RECOMMENDATIONS REFERENCE DIABETES MELLITUS IN PREGNANCY Maizuriati Abd Rahman

N a tio n a l O b st e tri cs R e g ist ry Table 6.1 Stillbirth rate from SDP 2011 and 2012 SDP 2011 2012 Total delivery FSB MSB Live birth Stillbirth rate per 1000 births Total delivery FSB MSB Live birth Stillbirth rate per 1000 births n n n n n n n n HTF Perlis 4,119 3 19 4,097 5.37 3,954 6 21 3,927 6.88 HSB Kedah 10,502 28 46 10,428 7.10 10,419 28 58 10,333 8.32 HPP 3,383 7 10 3,366 5.05 3,046 4 10 3,032 4.62 HRPB Perak 6,320 16 15 6,289 4.93 4,603 5 15 4,583 4.36 HTAR Selangor 12,477 35 63 12,379 7.92 12,212 41 59 12,112 8.26 HKL 11,868 46 77 11,745 10.47 11,995 24 97 11,874 10.19 HTJ Negeri Sembilan 4,886 5 15 4,866 4.11 6,273 12 20 6,241 5.13 Hospital Melaka 10,939 21 39 10,879 5.52 10,877 17 65 10,795 7.60 HSA Johor 12,641 33 76 12,532 8.70 12,466 34 60 12,372 7.60 HTAA Pahang 9,431 19 48 9,364 7.16 8,823 14 15 8,794 3.30 HSNZ Terengganu 12,181 27 79 12,075 8.78 12,945 33 84 12,828 9.12 HRPZ II Kelantan 13,220 14 90 13,116 7.93 11,096 17 45 11,034 5.62 HU Sarawak 9,941 21 35 9,885 5.67 1,522 3 7 1,512 6.61 HL Sabah 14,955 23 21 14,911 2.95 13,865 31 36 13,798 4.86 Total 136,863 298 633 135,932 6.85 124,096 269 592 123,235 6.99 55 tio n a l O b st e tri cs R e g ist ry Table 6.2 Distribution of stillbirth by age 2011 and 2012 Age 2011 2012 Total delivery FSB MSB Live birth Stillbirth rate per 1000 livebirth Total delivery FSB MSB Live birth Stillbirth rate per 1000 livebirth n n n n n n n n 10-14 129 2 127 15.75 126 126 0.00 15-19 6,776 20 27 6,729 6.98 5,786 17 22 5,747 6.79 20-24 26,282 57 94 26,131 5.78 22,731 55 86 22,590 6.24 25-29 47,462 86 192 47,184 5.89 43,913 74 188 43,651 6.00 30-34 33,727 66 140 33,521 6.15 31,264 61 151 31,052 6.83 35-39 17,286 45 121 17,120 9.70 15,618 44 95 15,479 8.98 40-44 4,807 20 49 4,738 14.56 4,314 18 45 4,251 14.82 45-49 367 3 8 356 30.90 316 5 311 16.08 50-54 26 26 0.00 26 26 0.00 55-59 1 1 - 2 2 0.00 Total 136,863 298 633 135,932 6.85 124,096 269 592 123,235 6.99 56 N a tio n a l O b st e tri cs R e g ist ry 65 Table 6.3 Distribution of stillbirth by ethnicity 2011 and 2012 Ethnicity 2011 2012 Total delivery FSB MSB Live birth Stillbirth rate per 1000 births Total delivery FSB MSB Live birth Stillbirth rate per 1000 births n n n n n n n n Malay 93,665 180 471 93,014 7.00 86,407 174 419 85,814 6.91 Chinese 8,572 16 30 8,526 5.40 7,552 17 30 7,505 6.26 Indian 6,477 29 37 6,411 10.29 6,218 21 49 6,148 11.39 Kadazan Dusun 4,048 7 9 4,032 3.97 3,718 10 3 3,705 3.51 Murut 349 3 346 8.67 263 1 262 3.82 Bajau 3,166 5 2 3,159 2.22 2,956 7 9 2,940 5.44 Iban 2,168 8 7 2,153 6.97 771 1 1 769 2.60 Melanau 123 123 0.00 38 38 0.00 Bidayuh 1,586 4 9 1,573 8.26 365 4 2 359 16.71 OA Peninsular Malaysia 924 6 6 912 13.16 761 1 7 753 10.62 Other indigenous group in Sabah Sarawak 2,720 1 3 2,716 1.47 2,351 4 7 2,340 4.70 Foreigner 11,429 37 53 11,339 7.94 10,694 26 58 10,610 7.92 Others 1,221 3 1,218 2.46 1,481 3 6 1,472 6.11 NA 415 2 3 410 12.20 521 1 520 1.92 Total 136,863 298 633 135,932 6.85 124,096 269 592 123,235 6.99 57 tio n a l O b st e tri cs R e g ist ry Table 6.4 Stillbirth in relation to Diabetes and Hypertension Medical disorders 2011 2012 Total delivery FSB MSB Live birth Stillbirth rate per 1000 births Total delivery FSB MSB Live birth Stillbirth rate per 1000 births n n n n n n n n Diabetes 11,899 19 76 11,804 8.05 10974 24 66 10,884 8.27 Pre-existing 957 2 14 941 17.00 747 9 6 732 20.49 Gestational 10,880 17 62 10,801 7.31 9,460 14 58 9,388 7.67 Hypertension 5,943 29 70 5,844 16.94 4,803 24 59 4,720 17.58 Pre-existing 1,060 6 15 1,039 20.21 805 3 14 788 21.57 Gestational 4,356 20 47 4,289 15.62 3,464 16 38 3,410 15.84 Pre-Eclampsia 950 4 19 927 24.81 799 6 11 782 21.74 Eclampsia 49 2 47 42.55 57 2 1 54 55.56 58 N a tio n a l O b st e tri cs R e g ist ry Table 6.5 Stillbirth rate in relation to risk levels at booking Risk Level at Booking 2011 2012 Total delivery FSB MSB Live birth Stillbirth rate per 1000 births Total delivery FSB MSB Live birth Stillbirth rate per 1000 births n n n n n n n n Red 3,088 16 40 3,032 18.47 3,123 18 42 3,063 19.59 Yellow 14,560 30 81 14,449 7.68 18,915 