 Complications of labor: Dystocia from disproportion, malpresentation,

abnormal uterine action, premature rupture of membranes may result in

asphyxia, amnionitis and birth injuries contributing to perinatal deaths.
 Fetoplacental factors:
Multiple pregnancy most often leads to preterm delivery and usual
complications.
Congenital malformation and chromosomal abnormalities are responsible for
15% of
perinatal deaths, the lethal malformations are mostly related to nervous,
cardiovascular or
gastrointestinal system.
Intrauterine growth restriction and low-birth-weight babies—Apart from
preterm delivery, intrauterine nutritional deficiency may be responsible for such
low weight babies which are more vulnerable to biochemical, neurological and
respiratory complications resulting in high perinatal deaths of about 50% when
the birth weight is less than 2 kg.
 Preterm labor and preterm rupture of the membranes are the known
leading causes of
prematurity.
 Unexplained: About 20% of stillbirths have no obvious fetal, placental,
maternal or obstetric causes.

Prevention
The following measures are helpful in reducing the perinatal mortality:
- Pre-pregnancy health care and counselling
- Genetic counselling in high risk cases and prenatal diagnosis to detect
genetic, chromosomal or structural abnormalities are essential.
Termination of an affected fetus is a positive step in reduction of
deaths due to congenital malformations.
- Regular antenatal care, with advice regarding health, diet and rest.
- Detection and management of medical disorders in pregnancy:
anaemia, diabetes, infections and preeclampsia-eclampsia.
Immunization against tetanus should be done as a routine.
- Screening of high risk patients those of poor socioeconomic status or
high parity, extremes of age, and twins, etc. and their mandatory
hospital delivery. Risk approach to RCH care is essential.
- Careful monitoring in labour to detect hypoxia early and avoidance of
traumatic vaginal delivery.
- Skilled birth attendant to minimize sepsis, at least three cleans are to
be maintained.
- Provision of referral neonatal service especially to look after the
preterm babies.
- Healthcare education of the mother about the care of the newborn.
Early and exclusive breastfeeding, prevention of hypothermia.