Associate Clinical Prof. Dr. Aisha M.

El-Bareg, MD, PhD

Senior Consultant in (Obs & Gyn)/Reproductive Medicine
Faculty of Medicine, Misurata University, LIBYA

May All Be Happy & Healthy 29 August 2017 1

 Theperinatal period commenced at
28 completed weeks of gestation
(time when birth weight is normally
1000g), and ends seven completed
days after birth.
 The neonatal period commences at birth
and ends 28 completed days after birth.

 Early neonatal period: first 7 days

 Late neonatal period : 7-27 days of life
Includes:
 Late Fetal death ≥ 28
weeks gestation.

 Early neonatal deaths:

≥ 7 days old baby

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 Perinatal mortality: all fetal & early
neonatal deaths weighing 1000g or
more between 28 weeks of gestation to
first week of neonatal life(WHO).
 Perinatal mortality rate: expressed in
terms of perinatal deaths per 1000 total
births.
•• Developing countries:
Perinatal mortality high,32-35
in developed per
nations
1000 in India
:<10 per 1000 births
  Perinatal Mortality Rate (PMR)

Fetal and Early Neonatal Deaths

X 1000
Total births (live, dead)

 Perinatal Mortality Ratio

Fetal and Early Neonatal Deaths

X 1000
live births
• Maternal age
–Teenage pregnancies, elderly gravida
• Parity
–Anemia, inadequate antenatal care,
inadequate rest,

•Socioeconomic factors: LSE

• Obstetric factors
–Placental insufficiency, APH, intrapartum
care, malpresentation ,multiple births
 Idiopathic: about 50 % cases
 Maternal:
◦ Hypertension, PET, DM, thyroid disorders
◦ Placenta previa, Abruption & cord
accidents
◦ Chorioamnionitis & other infections
◦ APS, Isoimmunization
 Fetal: Genetic Anomaly

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 Prematurity
 IUGR (SGA)
 Hypoxia
 Birth Trauma
 Neonatal Infections
 Congenital anomalies
 Aspiration pneumonitis
 Isoimmunization

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Antenatal Causes: Maternal diseases -
hypertension, cardiovascular diseases,
diabetes, infections, anemia, pelvic
diseases, anatomical defects.

Intranatal Causes: Birth injuries, asphyxia,

prolonged effort time, obstetric
complications;
Postnatal Causes: Prematurity, respiratory
distress syndrome, respiratory and
alimentary infections, congenital
anomalies
Prevention:

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 Preconception counseling
 Proper Antenatal Care & PND s.o.s
 Good Maternal hygiene & control of
genital infections
 Early recognition & effective treatment of
maternal factors
 Prevent PTL

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 Judicious use of interventions:
◦ Fetal Blood transfusion
◦ Fetal Therapy
◦ Fetal Operations
 Timely Delivery:
◦ Prolonged pregnancy
◦ DM, Preeclampsia
◦ IUGR, Oligohydroamnios, PROM
◦ Poor BPP (≤ 6 ) / nonreactive CTG
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 Prompt management of fetal distress
 Prevention of infection.
 Amnioinfusion to prevent Meconium
aspiration.
 Avoid:
◦ Traumatic delivery
◦ Prolonged labor

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 Proper resuscitation &
suction
 Prevention of
hypothermia & neonatal
infections
 Emphasize Breast feeding
 Education of Proper
feeding technique

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 Prompt treatment of
Acidosis, Anemia,
Infections etc.
 Good Neonatal Care
(NICU)

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 Proper antenatal care
 Prevention of preterm births, which is
very difficult
 Providing better care and monitoring
during the Intranatal period
 Regular use of partograph and timely
intervention.
 Intensive care of very low birth weight
and sick neonates.
May All Be Happy & Healthy 29 August 2017 18