The pathology in perinatal mortality in Nairobi, Kenya.

For appropriate planning of obstetric health care a knowledge of perinatal mortality is vital. To obtain the precise cause of death both obstetric and pathological data must be correlated. To this end an attempt was made to examine all the perinatal deaths in Nairobi over a 6-month period in 1981. All dead fetuses and neonates dying within 24 hours of birth and weighing 500 gm or more were autopsied and relevant obstetric data collected. An obstetric survey of all births within Nairobi over a 7-week period (5293 deliveries) was made to obtain baseline information. The restriction of neonatal deaths to those occurring in the 1st day of life was necessitated by logistical reasons. Preliminary data indicated that the stillbirth rate was 23/1000 total births and the 24-hour neonatal death rate was 12.6/1000 live births. Pathological findings are given; the data for singletons and multiple pregnancies have been combined. 497 of 702 perinatal deaths were autopsied. This sample is considered to be representative of the total. 494 of the 497 were blacks. Antepartum deaths comprised 23% intrapartum (fresh stillbirth) deaths 38% and 24-hour neonatal deaths 39% of the total. Overall severe malformations were the cause of only 6.6% of the deaths compared with 24% of the perinatal deaths in the UK in 1970. This low proportion is primarily due to the high frequency in Nairobi of avoidable obstetric causes of death such as cord prolapse (18% of all intrapartum deaths) birth trauma and prolonged labor. The high mortality from the complications of low birth weight (52% of the neonatal deaths occurred from hyaline membrane disease and/or intraventricular hemorrhage) are to be expected where modern neonatal care facilities are minimal. Histologically the lungs of the stillbirths in the "uncertain" category showed evidence of intrauterine anoxia i.e. aspirated meconium and amniotic squames. Neonatal "uncertain" deaths were mostly in the very low birth weight category and their lungs were immature. 4 aspects of these perinatal deaths are discussed: congenital malformations hyaline membrane disease birth trauma and infections. 21 of the 33 malformations were neural tube defects of which 15 had anencephaly with or without spina bifida. 50% of the neonatal deaths had hyaline mmembranes in their lungs. Cerebral birth trauma present in 38 cases resulted from excessive deforming pressure on the skull during delivery. Fetal infection may occur either transplacentally or from infected amniotic fluid. Of the former syphilis was the most frequent occurring in 3.2% of all the perinatal deaths. In Nairobi 62 stillbirths and 51 neonatal deaths showed evidence of amniotic fluid infection 22.5% of the total deaths.