The Consequences of Perinatal Asphyxia in Southeast Asia

The Consequences of Perinatal Asphyxia in Southeast Asia:

Can Women’s Groups Help to Reduce the Burden?

 

Matthew Ellis, of The Centre for Child and Adolescent Health, Bristol University, U.K., began his talk by describing the Kathmandu study (Figure 6.1) which was performed in a hospital setting. The potential outcomes of acute intrapartum events are shown in Figure 6.2. The data in Figure 6.3 show that perinatal asphyxia in Kathmandu is associated with a high incidence of stillbirths, especially when compared to the rates in the United Kingdom.

 

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Images of neonatal encephalopathy are shown in
Figure 6.4. Dr. Ellis described a simple system, applicable in low-income countries, of using tone evaluation to assess neonatal encephalopathy (NE) (Figure 6.5).

 

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In Dr. Ellis et al’s study of 15000 infants (
Figure 6.6), five percent of babies had an Apgar at one minute of 3 or less. Almost all babies with NE fell into that group. (However, it should be noted that most babies with Apgars at or below 3 did not develop NE.) The prevalence of the three levels of NE is shown in Figure 6.7 and the outcomes are shown in Figure 6.8  All grade 3 infants died -- usually within the first week of life. The “impaired” group included those with severe forms of impairment such as microcephaly, blindness and spastic quadriparesis (Figure 6.9)

 

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Intrapartum risk factors leading to perinatal asphyxia are shown in Figure 6.10 and are significantly greater than in developed countries (Figure 6.11). Other risk factors are shown in Figure 6.12. An additional risk factor is the use of syntocinon to induce labour.

 

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An intervention trial is underway in
Nepal (Figure 6.13). Village Development Committees (VDCs) are responsible for surveillance of 29,000 women. The intervention study consists of training and assigning village health workers to specific villages or wards. The trial’s objectives and outcomes are described in Figures 6.14 and 6.15. The methodology is described in Figures 6.16, 6.17, 6.18, 6.19 Figure 6.19 refers to a card matching game in which some cards are imprinted with images of specific problems and others are imprinted with images of preventive measures, including indications of whether certain problem should be handled at home or whether there should be a referral.

 

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The results of this intervention trial are shown in Figures 6.20 and 6.21; clearly there has been a significant reduction in the neonatal mortality, including early neonatal mortality (ENMR), rate in the intervention group. There has not been a change in the stillbirth rate. The maternal mortality rate has been reduced, although not significantly.

 

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Further comparisons of outcomes, employing different birth practices, are shown in
Figure 6.22.

 

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Dr. Ellis described a training program for traditional birth attendants (TBA) in
Bangladesh (Figure 6.23). This program is akin to the programs described above but also includes a specific focus on training in neonatal resuscitation. The training appears to have been successful although data on resulting neonatal survival is not yet available.

 

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