38 97 18,780 7.19 Green 72,316 139 283 71,894 5.87 71,481 125 291 71,065 5.85 White II 4,997 7 29 4,961 7.26 7,118 13 16 7,089 4.09 White I 16,851 25 63 16,763 5.25 14,371 16 66 14,289 5.74 No Code 6,467 35 47 6,385 12.84 4,303 25 41 4,237 15.58 NA 18,584 46 90 18,448 7.37 4,785 34 39 4,712 15.49 Total 136,863 298 633 135,932 6.85 124,096 269 592 123,235 6.99 59 tio n a l O b st e tri cs R e g ist ry Table 6.6 Stillbirth rate in relation to birth weight Birth Weight 2011 2012 Total delivery FSB MSB Live birth Stillbirth rate per 1000 births Total delivery FSB MSB Live birth Stillbirth rate per 1000 births n n n n n n n n 1000 1,246 108 226 912 366.23 1,187 96 233 858 383.45 1000 - 1500 1,501 36 99 1,366 98.83 1,388 36 84 1,268 94.64 1501 - 2000 3,843 36 88 3,719 33.34 3,451 37 85 3,329 36.65 2001 - 2500 16,194 33 68 16,093 6.28 14,492 32 72 14,388 7.23 2501 - 3000 50,450 41 68 50,341 2.17 44,894 35 56 44,803 2.03 3001 - 3500 46,106 30 38 46,038 1.48 42,375 21 36 42,318 1.35 3501 - 4000 13,570 8 20 13,542 2.07 12,632 8 13 12,611 1.67 4000 3,953 6 26 3,921 8.16 3,677 4 13 3,660 4.64 Total 136,863 298 633 135,932 6.85 124,096 269 592 123,235 6.99 60 National Obstetrics Registry 69 PREMATURITY National Obstetrics Registry National Obstetrics Registry CHAPTER 7 PREMATURITY Nor Jumizah Abd Kadir, Wan Abu Bakar Yusoff, Halimatun Mansor Sultanah Nur Zahirah Hospital,Terengganu SUMMARY The incidence of preterm birth in 2011 and 2012 was 10.4 and 11.3 respectively and we see a rising trend from our previous reports. Main contributor to premature births were preeclampsia, eclampsia and heart disease with NYHA 111.It was more among the OA Peninsular Malaysia and Indian women and in women in their first pregnancy as well as in women who are para 6 and more. 7.1 INTRODUCTION. HKL had the highest preterm births in 2010. In 2011 HKL had the highest preterm births at 14.2 and in 2012 HRPB Perak had the highest rate at 15.1. HL Sabah had the lowest preterm birth rate for both years. 7.2 PATIENT DEMOGRAPHICS Preterm births were higher in women in extremes of age. In 2011 preterm births was high in women aged 10-14 years at 20.2 and in 2012 in women aged 55 at 50. Preterm births were high in women with parity 6 and more in both years. It was high among the OA Peninsular Malaysia followed by Indians in both the years. 28.9 of babies that were premature had weight less than 2000g in 2011 and there was a slight increase at 30.4 in 2012. 7.3 CONTRIBUTING FACTORS TO PRETERM DELIVERIES The main contributing factor for prematurity was preeclampsia and eclampsia. In women with heart disease the premature deliveries were higher due to women’s worsening cardiac status 7.4 MODE OF DELIVERY Majority of the preterm deliveries were conducted by MOs with more than 6 months OG experience followed by staff nurses and HOs. About one third of the preterm babies were delivered by CS. 7.5 OUTCOMES 61 National Obstetrics Registry

7.5 OUTCOMES Slightly less than 50 of the babies were admitted to NICU and the nursery for

monitoring while the others were discharged to the mothers. There was fetal demise in 4 of these babies in 2011 and 4.4 in 2012.

7.6 CONCLUSION Preventing preterm births is a challenge. The causes can be numerous and complex

and not well understood. Prematurity is one of the major problems and it causes long term effects on the newborn. Two thirds of the babies were discharged to the mothers. To reduce preterm deliveries in adolescents and women above 40 years, women need access to contraception.

7.7 RECOMMENDATION

1. To prevent prematurity, women should be in good health before they embark on pregnancy and early antenatal care is important. 2. We should look into the association of smoking, drugs and assisted reproduction in relation prematurity in subsequent reports.

7.8 REFERRENCE

1. Green Top guideline No1b February 2011 RCOG. 62 National Obstetrics Registry Table 7.1: Total number of premature births for 2010 and 2012 Preterm birth 2010 2011 2012 n n n Total preterm delivery 11,219 8.1 14,181 10.4 14,060 11.3 Total delivery 138,315 100.0 136,863 100.0 124,096 100.0 Graph 7.1: Percentage of preterm births 2010-2012 63