PERINATAL MORTALITY

MEETING
March 2024

Dr Muti ullah
PGR Paeds-1, SHL
 NNU STATISTICS

Total Pts
590

OPD Short Stay Admissions

Gender
36%(210) 55% (325) 9% (55)

Male 52% Female 48%

Discharged Expiries 22% In NNU (0)
(300) (290)
78%(43) (12)
 UNIT WISE DISTRIBUTION

G1
12.7 (7)
G2
11% (6)

G3
9% (5)
Out-
born
67.2%
(37)
 GESTATIONAL AGE

32.9%
(18)
PRETERM
TERM

67.1%
(37)
Disease breakup
1; 2%
5; 9%

2; 4%

5; 9%

25; 45%

7; 13%

10; 18%

EOS HIE LOS Preterm with EOS

JNN TTN CHD
BLOOD CULTURE RECORD
Total samples sent - 44
• No growth - 61% (27)
• Bacterial Growths - 29% (17)
• Fungal growth - 0
 ISOLATED BACTERIA

ORGANISM NUMBER

Pseudomonas 13

Citrobacter 1

Klebsiella 1

S. Aureus 2
 SENSITIVITY PATTERN

ORGANISM SENSITIVITY

Pseudomonas Ciprofloxacin, Levofloxacin , amikacin

Gentamicin, Colistin, polymyxin

Staph aureus Vancomycin, Gentamicin

Citrobacter Aztreonam, Polymyxin

Klebsiella Doxycycline & Polymyxin

MORTALITY DATA
60
55

50

40 37

30

20 18
12
10
10
2
0
TOTAL INBORN OUTBORN

ADMISSIONS EXPIRED
 UNIT WISE DISTRIBUTION

UNIT ADMISSIONS EXPIRED PERI-NATAL

MORTALITY
G1 7 4 2
G2 6 2 2
G3 5 4 3
OUTBORN 37 2 -

TOTAL 55 12 7
EXPIRIES AS PER CAUSE

MAS, 11%

PT+RDS, 11%

HIE/Birth HIE/Birth asphyxia

PT+EOS, 11% asphyxia, EOS
56% PT+EOS
PT+RDS
MAS
EOS, 11%
 DURATION OF STAY
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
<24h 1-3d 3-7d
 GESTATIONAL AGE

20%

50% Very PT
Extremely PT
20% Term
Late PT
10%
 BIRTH WEIGHT

25%
33%
VLBW
ELBW
NBW
LBW

25%
17%
CASE SUMMARIES
G1
 G1:
B of Mehwish NB/1.5kg/F GA: 33+2 weeks
Diagnosis: HIE III/ Suspected Edward syndrome
DOA: 24.03.2024, 12.35pm DOE: 26.03.24, 3:45 pm DOS: 2 days 2hrs

• 25y, G5P1+3 , delivered by SVD at 33+2 weeks due to severe pre eclampsia & preterm labor
• Unbooked case. Risk factors; PIH, PV bleed for 2days
• At birth baby was resuscitated due to absent cry, intubated and then shifted to NICU.
• On examination floppy baby with microcephaly, occipital prominence, low set ears, clinodactly with
overlapping of fingers, Rocker bottom feet, mid dilated pupils and had suspected heart defect.
• Baby was initially put on invasive ventilation, inotropic support was started, IV antibiotics and fluids
were given. She was given trial of CPAP which was failed due to poor respiratory efforts.
• Baby was expired at 3rd DOL.
• COD: HIE
INVESTIGATIONS:

• CBC:

Hb-14.6 Plt- 109 TLC- 16.2

HCT- 47
• RFTs:
Urea- 35 Cr- 1.2
• S/E:
Na- 133 K 5.1
• LFTs:
STB- 0.4 ALT- 13 AST- 74
• CRP: 12.1
• ABGs
pH: 7.19 7.18
PCO2: 35.6 38.3
PO2: 159 201
HCO3: 13.6 14.4
TREATMENT GIVEN:
• IV fluids
• IV antibiotics (1st line)
• 2nd line on 26/3
• Inj Aminophylline
• Inotropic support
• Bicarb replacement
 G1:
B/O Sehar NB/0.6kg/Fe GA: 30+3 weeks
Diagnosis: Preterm, IUGR, Neonatal sepsis
DOA: 13.03.24, 10:35 am DOE: 17.03.24, 9:00am DOS: 4days

• Em-LSCS at 30+3 weeks d/t imminent pre-eclampsia, fetal distress on CTG.

