Evaluation of Stillbirth and Early Neonatal Death by Verbal and Pathological Autopsy and Their Correlation - A Hospital Based One Year Descriptive Study

Abstract

Background and objectives ABSTRACT Globally eight million deaths occur every year. In India perinatal mortality rate is 49/1000 births. Vital registration comprising cause of death is available only in less than three percent of all perinatal deaths. Verbal autopsy is cost effective, time saving method to assign the cause of deaths. The objectives of the present study were to determine cause of death in stillbirth and early neonatal death using verbal and pathological autopsy and its correlation. Methodology The present descriptive observational study was conducted at Teaching Hospital attached to Jawaharlal Nehru Medical College, Belgaum during the period of December 2007 to May 2009. Perinatal deaths meeting the selection criteria prospectively for 18 months were selected for the study. Validated verbal autopsy questionnaire with additional information was provided to women / relative with stillbirth/early neonatal death ( END ) , skilled birth attendant and neonatologist. Pathological autopsy without immunohistochemical and chromosomal tests were done. Results There were 3904 deliveries and 193 perinatal deaths were recorded in the study period. Among them 168 were stillbirths and 25 were ENDs. Among them, 110 stillbirths and three ENDs met selection criteria and included in the study as most of stillbirths cases agreed for pathological autopsy than END. Among 110 stillbirths, 76 were fresh stillbirths and 34 were macerated stillbirths. Perinatal X mortality rate was 49.4 per 1000 births. The principle cause of perinatal deaths were abruption ( 29% ) , placenta previa ( 5% ) , preeclampsia ( 17.2% ) , congenital anomalies ( 5.4% ) and unknown ( 20.9% ) by verbal autopsy. On pathological autopsy, placental pathology ( 41% ) and congenital malformation ( 5.4% ) were the principle causes of perinatal death. Six additional congenital anomalies were detected. Verbal autopsy has a high sensitivity and negative predictive value. Conclusions and interpretation Verbal autopsy is simple, cost effective and reliable tool in evaluating perinatal mortality in developing countries with limited resources.