Croatian Society of Gynaecology and Obstetrics, and Croatian Society of Perinatal Medicine of Croatian Medical Association
Abstract
Cilj rada. Analiza porasta perinatalnog mortaliteta u Hrvatskoj od 5,8‰ u 2004. na 6,4‰ u 2005. godini, da bismo ustanovili zašto je zaustavljen izrazito dobar trend smanjenja mortaliteta od 2000. godine. Materijal i metode. Analizirane su prijavnice perinatalnih smrti 381 perinatalno umrlog djeteta >22. tjedna. Posebno su svrstana mrtvorođena djeca i živorođena te rano neonatalno umrla djeca po dobi trudnoće te svrstana po kliničkim utvrđenim bolestima/stanjima majke u 8 skupina. Podjednako su umrla djeca svrstana u 11 skupina na temelju patoanatomskog nalaza učinjene ¬obdukcije. Dodatno je u svih umrlih ustanovljen način rađanja, antenatalna skrbi i fetalni rast. Rezultati. Od 381 perinatalno umrlog djeteta u 34,4% su nađena razna patološka stanja trudnoće, najčešće amnijska infekcija (13,4%) pa hipertenzija/preeklampsija (7,6%). U 18,1% je nedonošenost bila jedina dijagnoza. Patoanatomski je najčešći uzrok smrti bila asfiksija (22,8%) i maceracija bez drugih naznaka (15,0%). Kongenitalne anomalije su bile uzrok smrti u 15,0% svih ¬umrlih, češće u rano neonatalno umrlih (28,0%) nego u mrtvorođenih (7,1%). Carskim rezom je rođeno 18,3% perinatalno umrlih, češće u rano neonatalno umrlih (35,7%) nego u mrtvorođenih (7,6%). Rani neonatalni mortalitet rođenih ¬carskim rezom je znakovito niži u djece s 22–27 tjedana, podjednak u djece 27–31 tjedan, a viši u kasnijim razdobljima trudnoće. Antenatalna skrb je znakovito bila lošija u perinatalno umrle djece. Intrauterini rast fetusa je znakovito bio usporen, 26,5% ¬perinatalno umrlih je bilo lakše od 10. centile za dob, izraženije u mrtvorođenih (32,8%) nego u rano ¬neonatalno umrlih ((16,1%). Posebice je veliki broj nedostaščadi bio u mrtvorođenih s 27–31 tjedan (58,6%) te s 31–36 tjedana (57,1%). Mali broj trudnoća s usporenim rastom fetusa je bio antenatalno dijagnosticiran (18%). Zaključak. Za daljnje sniženje ¬perinatalnog mortaliteta u Hrvatskoj potrebno je dalje usmjeriti napore na antenatalni transport i rađanje djece vrlo niske i izrazito niske porodne težine (<1800 grama) u rodilištima III. razine, te na pravodobno otkrivanje djece s restrikcijom ¬rasta na razini primarne perinatalne skrbi.The aim. To analyze increased perinatal mortality rate in Croatia (infants 1000 grams) from 5,8‰ in the year 2004 to 6,4‰ in 2005. Material and methods. The perinatal death records for 381 perinatally dead fetuses/newborns of 22 gestational weeks were analyzed. Stillborns and early neonatally died infants were divided according to gestational age in the 8 groups of maternal diseases. At the same time infants who died in perinatal period were classified in 11 groups of pathoanatomic causes of death. Additionally in all cases the type of delivery, number of antenatal visits and ¬fetal growth were analyzed too. Results. Out of 381 perinatal deaths in 34,4% different pathologic conditions of ¬pregnancy were established: the most frequent was amniotic infection syndrome (13,4%) and thereafter the hypertension/preeclampsia (7,6%) while in 18,1% the prematurity/immaturity was the only diagnosis. Pathoanatomically the most frequent cause was asphyxia (22,8%) and maceration without other signs (15,0%). Congenital anomalies were the cause in 15,0% of all deaths, more frequently in early neonatal deaths (28,0%) than in stillborns (7,1%). In 18,0% of all cases Cesarean section (CS) was performed, more often in liveborns (35,7%) than in stillborns (7,6%). Early neonatal mortality of cases delivered by CS between 22–31 weeks of gestation was significantly lower, while it was higher in infants above 31 weeks of gestation. The mothers of infants who died perinatally have had significantly lower number of antenatal ¬visits. Intrauterine fetal growth was significantly restricted: 26,5% of perinatally dead infants had the birth-weight <10 centiles for gestational age, more expressed in stillborns (32,8%) than in those who died postnatally (16,1%). The frequency of SGA children was significantly increased in stillborns 27–31 wks (58,6%) and in those 32–36 wks (57,1%) of gestation. Very few (18%) of IUGR fetuses were diagnosed antenatally. Conclusion. In order to further decrease perinatal mortality in Croatia efforts should be made to endeavour the birth rate of VLBW and ELBW infants (<1800 grams) at the 3-rd level maternities and at primary obstetric health care to diagnose the SGA fetuses early and timely
