From Big Medical Encyclopedia

PERINATAL MORTALITY (grech, peri around, about + armor. natus the birth) — mortality of fruits and newborns in the perinatal period. Perinatal period (see) begins with the 28th week of pregnancy when the weight of a fruit reaches 1000 and more and height of 35 cm and more, includes the period of childbirth and comes to an end by the end of the 7th days of life of the newborn.

P.'s indicator of page includes an indicator of mortinatality — death of a fruit came during the period of the 28th week of pregnancy prior to childbirth (antenatal mortinatality) or at the time of delivery (intranatal mortinatality) — and an indicator of early neonatal mortality — death came in the first 7 days of life (see. Child mortality , Mertvorozhdennost ). Early neonatal mortality makes 40 — 60% of the level of child mortality.

P.'s indicator of page is expressed in per mille and calculated by a formula:

[Number mortinatus + number of the dead in the first 7 days of life] \[number all been born (live and dead)] * 1000

P.'s indicator of page in the certain countries of the world fluctuates from 15 to 30 per milles, and in some countries reaches 45 per milles. In the USSR, according to selective data, P.'s indicator of page makes 12 — 25 per milles in certain regions of the country. P.'s indicator of page depends on social and economic living conditions of the population, level of medical aid, approach to definition of viability of a fruit and a zhivorozhdennost. The USSR considers viable a fruit since 28 weeks of pre-natal development which weight not less than 1000, and height not less than 35 cm, a sign of a zhivorozhdennost is independent breath. For standardization of perinatal WHO statistics suggests to consider criterion of viability the weight of a fruit or newborn 1000 (irrespective of duration of gestation) and if weight at the birth is unknown, then duration of gestation of 28 weeks or growth of a fruit of 35 cm.

P.'s reasons for page divide on direct (the reasons depending only on a fruit) and the main (the reasons depending on the mother — system a placenta — a fruit). Carry asphyxia of a fruit and the newborn, a birth trauma, inborn malformations, a hemolitic disease of newborns to proximate causes of P. of page. The main role among proximate causes of P. of page belongs to asphyxia. The tendency to increase of a role in P. is noted by page of inborn malformations. In most cases proximate causes of P. of page are caused by diseases or patol, conditions of mother, complications of pregnancy and childbirth, pathology of a placenta and umbilical cord. The complicated childbirth, late toxicosis of pregnant women, extragenital diseases of mother are the most frequent main reasons for P. of page. Nearly a half of the dead in the perinatal period is made premature children (see).

The level P. of page is influenced by a number of factors, including age of mother, the previous abortions, an interval between childbirth, smoking and alcohol intake during pregnancy, etc. During the smoking during pregnancy there are toxicoses, premature births more often, children are born with a low weight. Alcohol intake during pregnancy often leads to late abortions, delay of psychophysical development of the child, deficit of its weight.

According to selective data, for first labor the age of the woman 20 — 24 years, for the second — 25 — 29 years is optimum. At primapara women at the age of 30 years the frequency of premature births is also more senior increases by 1,5 times, operational rodorazreshayushchy interventions are 3 times more often applied. In the perinatal period 1,5 times more often children at women whose first pregnancy ended with abortion perish. For the normal result of childbirth the interval between sorts 2 — is 5 years optimum. Closely the weight of the child at the birth correlates with the level P. of page. The weight of 3000 — 3500 g is optimum.

During the development of measures of prevention of P. of page special attention is paid on preservation and promotion of health of the woman to and during pregnancy (see. Antenatal protection of a fruit , Protection of motherhood and childhood ). Special attention shall be paid on the pregnant women having a high risk concerning development of perinatal pathology, holding actions for fight against late toxicosis of pregnant women, the wrong provisions of a fruit, pathology of a placenta and umbilical cord, anomalies of patrimonial activity, pre-natal infection of a fruit. In P.'s prevention by the village use of modern methods of identification and correction of disturbances of the state of health of newborns during the first hours and days of life, methods of resuscitation, and also strict observance a dignity is of great importance. - a gigabyte. the mode in departments of newborns.

For identification of ways of decrease in P. of page it is important to study all cases of death of children in the perinatal period for their systematization and development of rational measures of prevention.

See also Antenatal pathology , Perinatal pathology .

Bibliography: Grishchenko V. I. and Yakovtsova A. F. Antenatal death of a fruit, M., 197 8, bibliogr.; D and N. M. dyne, r N d h both to L. P. and With at m and r about in and L. M. The obstetric reasons of perinatal mortality, in book: Aktualn, vopr, a feather-bed of a logiya, under the editorship of G. M. Savelyeva and V. V. Cherna, t. 2, page 8, M., 1978; To Osh e of l of e in and N. G. Prevention of perinatal incidence and mortality, M., 1979, bibliogr.; M at the h and e in G. of Page and F r about l about in and O. G. Health protection of a fruit and the newborn in the USSR, M., 1979; P e of t r about in - M and with l and to about in M. A. and To l to them e of c of I. I. Perinatal mortality, L., 1965; Guide to the international statistical classification of diseases, injuries and causes of death, t. 1, page 419, Geneva, WHO, 1980; Frolova O. G., B and r x and t about in and T. P. and I am a N to about in and M. F. O ways of decrease in perinatal mortality, Akush, and ginek., No. 11, page 35, 1976; Chernetskaya E. O. O influence of some social and hygienic factors on the level of perinatal mortality, Zdravookhr. Grew. Federations, No. 8, page 23, 1975; Thompson J. Perinatal mortality in retrospect and prospect, Scot. med. J., v. 14, p. 89, 1969; Wallace H. M. Factors associated with perinatal mortality and morbidity, Clin. Obstet. Gynec., v. 13, p. 13, 1970.

O. G. Frolova.