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PubMed2002

[Perinatal mortality: a proposed analysis].

Perinatal mortality is an epidemiologic indicator that evaluates materno-infantil quality care indirectly. Obtaining rates of perinatal mortality from continuous and confident information systems allow us a more precise evaluation of quality care in developed countries. In developing countries as Mexico, there aren't yet evaluating health programs that let us to know the actual situation of our medical care. Being the main mistake subregister problems in regional and national perinatal mortality case. All this let us to a not optimum use of the limited resources given for health. The aim of this paper is to propose an analysis way into this matter for knowing our institutional and national situation. This would permit us to suggest effective strategies in the prevention of obstetric complications as in the preterm birth case. The main objective is to prevent death in the perinatal period.

Cause of Death↗
PubMed1991

Perinatal mortality--an intervention study.

Perinatal mortality is high in rural hospitals in South Africa. In part this is due to less than optimal care. This study determined the perinatal mortality experienced by a rural hospital and its clinics. Avoidable causes of death are described and various intervention strategies that effectively and rapidly prevented such deaths, reducing perinatal mortality by one-third, are outlined.

Hospitals, Rural↗
PubMedDate not supplied

Strontium fallout from Chernobyl and perinatal mortality in Ukraine and Belarus.

Perinatal mortality rates in the regions of Ukraine and Belarus surrounding the Chernobyl site increased in 1987, the year following the Chernobyl accident. The same year, increases of perinatal mortality were also observed in Germany and Poland, and the effect can be associated with the caesium burden in pregnant women. After 1989, there is an unexpected second rise of perinatal mortality in Belarus and Ukraine. This increase is shown to correlate with the strontium content in pregnant women. The findings parallel an increase of perinatal mortality in Germany following the atmospheric bomb tests in the 1950's and 1960's. While the effect from caesium is essentially limited to 1987, the effect from strontium persists until the end of the study period in 1998. The cumulative effect from strontium around Chernobyl outweighs the effect from caesium by at least a factor of 10. This is contrary to the assertion that the caesium content in the Chernobyl fallout was more than 10-times greater than the strontium content. Thus, the dose factor presently used seems to severely underestimate the effect of strontium on perinatal mortality.

Fetal Death↗
PubMed2004

The contribution of malaria in pregnancy to perinatal mortality.

The link between malaria and perinatal mortality was explored by systematically reviewing 117 studies published between 1948 and 2002. The mean perinatal mortality rate was higher in malaria endemic countries (61.1/1,000, 95% confidence interval [CI] = 52.1-70.1) than in non-endemic countries (25.8/1,000, 95% CI = 21.1-30.6). Similarly, the fetal mortality rate was higher in endemic countries (40.1/1,000, 95% CI = 32.1-48.0) than in non-endemic countries (20.0/1,000, 95% CI = 13.2-26.8) countries. Considering that perinatal mortality is an important indicator of obstetric care quality and socioeconomic development, further analysis was restricted to countries with a human development index between 500 and 800. In this category, the perinatal mortality rate was also significantly higher in endemic countries (50.5/1,000, 95% CI = 35.5-65.5) than in non-endemic countries (30.0/1,000, 95% CI = 25.7-34.3). In some publications, the occurrence of placental malaria and stillbirth was available. Placental malaria was significantly associated with a higher risk for stillbirth, regardless of parity (odds ratio = 2.19, 95% CI = 1.49-3.22, P < 0.001). Despite the limitations involved in this kind of review, all information found indicates that in endemic countries, malaria is an important determinant of perinatal mortality. Preventive measures such as intermittent preventive treatment or insecticide-treated bed nets could substantially reduce perinatal mortality and fetal wastage.

Africa↗
PubMed2001

Clinico-pathological study of causes of perinatal mortality in a developing country.

Perinatal mortality rates are an important indicator of the overall obstetric and neonatal services available, and the socio-economic status of the community. These rates are also used to identify shortcomings in services provided. The aim of this study was to identify clinical causative factors of perinatal deaths (supported by post mortem evidence where possible). This was a prospective descriptive study. The total number of deliveries and perinatal deaths over a 6-month period were recorded and clinico-demographic data noted. Post mortem examination information, if available, was also recorded. There was a total of 7789 deliveries over the 6-month period and 460 perinatal deaths, giving a perinatal mortality rate of 59/1000 deliveries; 45% (n = 207) of the perinatal deaths had post mortem examinations. The mean age was 26 years; 84.8% were single mothers. One-third of the group were un-booked: the mean gestational age of fetal death was 31 weeks, and the mean birth weight was 1700 g. Two-thirds of the perinatal deaths were stillbirths. The leading obstetric causes of deaths were: abruptio placentae (25.3%), hypertension in pregnancy (24.9%), prematurity (17.4%), unexplained stillbirth (13.4%) and intrapartum asphyxia (9.2%). The perinatal mortality rate of 59/1000 deliveries is high. Although this is comparable with other developing countries, there is a need for improvement in organisation of obstetric and neonatal care, staffing levels and access to and effective utilisation of antenatal services. These will probably lead to a significant reduction of this relatively high perinatal mortality rate.