• Booked.
• Antenatal risk factors: PIH +ve mother(Aldomet QID) with uncontrolled HTN
• At birth baby was resuscitated due to delayed cry
• APGAR scores of 4/10 at 1min and 7/10 at 5mins. Inj Vit K given
• Baby was shifted to NICU  CPAP (FiO2 30%, PEEP 5, Flow 5)was attached within 1st HOL
• Temperature was maintained, IV fluids, 1st line antibiotics and Inj. Aminophylline started.
• Baby developed abdominal distention on 2nd DOL evening and kept NPO TFO
• Baby developed apnea on 4th DOL in evening resuscitated by Ambu bagging  Reload with
aminophylline  fresh bleed was observed  persistent desaturation and bradycardia  attendants
refused intubation
• Baby was declared dead at 9am 17/3
• COD : DIC
INVESTIGATIONS:

• CBC:
Hb-13.1 PLT- 61 TLC-21.7
• RFTs:
Urea- 32 Cr- 1.1
• S/E:
Na- 134 K 4.1
• LFTs:
STB- 6.5 ALT- 18 AST- 92
• SEPTIC PROFILE:
CRP- 10.5
• ABGs
pH 7.219
pCO2 25.5
O2 196
HCO3 10.4

blood culture: no growth

TREATMENT GIVEN:
• IV fluids
• IV antibiotics ( 1st line )
• Inj flagyl
• Inj fluconazole
• 2nd line started on
• Aminophylline
• Inotropic support
G2
 G2
B of SABA NB/1.2kg/M GA: 30+3 weeks
Diagnosis: Preterm+RDS+VLBW
DOA: 27.03.2024 10:46am DOE: 27.03.24, 10pm DOS: 12 hours

• 30y, G4P0+3, Em-LSCS at 30+3 weeks. Delivered via Em-LSCS due to PIH+, placental abruption
• Unbooked case. Risk factors: PIH(Labetalol, hydralazine), placental abruption, Anemia(2pcv)
• At birth baby was resuscitated due to absent cry, APGAR 4/10 then 7/10
• Shifted to NICU and on CPAP (40% Fio2 and PEEP 6cmH2O). Surfactant given at 12.30pm.CPAP
settings tapered.
• Baby shifted to ventilator due to worsening of respiratory distress. Baby didn’t maintain saturation even
at maximum ventilator settings. Attendants were counselled. Baby went into bradycardia, Inotropic
support stepped up. Baby expired at 10 pm due to pulmonary hemorrhage with no respiratory, cardiac
activity, fixed dilated pupils

• COD: Pulmonary Hemorrhage

INVESTIGATIONS:
ABG
• CBC:
PH 7.31
HB: 16.5 TLC: 3.8 PLT: 28
PaO2 160
• RFTs:
Urea: 70 Cr: 1.0 PaCO2 30
• S/E: HCO3 22
Na: 136 K: 5.2
• LFTs:
STB- 1.3 ALT-23 AST-373
• SEPTIC PROFILE:
CRP-

Blood culture no growth

TREATMENT GIVEN:
• IV fluids
• IV antibiotics (1st line)
• Inj Aminophylline
• Inj fluconazole
• Inotropic supports
 G2
B Sonia NB/2.9kg/M GA: 41 weeks
Diagnosis: HIE III+MAS
DOA: 12.03.2024 7:15am DOE: 12.03.24, 9:00 pm DOS: 14 hrs

• G3P2+0, SVD at 41 weeks with grade 1 meconium by Labor induction.

• Unbooked case.
• At birth baby was resuscitated due to delayed cry APGAR 4/10 6/10
• In vit K given
• Baby moaning, cyanosed with depressed activity
• Baby was intubated and shifted to NICU
• P-SIMV rate 25 , PEEP : 5 , FiO2 40%
• Sick notes
• At 7.20pm baby developed bradycardia and persistent desaturation. Spo2 33% and HR <60. frank bleed
observed from ETT on start of chest compressions.Inj vit K, N/S bolus given  Inotropic support
started
• Expiry Notes: baby developed bradycardia despite inotropic support. Pulseless cold peripheries
Resuscitation was done but there was no cardiac and respiratory activity and pupils were fixed dilated.
Baby was Declared dead at 8.55pm
• COD: pulmonary hypertension(d/t MAS)
INVESTIGATIONS:
ABGs
Time 10am 8pm
• CBC: PH 7.32 6.72
Hb-15.4 PLT-156 TLC-3.8 HCT-49
• RFTs: PCO2 34.7 40.4
Urea-31 Cr-0.9 PaO2 181 179
• S/E: HCO3 18 5.3
Na- 136 K 5.9 Ca-10.6
• LFTs:
STB- 1.7 ALT- 16 AST- 71
• SEPTIC PROFILE:
CRP-

Blood culture No growth

TREATMENT GIVEN:
• IV fluids
• IV antibiotics (1st line)
• Vitamin K
• Inotropic supports
G3
B of Alishba NB/2.5kg/M GA: 34+5 weeks
Diagnosis: HIE Grade III/EOS
DOA: 24.03.2024 1:50pm DOE: 25.03.24, 1:00 am DOS: 12 hours

• 20yrs, PG, SVD at 34+5 weeks by (SHL scan) d/t non reactive CTG and increased BP
• UN-Booked case.
• Antenatal risk factors: PIH+, PV leaking 2days, UTI +ve, diarrhea and lower abdominal pain.
• At birth baby was resuscitated due to absent cry, intubated and then shifted to NICU
• APGAR 2/10  5/10
• Baby was extremely pale, bleeding from prick site, Pt in DIC, parents counselled. Blood products were
transfused
• Expiry notes: Pt was bleeding from prick site, ETT and OG. Pt was going into bradycardia even with
Inotropic support. Inotropic support was stepped up. Patient expired at 1 am

