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PubMed1995

[Analysis of trends in infant mortality with special reference to perinatal mortality in Austria (1965-1991)].

In Austria a marked decrease of perinatal mortality has been observed since the middle of the 1970s (Fig. 1). Regression models show a significant association with introduction of the mother-and-child health passport in 1974 and decreasing fertility of women older than 35 years. In part this decrease is due to a transfer of deaths from the perinatal period to later periods (Fig. 3). Some perinatal deaths were shifted to the periods of 2nd to 4th week and 2nd to 12th month after birth, respectively. From the difference between expected and observed perinatal mortality a saving of 13,400 perinatal deaths since 1974 has been calculated. Some of these children were in fact saved from death, whereas some of them died during a later period of the first year of life.

Adult↗
PubMed1989

Perinatal mortality in Belgium.

Perinatal mortality in Belgium remains high compared with other countries of Western Europe, although a marked decrease was observed during the period from 1956 to 1984. Analysis of the death causes indicates that further progress is feasible. Social inequalities and geographic variation are persisting in spite of the long-established policy of social welfare and free access to health services. Most of the studies on perinatal mortality in Belgium are descriptive and based on data recorded in birth and infant death certificates. In the future, alternative sources of information should be used to analyze more precisely and to understand more clearly the interactions between the different determinants of perinatal mortality and to evaluate the impact of social and health services.

Belgium↗
PubMed2005

Racial and ethnic disparities in perinatal mortality: applying the perinatal periods of risk model to identify areas for intervention.

OBJECTIVES: To determine the feto-infant mortality rate for New York City, assess racial/ethnic variations and identify areas for intervention using the Perinatal Periods of Risk (PPOR) approach. METHODS: The PPOR model examines fetal and infant deaths by age at death (fetal, neonatal, postneonatal) and birthweight (500-1499, > or =1500 g). It groups age at death and birthweight into four categories to identify problems hypothesized to lead to the death: factors related to Maternal Health and Prematurity, Maternal Care, Newborn Care and Infant Health. The model was applied to fetal and infant deaths occurring in New York City using Vital Records data from 1996-2000. Analysis was completed for the entire city and by race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Asians/Pacific Islander). RESULTS: The overall feto-infant mortality rate was 11.5/1,000 live births plus fetal deaths. This rate varied by race/ethnicity; black non-Hispanics had a higher rate than other racial/ethnic groups. Conditions related to maternal health and prematurity were the largest contributing factors to feto-infant mortality (5.9/1000) in New York City. Among blacks and Hispanics, problems related to maternal health and prematurity contributed a larger share than among whites and Asians/Pacific Islanders. CONCLUSION: The use of the PPOR approach shows that the racial/ethnic disparities in feto-infant mortality that exist in New York City are largely related to maternal health and prematurity. Interventions to reduce the feto-infant mortality rate should include preconception care and improvements in women's health.

Ethnicity↗
PubMed1997

Term and postterm twin gestations. Placental cause of perinatal mortality.

OBJECTIVE: To compare perinatal mortality in twins and singletons and to study the influence of fetal sex, placentation and maternal parity on perinatal mortality in term and postterm twin gestations. STUDY DESIGN: The subjects of the study were 1,511 twin pairs and 3,022 singletons. All were born at a gestational age of 27 weeks or more in two clinics in Amsterdam between 1931 and 1975. RESULTS: Perinatal mortality was lower in twins than in singletons until 37-38 weeks and higher afterwards. In twins, perinatal mortality was higher in boys than in girls, in monochorial than in dichorial twins, and in primiparae than in multiparae, especially in the last trimester. CONCLUSION: The development of the twin placenta may set limits in term and postterm twin gestations and may be responsible, to some extent, for the increase in perinatal mortality.

Female↗
PubMed1993

[Changes in perinatal mortality in twins].

Perinatal mortality of twins born in South Moravian Region in the years 1983-1987 was compared with that observed in the years 1970-1976. The perinatal mortality of twins decreased from 119,35 per thousand to 64,21 per thousand (the corresponding numbers for the whole population of the region in question are 16.48 per thousand and 11.30 per thousand respectively). The mortality of twins shows no reasonable changes. The early neonatal mortality decreased from 98.32 per thousand to 41.23 per thousand (the corresponding numbers in the whole population are 10.25 per thousand and 6.05 per thousand respectively). As in other countries the most important cause is the decrease of prematurity. This was observed both in the evaluation according to the birth weight and according to the gestational age as well as when the main cause of death was evaluated. Nevertheless also in the second sample a higher mortality of twins B than that of twins A was observed. The results of the leading clinics in the perinatal care show no more higher mortality of twins B namely due to the decrease of the number of RDS deaths. To achieve such object will be the nearest task in our perinatal care for the twins pregnancies and neonates.

Birth Weight↗
PubMed1988

Is perinatal mortality still a good indicator of perinatal care?

