Mortalidad perinatal. Distribución según la edad gestacional y el peso al nacimiento. Causas más frecuentes. Revisión epidemiológica de 10 años | Clínica e Investigación en Ginecología y Obstetricia

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Resumen

Objetivos:Evaluar la mortalidad perinatal (MP) de los últimos 10 años (1994–2003) habida en el Servicio de Obstetricia del Hospital Miguel Servet de Zaragoza. Se distribuye según la edad gestacional y el peso al nacimiento. Se analizan las posibles causas tanto maternas como fetales que pudieran estar implicadas.

Material y métodos:Sobre un total de 37.665 recién nacidos (RN) de más de 500 g de peso,hubo 368 nacidos muertos o que fallecieron antes de los 28 días completos de vida. El Hospital Maternoinfantil es un centro de referencia (nivel terciario) para las comunidades de Aragón y La Rioja, para la provincia de Soria y para los RN o sus madres con problemas procedentes de la actividad privada local.

Resultados:La MP global es del 9,770/00. Para las comparaciones internacionales,la MP I (> 28 semanas y hasta 7 días de vida) es del 5,620/00. Según la edad gestacional,un 72,28% son RN pretérmino,la mitad (50%) con menos de 32 semanas de gestación.Por pesos al nacimiento,la MP está gravada por lagran inmadurez:un 36,68% de los RN con un peso < 1.000 g y un 51,90% < 1.500 g,70 RN proceden de partos múltiples y todos ellos son pretérmino. La MP de los partos múltiples es globalmente del 46,51 0/00 (el 42,790/00en gemelos). Las causas fetales más frecuentes son la asfixia y la anoxia antes del inicio deltrabajo de parto (26,84%),la inmadurez extrema,tener un peso < 1.000 g (16,30%) y la patología respiretoria (12,22%). Las causas maternas más frecuentes son las gestaciones múltiples (19,02%),la rotura prematura de las membranas (12,22%) y el desprendimiento prematuro de la placenta y la hemorragia placentaria (10,05%).

Abstract

Objectives: To evaluate perinatal mortality (PM) during the last 10 years (1994-2003) in the Obstetric Department of the Miguel Servet Hospital in Zaragoza.Data are distributed in relation to gestational age, and weight. Both maternal and fetal possible causes of PM are analyzed.

Material and methods: Of a total of 37665 newborns (NB) of more than 500 g weight, there were 368 who were either born dead or died within the first 28 days of life. Our Hospital is a tertiary care center with for the regions of Aragon and La Rioja and the province of Soria and also for those newborns or mothers with problems in the private hospitals.

Results: Global perinatal mortality is 9.77%. For international comparison, perinatal mortality I (more or = 1000 g or 28 weeks gestational age and less or = 7 days of life) is 5.62%. According to gestational age, 72.28% are pre term deliveries and half (50%) are less than 32 weeks. By birth weight, 36.68% are lessthan 1000 g and 51.90% are less than 1500 g. The number of perinatal deaths in multiple pregnancies was 70 and all of them were pre term. Perinatal mortalityin multiple pregnancies is, globally, 46.51%, (42.79% in twins). The most common causes of fetal death: were intrauterine asphyxia or anoxia, extremeprematurity, less than 1000 g (16.30%) and respiratory pathology (12.22%). The most frequent maternal causes were: multiple delivery (19.02%), prematurerupture of membranes (12.22%), placental abruption and placental haemorrhage (10.05%).

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