• COD: DIC
INVESTIGATIONS:

• CBC: Time 3pm

PH 7.24
• RFTs:
• S/E: PaO2 197
PCO2 22.6
• LFTs:
Hco3- 9.8
• SEPTIC PROFILE:
TREATMENT GIVEN:
• IV fluids
• IV antibiotics (1st line)
• Inotropic supports
• Blood products
• Inj phenytoin
B ghousia NB/2.0kg/F GA: 35+5
Diagnosis: MAS/HIE grade III
DOA: 21.03.2024 1am DOE: 22.03.24, 8.50pm DOS: 1 day 21hrs

• PG, Em-LSCS at 35+5 weeks d/t fetal distress, non reactive CTG
• booked case.
• Antenatal risk factors: DM+ 1year, HTN+ 3years, Hypothyroid for 7years, Hep E IgM+, PV bleed in
1st trimester, 2days history of fever, vomiting, L/M & UTI+ for 3days.
• At birth baby was resuscitated due to absent cry, intubated and then shifted to NICU (Absent cry,
grade III meconium, bradycardia  suctioning and stimulation  no cry no respiratory activity HR<100
 ambu bagging  no cry no rep activity , HR>100  ETT placed ambu bagging done  weak irregular
respiratory efforts )
• Receiving Notes: received & on vent at 1.50am P-SIMV FiO2 40%, PEEP 4, PCV 15, PSV 12, pulses
adequate, poor reflexes
• Sick notes:
• Baby was given trial of CPAP which failed
• Baby became sick and intubated again.
• On 2nd DOL baby became cyanosed with bradycardia Resuscitation was done with no improvement in
saturation and cardiac activity.
• Expiry notes: At 8.50 pm pt was pulseless with no cardiac activity CPR was done but there was no
improvement in Cardiac and Respiratory activity of the baby  pt was declared dead.
• COD: Cardiopulmonary arrest d/t HIE grade III
INVESTIGATIONS:

• CBC: ABGs: 11am 10pm

Hb-12.0 PLT-113 TLC-17.1 pH: 7.319 7.320
• RFTs: PCO2: 30.3 39.6
Urea-60 Cr-1.2 PO2: 169 188
• S/E: HCO3: 10.9 20.4
Na- K Ca-7.5
• LFTs:
STB- 0.7 ALT- 56 AST- 155
• SEPTIC PROFILE:
CRP-0.34
TREATMENT GIVEN:
• IV fluids
• IV antibiotics (1st line, 2nd line started on first day eve)
• Inj phenytoin
• Inotropic supports
B of Shumaila twin 1 NB/2.0kg/F GA: 35+3
Diagnosis: HIE grade III
DOA: 21.03.2024 12.30am DOE: 22.03.24, 3.25am DOS: 26hrs

• G5P4+0, twin pregnancy SVD at 35+3 weeks Twin 2 normal discharged, twin 1 
• Unbooked case
• Antenatal risk factors: PIH+, Twin gestation
• At birth baby was resuscitated due to absent cry, intubated and then shifted to NICU (Absent cry,
bradycardia  suctioning and stimulation  no cry no respiratory activity HR<100  ambu bagging  no
cry no rep activity , HR>100  ETT placed ambu bagging done  weak irregular respiratory efforts )
• Receiving Notes: received & on vent at 1.00am P-SIMV FiO2 50%, PEEP 4, PCV 15, PSV 12, pulses
poor, poor reflexes, peripheral cyanosis, inotropic supports started
• Sick notes:
• At 6.00 am invasive CPAP trial over 1hr  baby was extubated & shifted to cpap
settings 30%, peep 6, flow 8
• At 5pm baby was dehydrated with poor pulses and shallow respiratory efforts, NS bolus was given
and Inotropic support started  had frequent apnea episodes then at 10pm baby was intubated
 baby went into bradycardia with persistent desaturation resuscitation was done &
Inotropic supports stepped up.  PCV transfusion was done
• Expiry notes: At 3:15am pt suddenly collapsed and was pulseless with no cardiac activity CPR with
was done but no improvement in Cardiac & Respiratory activity  Baby was declared dead at 3.30
• COD: cardiopulmonary arrest d/t DIC
INVESTIGATIONS:

• CBC: ABGs: 7pm

Hb-9.9 PLT-133 TLC-7.1 pH: 7.220
• RFTs: PCO2: 12.1
Urea- Cr- PO2: 104
• S/E: HCO3: 5.0
Na- K Ca-
• LFTs:
STB- ALT- AST-
• SEPTIC PROFILE:
CRP-

Blood culture no growth

TREATMENT GIVEN:
• IV fluids
• IV antibiotics (1st line)
• Inotropic supports
• Inj. vit K
• Inj. adrenaline
THANK YOU