Improving perinatal outcomes: lessons learned from a low middle-income
public hospital: An observational study from North India
Abstract
Evaluate the impact of third trimester ultrasound in identifying ,small
for gestational age (SGA) growth restricted (FGR) and appropriately
grown fetuses (AGA).Analyse their outcomes ,ascertain the main causes of
perinatal death and lastly compare ultrasound intervention to standard
antenatal care . Design Prospective observational study Setting
Secondary care, government hospital Population Antenatal women Methods
Based on estimated fetal weight by scan , patients were categorized into
FGR < 3, SGA >3 and <10 and AGA
>10 centile. Perinatal outcomes and deaths were analysed by
category. Health Ministry data was extracted for standard care outcomes
and compared to study group. Main Outcomes Perinatal deaths and
causes,composite neonatal morbidity ,severe adverse outcomes Results
Number of births in study and standard care was 1817 and 15,427
respectively. Detection rate by ultrasound for FGR/SGA fetuses was
28.5%.This contained 44.8% (13/29) of all perinatal deaths. Neonatal
deaths, composite neonatal morbidity, serious adverse perinatal outcomes
were significantly more in FGR compared to AGA. Standard care group had
twice as many stillbirths RR 2.32(1.3-4.1)and early neonatal deaths
(RR2.5 (1.18-5.34) . Majority of perinatal deaths (17/29; 58.6%) in
study group were the direct result of failure to recognize antepartum/
intrapartum risk factors, leading to delayed delivery. In addition (3/12
; 25%), women reported late after decreased fetal movements and ( 3/12
25%)were post dated. Ill-equipped nursery contributed to neonatal
mortality in (10/17 ; 58.8%) cases. Conclusion Perinatal outcomes will
not improve by ultrasound identification of small fetuses unless
concomitantly, obstetric protocols and patient awareness programmes are
not improved.