Perinatal Mortality in Bahrain

EDITORIAL COMMENT: It is always interesting to read of medical practice and results obtained in other lands. Comparisons of results in successive years in one community is an easier proposition than comparisons between different communities. Nonetheless it is noteworthy that in Bahrain the incidence of lethal fetal malformations, 1985–1987, was 4.9 per 1,000 total births and the perinatal mortality rate was 19.6 per 1,000. In Victoria in 1985 the lethal malformation rate was 3.2 per 1,000 (195 of 61, 176) (1) but if the 58 terminations of pregnancy after prenatal diagnosis and before 20 weeks' gestation are included, the rate becomes 4.1 per 1,000, which is similar to the Bahrain figure, and identical to the rate in Victoria 1976–1979, when termination because of fetal anomaly before 20 weeks' gestation was seldom performed. In Victoria in 1986 the lethal malformation rate was 2.8 per 1,000 (172 of 61,253) (2) and when the 82 terminations, before 20 weeks' gestation because of fetal anomaly are included the rate was again 4.1 per 1,000. There are several reports that the incidence of major fetal malformations is very low in Chinese populations and one explanation is that this is due to a very low incidence of consanguinity. El‐Shafei and her colleagues have reported a significant association between congenital malformation and consanguinity in Bahrain (3). Table 2 in this paper lists the individual lethal abnormalities recorded; this survey must be continued with investigation of a much larger series before it will be possible to identify if there are individual malformations that have a higher incidence in Arabs. Although lethal malformations are usually obvious they may be an unexpected finding at autopsy; thus the absence of autopsy in Bahrain is another consideration in this comparison of statistics; in Victoria, in 1986, autopsies were performed on 78% of stillborn infants and 65% of neonatal deaths. The authors conclude that more widespread use of antenatal tests of fetal condition would result in improvement in the stillbirth rate; although their ratio of stillbirths: neonatal deaths (60.9%:39.1%) was only marginally higher than in Victoria for the 2 years 1985–1986 (55.5%:44.5%), the incidence of stillbirths in Bahrain (11.9 per 1,000 births) was almost twice that in Victoria during the 2 years 1985–1986 (6.4 per 1,000 births). Summary: A review of 583 perinatal deaths at the Ministry of Health hospitals in Bahrain, during the years 1985–1987 revealed a perinatal mortality rate of 19.6 per 1,000 total births. Lethal congenital malformations accounted for 145 (24.9%) deaths. Of the 438 normally formed infants there were 42.2% antepartum, 115 (26.3%) intrapartum and 138 (31.5%) early neonatal deaths; in 82.7% of cases the death was considered to be unavoidable. The population of Bahrain for 1986 according to the Central Statistics Organization (1) was 435,065, the majority of which was served by the Ministry of Health Maternity Service with approximately 10,000 deliveries per annum. The Ministry of Health provides maternity services through one main maternity hospital and 2 peripheral hospitals with consultant obstetric care. In addition to these, there are 3 maternity units run by midwives. High risk cases are usually delivered in the main hospital as there is a neonatal intensive care unit attached to it. The latter also acts as a referral centre for all sick babies in Bahrain. An analysis of the causes of perinatal deaths is an effective way of assessing the efficiency of maternity services. The objective of this study was to identify and improve the various factors influencing perinatal mortality in Bahrain.