasing the perinatal mortality.Materials and Methods1.Data collectionAccording to the MCH surveillance protocal of Zhejiang province,total 444212 perinatal infants were eligible surveyed in 30 monitoring sites from the year 2006 to 2007.During these two years period 5215 perinatal death were reported.Detail information of these perinatal death was collected by the local hospital.All the case reports were sent to the Department of Women's Health,Women's Hospital Zhejiang University every half year according surveillance protocol.All the case information was input to the SPSS 13.0 program by the staff of Department of Women's Health.The definition of perinatal death was followed standard I of perinatal period based on the national obstetrics and gynecology text book.All of our study data were matching the standard of definition.2.Analysis MethodThe descriptive statistics was used for mother's social economic status analysis in SPSS 13.0.1.Calculate the perinatal mortality1)According to the classification,5215 cases are classified into prenatal fetal death, stillbirth,early neonatal death and get the number of each classification and percentagers. 2)In the 30 monitors monitoring sites,there are 444212 perinatal infants delivering during year 2006 to 2007,then calculate the average perinatal mortality within 2 years.11 regional perinatal mortalities were calculated respectively.3)The comparison was done for each perinatal mortality.2.Analysis the main causes ofperinatal death:1)According to the monitoring scheme of Zhejiang province,detail information of each perinatal death record was entering the software of SPSS13.0.The death reasons was classified six categories which were maternal factor,placenta reason,umbilical cord reason,fetal reason,neonatl diseases,birth defects respectively.The numbers of cases for relative reasons was obtained.The overlapping reason was exited for each case on the other hand.2)Further death cause was analyzed in each of six categories.For example,there were 731 perinatal death caused by maternal reason.Under this reason mother had different pregnant complications like pregnancy-induced hypertension syndrome (PIH),pregnant diabetes,liver disease etc.so further detail death cause was analyzed under each category case by case.3.Analyse social economic factors related with perinatal death:1)Mother's social economic status was analyzed.These social economic factors included mother's age,birth place,living place,education,occupation,husband age, family income level.2)Mother's economic status was divided in 3 levels,up,middle and low levels comparing with the local people economic condition.Mother who was not the registration local resident was called floating people.3)Analysis mother's health care acceptance during pregnancy.If mother had health checking before the 12 gestation weeks we called her early health care.If mother finished 6 times health checking during the pregnant period we called system health care.Result1.Perinatal Mortality 5215 perinatal death were reported during the period of 2006 to 2007 in 30 surveillance sites in Zhejiang province.Meanwhile 444212 perinatal infants were delivered in the same surveillance sites.Among 5215 perinatal death 3416 were stillbirth and 299 fetus died during the labour,1500 were the neonatal death within the first seven days.The average perinatal mortality is 11.74%oo,The rate difference in 11 regions Zhejiang province the highest perinatal death rate was 14.04‰in Ningbo, the lowest is 9.32‰in Zhoushan.2.Causes of perinatal deathAccording to the monitoring scheme of Zhejiang province,six factors were recognized as major reasons,which were maternal factor,placenta factor,umbilical cord factor,fetal factor,neonatl diseases,birth defects.Then further detail death cause was analyzed From our data four main single causes were birth defects,premature, neonatal asphyxia,umbilical cord entanglement.3.Sociological factors related with perinatal death39.58%perinatal deaths happened in floating people in 30 monitoring sites, and the mortality rate was 13.75%o which was higher than the mothers of native residents which was 10.42‰in perinatal mortality rate.In our study data the mothers were mostly at mid-level economical status,but the mothers in floating population were mainly in low economic status.Also the mothers had very low perinatal health care rate 75.64%mothers was no perinatal health care during pregnancy in floating population,meanwhile 37.33%mothers did not have health care in our study group.51.77%mothers had perinatal health checking less than 3 times during pregnancy,only 28.48%mothers had more than 6 times perinatal health checking during pregnancy.ConclusionAlthough the perinatal mortality of Zhejiang Province was in the low level range.It still had gap to reach the lowest level comparing with Shanghai city in China and other developed counties in the world.Improving perinatal health care service,giving more help to low social economic women like floating population,are the important work for health worker and also for the administration department in Health Bureau Zhejiang Province.