What do the numbers say? - Introduction of the WHO ICD-PM and 3-delay classification in perinatal audit in a tertiary care institute, South India
Introduction: 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 using WHO ICD-PM and 3-delay classification and to formulate methods of reducing the perinatal mortality rate (PMR)
Methods: We conducted an audit from January 2018 to December 2018 for all still births beyond 26 weeks gestation and early neonatal deaths. WHO ICD PM Classification was used and underlying factors were divided according to 3-delay classification. Gestational age specific mortality was calculated for significant underlying factors such as pre-eclampsia and gestational diabetes. The data was analysed using descriptive statistical measures.
Results: We recorded a perinatal mortality rate of 6.1 among booked cases and 21.32 among referred cases. FGR was the most common antenatal condition, accounting to 33.3 % of antepartum deaths. Abruption is our leading cause of intrapartum fetal death(86%). Prematurity accounted to 52% of neonatal deaths with sepsis accounting to 25%. Phase 2 delay was more common than phase 1.Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (>24h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk factor associated with 50.5 % of all the causes.
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. The gestation age specific mortality can be found helpful for clinical decision making for ideal admission time and for future audits.