The increasing influence of very immature infants on perinatal mortality rates (PMR) led us to question the usefulness of this parameter in assessing perinatal care. To examine this further we have compared the incidence of perinatal asphyxia amongst mature babies (greater than or equal to 35 weeks gestation) for two geographically-defined populations of over 500,000 people. Both areas have a teaching hospital-based maternity service and comparable perinatal mortality rates. The incidence of severe post-asphyxial encephalopathy showed a marked excess in one population (1.93 vs 0.61 per 1000 births), which was not obviously explicable. Taken in conjunction with the figures for stillbirth in labour, this represented a 2.8 times greater risk for either fetal death in labour or severe asphyxial insult. It would appear that perinatal mortality rates do not accurately reflect important differences in those perinatal outcomes most likely to be affected by perinatal care.

Asphyxia Neonatorum↗
PubMed1982

Clinical causes and classification of perinatal mortality in Lagos.

Perinatal deaths in singleton births at the Lagos University Teaching Hospital during a 5-year period were reviewed. Causes of deaths were classified into eight groups using a modified form of the Aberdeen classification. Perinatal mortality was high (42.5/1000 total births). The stillbirth rate was 32.5/1000 total births. The major causes of perinatal mortality were trauma (30.5%), low birth weight (23.9%), hemorrhage (13.7%), toxemia of pregnancy (10.3%) and mature, cause unknown (10%). Congenital malformation (4.3%) was not a major cause of perinatal deaths in this study.

Female↗
PubMed1992

Maternal and perinatal mortality.

Maternal and perinatal mortality are important health problems in the United States. Emerging causes of maternal deaths are embolism, cardiomyopathy, anesthesia complications, adult respiratory distress syndrome, and acquired immunodeficiency syndrome. Maternal deaths continue to be underreported. Active surveillance is needed to better identify maternal deaths and to understand their causes and risk factors. Although perinatal deaths have declined recently--primarily because technologic advances have improved low-birth-weight babies' chances for survival--they remain a problem, particularly among blacks. Clinicians should strive to reduce preventable deaths among black normal-birth-weight babies and to prevent low birth weight and premature birth among black infants. Future research should focus on determining whether early prenatal care and cesarean delivery actually reduce perinatal mortality. A better understanding of prenatal and intrapartum care and their benefits will help in the development of strategies to reduce perinatal and maternal deaths.

Cause of Death↗
PubMed2003

Perinatal mortality in rural China: retrospective cohort study.

OBJECTIVES: To explore the use of local civil registration data to assess the perinatal mortality in a typical rural county in a less developed province in China, 1999-2000. DESIGN: Retrospective cohort study. Pregnancies in a cohort of women followed from registration of pregnancy to outcome of infant seven days after birth. SETTING: Routine family planning records in 20 rural townships in eastern China. SUBJECTS: 3697 pregnancies registered by the local family planning system during 1999. MAIN OUTCOME MEASURES: Abortions, stillbirths, early neonatal mortality, perinatal mortality. RESULTS: Only three cases were lost to follow up. The average age of the women at pregnancy was 25.9 years. Three hundred and twelve pregnancies were aborted and 240 ended in miscarriage (total 552, 15%). The perinatal mortality rate was 69 per 1000 births, the rate of stillbirth was 24 per 1000 births, and the early neonatal mortality was 46 per 1000 live births. The early neonatal mortality was 29 in boys and 69 in girls per 1000 live births. The perinatal mortality rate increased notably with parity and was higher in townships having lower income per capita. CONCLUSIONS: The family planning system at the most local level is a useful data source for studying perinatal mortality in rural China. The perinatal mortality rate in the study county was higher than previously reported for both rural and urban areas in China. The results by parity and sex of the infant raise concern over the impact of the one child policy.

Adult↗
PubMed1982

Monitoring perinatal mortality by birth weight specific mortality rates.

The perinatal mortality at University Central Hospital of Turku, Finland decreased significantly from 15.7/1000 in years 1970-75 to 8.9/1000 in years 1976-78. The main decrease has occurred in weight groups of 1000 g and more. In years 1976-78 the perinatal mortality of non-malformed babies in the weight group 1500-1999 g was 93/1000, in the group 2000-2499 g 21/1000 and in the group of 2500 g and over 1.7/1000. The early neonatal mortality of non-malformed infants has decreased significantly only in the weight group of 1500-1999 g. The 1-week survival rate has been 48% in the weight group 500-999 g, but 77% in the weight group 1000-1499 g. The birth weight specific mortality rates are greatly required when the quality of obstetrical care is assessed. Birth weight specific neonatal mortality rates are essential when guidelines for elective termination of third trimester pregnancy are designed.

Birth Weight↗
PubMed1982

Infant, neonatal and perinatal mortality rates in Singapore.

