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PubMed1998

Time trends in twin perinatal mortality in northern England, 1982-94. Northern Region Perinatal Mortality Survey Steering Group.

The dynamics of perinatal mortality rates (PNMR) and causes of death in twin pregnancies over 13 years in the Northern Region of the National Health Service in England is described. All twin perinatal deaths occurring between 1982-1994 were identified from the Northern Region Perinatal Mortality Survey. The twinning rate increased from 9.9 per 1000 maternities in 1982 to 12.0 in 1994. There was a total of 10,734 twin pregnancies and of these 421 resulted in 530 perinatal deaths. The perinatal mortality rate in twins significantly decreased over time (1982-87, 55.4 per 1000; 1988-94, 44.4 per 1000; P = 0.01). The PNMR was significantly higher for twins from like-sexed than from unlike-sexed pairs (53.5 and 34.4 per 1000 respectively, P < 0.001). Despite no improvement in birthweight distribution in the twin population, birthweight-specific perinatal mortality rates for both like and unlike-sexed twins decreased for each birthweight category in 1988-94 compared with 1982-87. Twins with very low birthweight (< 1500 g) comprised 69%, and preterm twins (< 37 completed weeks of gestation) 74.9% of all twin perinatal deaths. The major immediate cause of early neonatal death was pulmonary immaturity (63%); antepartum anoxia caused 76.9% of antenatal deaths. Unexplained preterm labour and intrauterine death were the leading obstetric factors underlying death in twins. Despite a decrease over the 13 years, the perinatal mortality rate in twins in the Northern Region remains high. Continued monitoring of trends in twinning and mortality rates is needed to inform health care planning.

Birth Weight↗
PubMed1993

Estimate of perinatal mortality risk.

Perinatal mortality is usually calculated according to the World Health Organisation as stillbirth and first week mortality at a specified week of gestation divided by all births at that same gestational week. This is not a meaningful indicator of the risk of future perinatal death for a living fetus. We have developed an approach to estimate the prospective risk of perinatal mortality. Data were derived from the Perinatal Database of the Netherlands. We calculated the prospective risk of perinatal mortality by dividing all future perinatal deaths from a certain week of gestation by all fetuses that remained undelivered. Using this statistic there is a decline in risk from 16 to 39 gestational weeks and an increase from 39 weeks onwards.

Databases, Factual↗
PubMed1989

Delivery following cesarean section and perinatal mortality.

The perinatal mortality in 1498 patients with one or more previous cesarean section scars delivered between 1972 and 1982 was analyzed. Repeat elective cesarean section was performed in 654 (44%) patients and 844 (56%) were subjected to a "trial of scar." Successful vaginal delivery occurred in 702 (83%) patients and 142 (17%) had emergency repeat operations. There were 46 perinatal deaths, giving a perinatal mortality rate (PMR) of 30.3/1000. It was lowest in patients who electively had a cesarean section (10.6/1000). The corrected PMR was twice as high in the trial of scar group. The PMR for the overall hospital population (27,072 babies) during the study period was 22.5/1000. There were four perinatal deaths in association with dehiscence of the uterine scar. The PMR in trial of scar patients decreased from 40/1000 to less than 20/1000 without a major change in policy. Meanwhile the unit cesarean section rate increased from 5 to 10%, but the repeat section rate was consistent at around 38.5%. Regional analgesia was used in 192 patients, for repeat section in five and trial of scar in 187. Oxytocin was given to 546 (65%) patients. Scar rupture is considered the major contraindication to a trial of scar, but emphasis was not laid on the possible increased perinatal mortality with this procedure before the 1980s. In view of the improvement in the PMR and the added risk to the mother with cesarean delivery, we advocate a policy of trial of scar with informed consent in selected cases.

Cesarean Section↗
PubMed1990

[A statistical study of the countermeasures to reduce the maternal mortality based on the relationship between the maternal mortality rate and perinatal mortality rate].

