Delivery of the full guardianship role in reducing perinatal mortality for discussion. Each stage of perinatal mortality changes in trend as shown in Table 2: stillbirths, early neonatal period, total number of perinatal deaths, and the countdown per thousand cases. Note: The table of perinatal deaths does not include premature deaths with a pregnancy duration of less than 32 weeks or lethal malformations in newborns.
Table 3 shows the changes in trends of cesarean section rates and severe neonatal asphyxia over different years. From May 1995 to May 1998, the total number of perinatal cases was 255, with 62 cases of asphyxia (2.1%). In 1998, there were 3023 cases, with 60 cases of asphyxia (1.9%). From May 2001 to May 2004, the asphyxia rate was 3989 cases (380.95%), with no significant difference observed between these periods. Some scholars believe that admission care tests may help detect fetal hypoxia and acidosis early. However, due to the short duration of such tests, they cannot fully reflect the entire process of childbirth or intrapartum factors affecting fetal oxygen supply, such as umbilical cord, placental function, uterine contractions, and the birthing process, as well as the pregnant woman's physical condition.
These factors gradually manifest as labor progresses. If not detected, even with normal admission care tests, some cases of neonatal asphyxia might still occur. Continuous fetal heart monitoring during labor helps in timely detection of fetal distress and correct handling. Our approach is to conduct a guardianship test for pregnant women upon admission if they have irregular contractions, with no exceptions. During the latent phase, custody can be interrupted repeatedly, but once entering the active phase, continuous monitoring of fetal heart rate and uterine contractions should be maintained until delivery. Blood pressure and oxygen levels of pregnant women should be monitored at any time during this period. Early artificial rupture of membranes allows for active observation of amniotic fluid status, while B-ultrasound helps understand the fetal position. In short, we aim to make the delivery process for pregnant women and fetuses as fully supervised as possible.
From our care practice, we conclude: (1) If variable deceleration waveforms are confirmed during childbirth, it often indicates umbilical cord around the neck. (2) Neonatal asphyxia and perinatal deaths mainly occur in cases with variable decelerations and jumping baseline medical histories, which require special attention. Once abnormalities are detected, prompt measures should be taken. Data show that severe neonatal asphyxia in the third stage is around 0.95%, significantly lower compared to the first two phases. Table 2 also indicates a yearly decrease in stillbirths, early neonatal deaths, and perinatal deaths in the third phase, aligning with our delivery full guardianship exception graphics. Timely measures taken are inseparable from these results. Data also reveal no significant difference in cesarean section rates in the third stage compared to the first two stages, indicating that cesarean section is not the last factor in reducing perinatal mortality. In practice, we understand that full guardianship during delivery is an effective measure to protect fetal and newborn safety and reduce perinatal mortality.
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