Journal Article↗
PubMed1996

The effect of placental malaria infection on perinatal mortality in rural Malawi.

Perinatal deaths (fetal or infant deaths from the 28th week of pregnancy up to the seventh day after birth) occur as a result of adverse conditions during pregnancy, labor, and delivery, or in the first few days of life. Placental malaria infection is known to increase the risk of delivery of a low birth weight infant, thus, potentially increasing the risk of perinatal and infant mortality. To better understand the relationship among the adverse events in pregnancy, including placental malaria infection, adverse conditions in labor, and birth weight to perinatal mortality, we investigated the perinatal mortality among a cohort of infants born to rural Malawian women for whom placental malaria infection status and birth weight were documented. Among the 2,063 mother-singleton infant pairs, there were 111 perinatal deaths (53.8 perinatal deaths per 1,000 births). The risk of perinatal death increased as birth weight decreased. Risk factors identified for perinatal mortality among all infants excluding birth weight included abnormal delivery (cesarean section, breech, or vacuum extraction), a history of a late fetal or neonatal death in the most recent previous birth among multiparous women, reactive maternal syphilis serology, nulliparity, and low socioeconomic status. Placental malaria infection was not associated with increased perinatal mortality, but was associated with lower perinatal mortality among normal birth weight (> or = 2,500 g) infants (odds ratio = 0.35, 95% confidence interval = 0.14, 0.92). Interventions to address these risk factors could have a substantial impact on reducing perinatal mortality in this population.

Adolescent↗
PubMedDate not supplied

One year audit of perinatal mortality at Kathmandu Medical College Hospital.

INTRODUCTION: Perinatal mortality is a sensitive indicator of the quality of service provided to pregnant women and their new borns. Regular audit of perinatal mortality will help in finding out preventive factors and thus helps in reducing perinatal mortality rate in an institution. OBJECTIVE: This study was carried out to determine perinatal mortality rate (PMR) and the factors associated with it at KMCTH in the one year period (Bhadra 2059-Shrawan 2060) MATERIALS AND METHODS: This is a retrospective study of entire still births and early neonatal deaths that occurred at KMCTH during the one year period (Bhadra 2059-Shrawan 2060). The study was done by collecting the data of all stillbirths and early neonatal deaths from record books of the Special Care Baby Unit, Labour Room and operation theatre. RESULTS: Out of 563 total births in the one year study period, 17 were still births (SB) and 10 were early neonatal death (ENND). Out of 17 SB, 7 were of < 1 kg and out of 10 ENND, 3 were of < 1 kg. Thus, perinatal mortality rate during the study period was 30.7 and extended perinatal mortality rate was 47.9 per 1000 births. Perinatal deaths were mostly due to extreme prematurity, birth asphyxia, septicemia and congenital anomalies. According to Wiggleworths classification, 18.5% of perinatal deaths were in Group I, 14.8% in Group II, 22.3% in Group III, 40.7% in Group IV and 3.7% in Group V. Intrapartum asphyxia was the commonest cause of perinatal deaths, but majority of these babies were of low birth weight. Prevention of preterm births, better care during intrapartum period, more intensive care of very low birth weight and preterm babies would help in reducing the present high perinatal mortality.

Cause of Death↗
PubMed1998

Perinatal mortality in breech presentation sibships.