Although both the Japanese maternal mortality rate (MMR) and the perinatal mortality rate (PMR) have decreased remarkably in recent decades, the former is still high compared with other advanced countries. A statistical analysis on the relationship between the MMR and the PMR was performed to investigate this discrepancy. During the period of study, both rates fell by over 50 percent. There were definite statistical differences among the PMR for each prefecture but almost none among the MMR. The prefectures with high PMR remained generally high in the PMR and the prefectures with low PMR also remained low in the MMR. There was no significant correlation between the PMR and the MMR. Both maternal and perinatal deaths due to common causes decreased in number, and there were few regional differences concerning effective measures against them. The leading causes of maternal death which are irrelevant to perinatal death are emboli, bleeding, and some other rare medical complications. Emphasis should therefore be laid upon the early diagnosis and treatment of amniotic fluid embolism apart from measures against haemorrhage. Countermeasures for rare complications are also of great importance.

Embolism, Amniotic Fluid↗
PubMed1979

The Scottish perinatal mortality survey.

Perinatal deaths in single births that occurred in Scotland during 1977 were investigated by case-record analysis. Causes of death were divided into nine categories, an extended version of the Aberdeen classification being used. Out of 1012 single perinatal deaths, 265 were due to fetal abnormality, which in 140 cases was malformation of the central nervous system. Of the 747 normally formed infants, 446 weighed 1500 g or more, of whom 82 died intra partum and 154 were born alive. The largest single cause of death was low birth weight in normally formed babies whose mothers had no complications of pregnancy (302 cases). Of these babies, 103 (34%) were growth-retarded. Rhesus incompatibility (16 deaths) and maternal diabetes (seven deaths) were not major causes of perinatal loss. These results were thought to be valuable in illustrating the main causes of perinatal mortality and directing attention to important issues. Hence a modified version of the study is being continued to see whether yearly audit by regional assessors is a feasible and practical way of monitoring trends in perinatal mortality.

Birth Weight↗
PubMed1984

Perinatal mortality in a large perinatal center: five-year review of 31,000 births.

The perinatal mortality rate for 30,928 babies born at Medical Center Hospital, San Antonio, Texas, between 1978 and 1982, was 20.3/1,000 births. Neonatal and fetal mortality rates were, respectively, 10.1/1,000 live births and 10.4/1,000 births. Exclusion of babies who weighed less than 500 gm yielded adjusted fetal, neonatal, and perinatal mortality rates of, respectively, 9.2, 9.8, and 17.9. Birth weight-specific mortality rates were calculated by groups of 250 gm birth weight for all neonates and by increments of 100 gm for babies who weighed 500 to 1,499 gm. Male infants, intrauterine growth-retarded babies, and babies whose mothers were less than 15 years old contributed more deaths than would be expected from the characteristics of the obstetric population. Presumptive cause of fetal death was unknown in 32%, fetal anoxia in 21%, maternal pathologic conditions in 20%, inappropriate fetal growth in 13%, congenital malformations in 8%, and systemic fetal infections in 6%. Leading presumptive causes of neonatal death were immaturity (29%), congenital malformations (18%), hemorrhages (16%), and systemic infections (10%). Hyaline membrane disease and necrotizing enterocolitis contributed, respectively, 7% and 6% of deaths. Past and future trends of perinatal mortality are discussed.

Birth Weight↗
PubMed1998

The impact of consanguinity and inbreeding on perinatal mortality in Karachi, Pakistan.

Close consanguineous unions continue to be extremely common in much of West Asia, including Pakistan. However, the impact of inbreeding on offspring mortality, particularly perinatal mortality, remains poorly documented. This paper attempts to measure the mortality risks associated with consanguinity and inbreeding while controlling for the effects of other potential confounders. The study sample comprises a multi-ethnic population residing in selected squatter settlements of Karachi. The adjusted odds ratio for perinatal mortality in the offspring of women married to their first cousins was 2.0 [95% CI 1.5, 2.6]. When parental inbreeding was also taken into account, the adjusted odds ratio for perinatal mortality increased further. Analysis of a subsample of data limited to pregnancies to women aged 35 years or above (at the time of the survey) showed that, despite adjustment for important biological and socio-demographic factors, both consanguinity and inbreeding remained important predictors of perinatal mortality in the offspring. Implications of the present study for further research are highlighted.

Adolescent↗
PubMed2006

[A proposed new interpretation and revised definition of perinatal mortality].

