Retrospective analysis of perinatal mortality in Belgrade in 1996
Authors: Milankovic Jasna 
Published: May 2019

Through the set hypotheses and presented results of statistical analysis it
was attempted to answer the question of what more could be done in our
country, especially in the health sector, to decrease perinatal mortality,
so as to achieve the level which some northwest European countries already
have. On the basis of data of official statistics, there is still
insufficient cooperation in Belgrade between departments in the same health
institution, as well as between certain levels of health care, without
appropriate transfer of information on the women who have just given birth,
namely the new-born (pregnancy card). A lack of uniformity in the level of
equipment and insufficient usage of genetic counseling offices is present.
About 62% of pregnant women reports to the counseling offices for pregnant
women for the first time in the first trimester, which is not sufficient.
The standardization of the application of doctrinal standpoints should be
achieved, especially in the diagnosis of risk factors and the provision of
adequate medical documentation for transfer of information during pregnancy,
labor and the condition of the newborn. Within that, it is necessary to
continually provide expert advanced training of health workers in the
future, in the organization of the relevant institution. The research
results of biological variables of women who have just given birth, such as
average age, parity, abortion and illness in her reproductive history, as
well as the most common complications during delivery, showed that no
significant deviation as regards this risk factor within control and risk
groups. The stated data indicated that in the risk group there were somewhat
more primipara, which might present an increased factor of risk for the
outcome of the delivery, while there were almost the same percentage less
than in the control group of the women who bore their second child. On the
other hand, there were less women who previously had an abortion in the
sample. Biological variables of newborns showed that in the risk group, out
of the total infant deaths, 41.6% were stillborn, and 57.3% died during the
first week, namely 22.6% during the first day of life. The ratio between
sexes was almost identical: 44.8% of dead newborns were male and 44.4% were
female sex. In the first twentyfour hours, namely in the first five hours
upon birth, the mortality of male newborns was greater by about 10%. The
mortality of female newborns was greater in the second day of life, by about
7% of the mortality of the male newborns of the same age. Upon reception
into the maternity hospital already, normal state of the fetus was noted in
only one third of the cases with these deliveries, while in two thirds death
had already occurred or suffering of the fetus was present. As many as 198
or 71% of newborns were prematurely delivered. Not a single delivery was
noted after term. 3.9% of the newborns had weight upto 499 grams, as many as
29.4% had exceptionally small weight (500-999 g), and another 20.8% small
weight at birth (1000-1499 g). In 19.4% cases, the fetus was completely
immature, while in 60.6% of the cases the delivery came between the 28th and
36th gestation weeks. As early as the first minute of birth, the lives of
over 60% of the liveborn children were endangered (low apgar score). Over
one half of the newborns which received the mark one or two in the first
minute upon birth, died in the first seventy-two hours of life. The most
critical were the first five hours upon birth, as well as the second day of
life. The knowledge of the samples of seminatal mortality in Belgrade also
represents a basis for further programming of health care for the mother and
child on the city level. A dominant mortality sample is severe asphyxia
(60%). In 13.8% of the cases, the cause of death is registered as unmarked
or unknown, so the second place according to intensity is present as
respiratory distress (6.9%). Multiple deliveries with seminatal mortality
were present in 26.9% cases. Most of the deliveries were carried out with
the "normal" position of the fetus, while 15.1% of the deliveries were
pelvic, and 17.3% were carried out by some childbearing operation technique.