Total perinatally related losses at Tygerberg Hospital - a comparison between 1986, 1993 and 2006.

OBJECTIVE To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology. METHOD At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the metropolitan area serviced by Tygerberg Hospital were included in the prospective descriptive study. RESULTS The total number of singleton births was 10 396. The total of perinatally related losses (TPRL) rate was 26.2 per 1,000 births. The leading primary obstetric causes of death were: infections (47 - 17.3%), spontaneous preterm labour (PTL) (41 - 15.1%), antepartum haemorrhage (APH) (40 - 14.7%), intra-uterine growth restriction (IUGR) (40 - 14.7%), fetal abnormality (31 - 11.4%), hypertensive disorders (25 - 9.2%), unexplained intra-uterine deaths (IUD) (20 - 7.4%), intrapartum hypoxia (12 - 4.4%) and maternal disease (9 - 3.3%). A total of 162 placentas were sent for histology; 58 reports changed the primary cause of death. CONCLUSION The TPRL rate for singleton pregnancies was 26.2 per 1,000 births for the study period. The TPRL rates in 1986 and 1993 were 36.7 and 30.5 per 1,000 deliveries. Infection is now the leading primary cause of death, followed by spontaneous PTL, APH and IUGR. During the previous two study periods, APH was the leading primary cause of death, followed by spontaneous PTL. Unexplained IUDs ranked third in 1986, fourth in 1993 and seventh in this study because of the availability of placental histology. Placental histology reports changed 21.3% of the primary causes of death.