Infant, neonatal and perinatal mortality rates are reliable indices of the health status and delivery of health care in a country. These rates have been declining in Singapore since World War II, and presently have become comparable to those of many developing countries. The pattern has also changed; postneonatal mortality has fallen markedly, resulting in neonatal mortality accounting for 75% of infant mortality, and first week mortality for 85% of neonatal mortality. Perinatal mortality rates have also declined over the years, due mainly to a decline in the first week mortality rates though a slight fall in stillbirth rates has also occurred. Further improvements can be expected in the perinatal and neonatal mortality rates. As neonatal intensive care improves, the prognosis of the very small and feeble infants will be brighter even though the efforts required might be very much greater. Such a challenge will prove to be very exciting and stimulating, and be an impetus to the raising of neonatal intensive care to a much higher level.

Female↗
PubMed1982

Ethnic differences in perinatal mortality--a challenge.

The perinatal mortality rates of mothers who delivered at St. Thomas's Hospital from 1969 to 1976 have been examined. The rate in the West Indian population was significant higher than in the United Kingdom white population. The increased West Indian mortality was confined to infants with a birth weight of more than 2.0 kg and a gestational age of more than 37 weeks. The relative risk of perinatal death for West Indian mothers compared with UK white mothers was 1.4 at birth weights of 2.5 kg to 2.9 kg, rising to 4.3 at 4.0 + kg. West Indian perinatal mortality in term babies of normal birth weight was higher in all maternal age and parity groups except parity 3, but the difference was greatest in women aged 30 or over. The African perinatal mortality rate was not significantly greater than the UK white rate although it followed the West Indian trends. Pre-eclampsia and forceps delivery were associated with a greatly increased perinatal mortality in West Indian babies. The excess West Indian mortality could not be explained completely by differences in the proportions of stillbirths and early neonatal deaths nor by the distribution of births by parity, maternal age, or social class. Possible explanations for the differences in mortality are discussed.

Birth Weight↗
PubMed1980

[Experiences in studying multiple causes of perinatal mortality on the basis of a special "perinatal death certificate"].

The importance of the perinatal mortality requires a thorough study of its causes. The development of effective measures for reduction of perinatal mortality must be based on the knowledge of not only the immediate causes of death of the baby (fetus) but also of all the factors of diseases and conditions of the mother, conditions of the placenta, external causes exerting a marked damaging effect on the fetus. The paper describes the experience of investigating multiple causes of perinatal mortality on the basis of a special "Perinatal Death Certificate" (registration form 246-PS) introduced in the USSR in 1974, using for coding the International statistical classification of diseases, traumas, and death causes of the IX revision which will be used in this country since 1981. This experience permits to formulate suggestions for the development of multiple causes of perinatal death within the framework of the national statistics.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Intrauterine growth retardation--perinatal mortality and postnatal morbidity in a perinatal center].

OBJECTIVES: The intrauterine growth retardation (IUGR) contributes specially to perinatal mortality and morbidity. An effective treatment is not yet available. The purpose of this study is to analyse the perinatal data of a cohort with IUGR-infants including mortality and morbidity and to describe prematurity and IUGR as a combination of high risk. STUDY DESIGN: We have analysed the perinatal data of a cohort of 220 patients with IUGR-infants including mortality and morbidity. Regularly we examined fetal ultrasonographic growth, doppler measurements of fetal and maternal vessels and CTG, as well as indicated amniocentesis, placentesis and cordocentesis. Entry criteria were: normal menstrual period before pregnancy, clear gestational age, complete history of pregnancy. RESULTS: At the Department of Gynaecology & Obstetrics, University Hospital, Homburg/Saar, the incidence of IUGR (< 10th Percentile) in premature babies and newborns was 13.1% over five years (1993-1997). The percentage of premature babies with IUGR was 18.6%. The overall mortality was 4.1%, the perinatal mortality was 3.6% and the neonatal mortality was 2.7%. In 1.4% intrauterine foetal death was observed, all associated with a birthweight below the 3th percentile. The average duration of pregnancy was 34 + 4 weeks. A high perinatal mortality of 13.1% and an overall mortality of 14.7% was observed. 11.4% of the premature babies with IUGR showed deformities and about 2% presented chromosome aberrations. 46.4% of children have been transferred to the Neonatal Intensive Care Unit. 57.1% of the postnatal complications have been related to the lungs, 26.5% to the cardiovascular system and 14.3% to the cerebrum. Maternal complications were referred to: SIH/EPH-gestosis (65.4%), HELLP-syndrome (5.8%), nicotine abuse (31.4%), pregnancy anaemia (17.3%) and gestational diabetes with insuline therapy (7.7%). On the placental site the most noticeable conditions have been placental insufficiency (40.6%) and placental infarction (28.7%). CONCLUSION: Children with IUGR are exposed to high perinatal mortality and postnatal morbidity. Premature babies in association with an IUGR are at high risk. The surveillance of the pregnant women and the new-born children should be performed in a perinatal centre.

Birth Weight↗