Towards reducing perinatal deaths in South Africa. Policy brief.

A population-based study conducted in 1986 by the University of Stellenboschs Department of Obstetrics and Gynecology found that antepartum hemorrhage which consisted largely of abruptio placentae caused 27.8% of perinatally related deaths; spontaneous preterm labor 24.8% of deaths; and infection 9.3% of deaths. The same study was repeated in 1993 examining prospectively all perinatally related deaths in the Tygerberg area that occurred during the year. In 1993 antepartum hemorrhage caused 25.5% of deaths and preterm labor 20.3%. The level of perinatally related mortality decreased by 31.9% from 22.6 to 15.4 deaths per 1000 births while total perinatally related wastage decreased by 17.3% from 38.1 to 31.5 per 1000 births. The number of late abortions and stillbirths remained largely unchanged but the number of neonatal and perinatally related deaths decreased by 48.8%. Due especially to a significant increase in syphilis-related mortality infection as a cause of death increased from 9.3% to 13.8%. Factors which contributed to the decline in perinatal mortality and policy recommendations are presented. The current perinatal mortality rate of 15.4/1000 has been achieved with a minimum of expensive modern technology but with considerable emphasis upon the training of personnel and quality control. Efforts will be made to reduce the rate even further to 10/1000 by 2000.