Perinatal mortality in Shimla (Himachal Pradesh).

Perinatal mortality was reported between January 1980 and December 1987 among 12798 births in Kamla Nehru Hospital Shimla Hamachal Pradesh state India. The mortality rate was 68.29 per 1000 live births for perinatal deaths and 34.38 per 1000 for still births. The early neonatal death rate was 35.11 per 1000. The perinatal mortality rate (PNMR) showed a statistically significant decline from 75.4 per 1000 in 1980 to 2 per 1000 in 1987. PNMR was 52.2 per 1000 among mothers 20-34 years old and 115.7 and 198 respectively among mothers under 20 and over 35 years old. PNMR was 76.9 among first births and 87.5 among multiple births. Differences by maternal age and parity were all statistically significant. 77.1% of deaths occurred among unbooked cases; only 23% of deaths occurred among booked cases. PNMR among preterm births was 597.9 per 1000 and 27.49 among term births between 37-41 weeks. The PNMR among post-term births (over 42 weeks) was 93.61 per 1000. The low birth weight (LBW) infants had significantly higher PNMR. 37% of births were LBW and 72% of perinatal deaths were among LBWs. 58.90% of boys and 41.2% of girls died of perinatal mortality. PNMR was 5 times higher among twins and 10 times higher among triplets. The highest PNMR was among breech presentations (318 per 1000) followed by cesarean section deliveries (229 per 1000) and vertex deliveries (149 per 1000). 43% of perinatal deaths were due to asphyxiation; other key causes were congenital malformations and infections. Hypothermia from the year round cold weather may have contributed to the higher prematurity and emergency deliveries. The suggestion was for improved prenatal care in rural areas early identification of high risk mothers by community health workers closer supervision and timely admissions in order to reduce the severity of emergencies and provision of Level II and III neonatal care in specific health centers.