Abstract

Aims: To determine the causes of perinatal mortality and to calculate perinatal mortality rates at Hacettepe University Hospital.

Material and Methods: In 1998 the Perinatal Mortality Study Group was established at Hacettepe University. The study group was constituted by the Department of Pediatrics, Units of Pediatric Pathology, Pediatric Cardiology, Pediatric Surgery, Genetics and Neonatology and the Department of Obstetrics and Gynecology, Perinatology Unit. At the end of every month, each case (including autopsy results if available) was discussed among the group, and the cause of mortality was determined according to the Modified Wigglesworth Classification, by the consensus of the group members. Perinatal mortality rates at Hacettepe University were prospectively calculated. Perinatal mortality figures of two periods were compared (1998–1999: Group A and 2000–2001: Group B).

Results: Total number of births over 500 grams was 3173 in Group A and 3013 in Group B. Perinatal mortality rate was 33.72/1000 in Group A and 16.92/1000 in Group B.

Of the perinatal deaths, 61.46% were intrauterine deaths and 38.54% were early neonatal deaths in Group A. In Group B, 58.83% were intrauterine deaths and 40% were early neonatal deaths.

In Group A, 72% of the deaths were < 1500 grams, and 53.3% were 500–1000 grams. The most common cause of death during this period was prematurity (Modified Wigglesworth Group III) (29.3%), followed by lethal congenital malformations (Group II) (26.6%) and macerated intrauterine deaths (Group I) (22.9%). Autopsy was available in 70.7% of the cases and micronecropsy was available in 12%. Genetic studies were performed in 24% of the cases and termination of pregnancy was carried out for fetal anomalies in 10.7% of the cases.

In Group B, 72.6% of the cases were < 1500 grams and 47.1% of the cases were 500–1000 grams. The most common cause of death during this period was lethal congenital malformations (Group II) (31.4%), followed by macerated intrauterine deaths (Group I) (21.5%) and specific causes (Group V) (21.5%). Autopsy was available in 70.17% of the cases and micronecropsy was obtained in 10.52% of the cases. 20% of the cases underwent genetic studies during pregnancy and termination of pregnancy was carried out in 19.29% of the cases.

Conclusions: Perinatal mortality rate has decreased at Hacettepe University over the last two years. The authors believe that this is a result of the multidisciplinary work which has had an impact on perinatal and neonatal care. The most common cause of mortality has changed from prematuriy to lethal congenital malformations in this period. Since our institution is a referral center, around 60% of mortality is due to intrauterine deaths and around 30% of the deaths are due to lethal congenital malformations. Unfortunately lethal congenital malformations are referred to our center at an advanced stage of pregnancy.