Essential Statistics
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
All community health centres & hospitals should calculate their low birth weight rates, stillbirth rates, early neonatal death rates & perinatal mortality rates on a monthly basis. Annual summaries can be made at the end of each year. Babies that weigh <1 kg at birth are usually excluded from these calculations
Low birth weight rate = number of babies <2.5 kg at birth divided by all births in a given time period. This is expressed as a percentage (e.g. 15%).
Stillbirth rate = number of stillborn babies divided by all births in a given time period. This is expressed as a proportion of a thousand (e.g. 17/1000).
Early neonatal death rate = number of babies who died in the first 7 days after delivery divided by all live births in a given time period. This is expressed as a proportion of a thousand (e.g. 13/1000).
Perinatal mortality rate = number of stillborn babies plus the number of early neonatal deaths divided by all births in a given time period. This is expressed as a proportion of a thousand (e.g. 30/1000).
The perinatal mortality rate is the best measure of total perinatal care in a region & reflects the characteristics of the community served & its obstetric health service. Perinatal mortality rates in South Africa range from less than 10/0000 in affluent & well served communities to 80/1000 in impoverished areas with poor health services. As the low birth weight rate is a measure of the socioeconomic status of a community, the perinatal index may be calculated to control for the influence of socioeconomic conditions.
Perinatal care index = perinatal mortality rate (per thousand) divided by the low birth weight rate (as a percentage). A high perinatal care index indicates problems in perinatal care in a region or hospital. From the above examples, the perinatal care index is 30 divided by 15 = 2.0. A perinatal care index <2.0 is satisfactory for most South African government hospitals, but all institutions should strive for an index of 1.
Maternal death = death of a woman while pregnant or within 42 days after the end of a pregnancy
Direct cause of maternal death = death resulting from a condition specific to pregnancy, e.g. from pre-eclampsia, puerperal sepsis.
Indirect cause of maternal death = death resulting from a condition that is not specific to pregnancy, but where pregnancy may have aggravated the condition, e.g. cardiac disease, HIV disease, diabetes mellitus.
Maternal mortality ratio = number of maternal deaths divided by all live births recorded in a given time period. This is expressed as a ratio of deaths against one hundred thousand live births (e.g. 150:100 000).