A proposed new interpretation and revised definition of perinatal mortality. Perinatal mortality rate is a commonly used index, which reflects the quality of obstetrical and neonatological care. Relying on critical remarks considered for his study, the author believes that a novel classification should be developed in order to redefine the term perinatal mortality and pregnancy-related losses. The author points out that intrauterine death during pregnancy cannot be associated with fatal incidents about birth, because the former precedes the latter. While regarding the cases of intrauterine death at late pregnancy as being important specific indicators, the author proposes excluding them from the cases covered by the term perinatal mortality. Furthermore, the author argues that all cases of neonatal death, that is, those at birth and those occurring in the first 28 days of life should be regarded as cases of perinatal mortality. It is reasonable to extend perinatal period this way, because due to a more advanced neonatological care, immature preterm babies may be lost 6 or even 27 days after birth. A novel interpretation of perinatal mortality, not including the cases of intrauterine death at late pregnancy, but including all cases of neonatal mortality makes perinatal mortality rate a more exact qualifier of obstetrical and neonatological care.

Female↗
PubMed1984

[Toward a reduction of perinatal mortality].

Having studied perinatal mortality in Ille-et-Vilaine from 1972 onwards, the authors have come to realise how out of date the present method of working out perinatal mortality is because it only takes account of late intra-uterine death and early neonatal mortality of infants weighing at least 1 kilogram. The old method does not take notice of the changes that have occurred because of the progress that has taken place in obstetrics and neonatology such as the survival of an increasing number of newborn that weigh less than 1,000 grams or of the fact that the distinction between early and late neonatal death seems to be less and less valid. It does not add up to the total of "lost pregnancies". Furthermore, it does not make it possible to compare our figures with those published in foreign countries. The authors therefore feel that a new definition of perinatal mortality should be made, and this should satisfy the four following requirements: It should include on the one hand all fetuses and newborn that weigh at least 500 grams and on the other hand it should include early and late mortality and even mortality that occurs after the neonatal period. It should take into account the problem of false still-births. It should take into account fetal malformations and abnormalities that have called for therapeutic abortions because they are among the principal causes of perinatal mortality. It should study all the statistics and publications on this subject.

Abortion, Therapeutic↗
PubMed1993

[[Perinatal mortality rates in single and multiple births, and the effects of maternal age, birthweight, and other factors on the perinatal mortality rates in Japan]].

"The perinatal mortality rate (PMR) was analyzed using... Vital Statistics for 1950-1991 in Japan. Secular changes in the PMRs were analyzed according to sex and single-multiple births. This paper also investigated the effects of maternal age, birth order, gestational age, and birthweight on the PMR." (SUMMARY IN ENG)

Age Factors↗
PubMed1995

Effect of changing the stillbirth definition on evaluation of perinatal mortality rates.

The perinatal mortality rate is widely used as a summary statistic for evaluating the effectiveness of perinatal care. Since October, 1992, it has been a legal requirement in England and Wales to register fetal deaths at 24-27 completed weeks of gestation as stillbirths (in addition to those after 28 weeks), thereby altering the definition of perinatal death. In a cohort analysis of all babies born to women resident in Wales during 1993, we assessed whether the revised definition of perinatal mortality rate more appropriately measures effectiveness of care. There were 36,793 births and 313 perinatal deaths (221 stillbirths, 92 early neonatal deaths). At 24-27 weeks' gestation there were 59 (39%) survivors and 93 deaths (52 stillbirths, 36 neonatal deaths [28 early, eight late], and 5 postneonatal deaths). 119 babies had a birthweight below 500 g; one survived and 24 were perinatal deaths. Of the 36 late neonatal deaths all were attributed to perinatally related events. Increased survival of infants at 24-27 weeks' gestation emphasises the importance of including all these infants in the perinatal mortality rate, but it would be a more useful measure of the effectiveness of perinatal care if it excluded babies below 500 g, and included late neonatal deaths.

Adult↗
PubMed1998

[Analysis of perinatal mortality in the Tarnobrzeg region between 1976-1997].

The aim of the work was to show, how the birth weight influenced the mortality of perinatal fetus and newborn babies and it was to indicate the most common death causes. The analysis included 196277 newborn babies and 3767 died (perinatal mortality). During the period 1976-1997 a rate of perinatal mortality decreased from 25.4/1000 to 10.0/1000--it was due to diminution of postnatal mortality and elimination of intranatal deaths. It was noticed that there was the progressive increase of congenital defects among the causes of perinatal deaths.

Catchment Area, Health↗