OBJECTIVE: To compare perinatal mortality in breech presentation delivered vaginally and by cesarean in individual births and in sibships. METHODS: A national, population registry-based study, 1967-1994, was conducted, with maternal record linkage of sibships, comprising the first to the third birth of a mother. The main outcome was perinatal mortality. Odds ratios of perinatal mortality were calculated and adjusted by logistic regression analysis. RESULTS: The overall relative perinatal mortality was 4.3 (95% confidence interval [CI] 4.1, 4.5) in breech compared with nonbreech presentation and 5.4 (95% CI 4.7, 6.2) in vaginal compared with cesarean delivery. The relative perinatal mortality in breech compared with nonbreech presentation was lowest in birth order one compared with birth orders two and three. In breech vaginal delivery compared with cesarean delivery, the opposite effect of birth order was found. The highest perinatal mortality was found in a current breech presentation of a sibship with no previous breech births. In birth subsequent to breech births, perinatal mortality was more or less independent of current presentation, without respect to delivery method. The increased perinatal mortality in breech presentation is explained partly by its association with other risk factors for perinatal death. CONCLUSION: Women with recurring breech presentation represent a lower risk of adverse perinatal outcome. This might be explained by a biologic mechanism or by increased quality of antenatal care. An increased mortality in subsequent nonbreech siblings after a breech presentation was surprising.

Breech Presentation↗
PubMed1999

[Reduction in malformation-related early mortality--a possibility for modifying perinatal mortality].

From 1980 to 1996 1.8% of all births died as a result of malformations during the first week of life. This rate has been declining significantly after 1992. Congenital malformations of the heart have increased significantly because of improved diagnostic methods. From 1980 to 1996 0.67/1000 of all children died of vitium cordis during the first week of life. From 1992 to 1996 this group of malformations increased the perinatal mortality rate by 0.4/1000. There is a decreased mortality rate of neural tube defects by 0.25/1000 1980 to 1986 and by 0.08/1000 1992 to 1996. Trisomy 21: the early mortality rate decreased from 0.07/1000 to 0.03/1000. The number of non-deceased children with Down's syndrome remains constant, even though 40 per cent of all cases with trisomy 21 were prenatal. 3 per cent of all malformed newborn died during the first week of life as a result of their congenital malformations. The possibility of primary prevention of malformations with folic acid has not been sufficiently utilised.

Cause of Death↗
PubMed1988

Perinatal mortality in a Saudi maternity hospital.

Perinatal mortality was analyzed in infants to mothers who delivered at the main Maternity hospital in Riyadh and who represented a large proportion of the obstetric population in the city. The crude perinatal mortality rate was 39.8 per 1000 births. The birth weight-specific mortality rates were compared with the corresponding Swedish rates. The ratio between the birth weight-specific mortality rates in Riyadh and Sweden increased from the lightest to the heaviest birth weight category. Thus the perinatal mortality rate was 2.3 times higher in infants less than 1500 g, and 8.8 times higher in infants with birth weights of 3500 g and more. Similarly, the ratio between the gestational age-specific mortality rates in Riyadh and Sweden increased with advancing gestational age. The perinatal mortality rate of infants less than 28 weeks was 1.6 times higher, and that of term infants 4.8 times higher than in Sweden. The findings indicated shortcomings in the obstetric services. The perinatal mortality rate of teenage mothers, who comprised 17 percent of the material, was 9.1 times the Swedish rate. Other risk groups were para 0 mothers and mothers with a previous infant loss.

Adult↗
PubMed1991

Perinatal mortality in Norway: experience with perinatal audit.

In order to improve perinatal service, special committees have been established in every county in Norway. These committees are responsible for making local guidelines and performing inquiries (audits) of all perinatal deaths. The focusing upon avoidable and possibly avoidable factors and identification of suboptimal care seems to be valuable in improving the quality of medical work. In 1989 the perinatal mortality was 7.8 per 1000 births.

Female↗
PubMed1983

Birthweight and perinatal mortality: II. On weight-specific mortality.

The study of perinatal mortality requires a sound understanding of the influence of birthweight on perinatal mortality. This paper discusses one aspect of this problem--the pattern of weight-specific mortality. Mortality is very high at the lowest birthweights, falls to a minimum within the range of the most frequent birthweights, but rises again for the heaviest birthweights. Such a curve is best displayed and modelled by plotting the ratio of deaths to survivors on a logarithmic scale. Transformed in this way, perinatal risk may be regarded as the sum of three components--one independent of birthweight, one which decreases linearly with birthweight and one which increases linearly with birthweight. These two lines appear to have slopes of equal magnitude. Each is shown to represent general susceptibility to perinatal problems, rather than the cumulative effect of diseases specific to low birthweight or to high birthweight.

Birth Weight↗
PubMed1991

Perinatal mortality and associated morbidity.

Perinatal mortality remains an important topic, with wide ranging coverage in the literature. I have considered three main themes: preexisting risk factors, clinical management, and perinatal mortality reviews. Three major studies have identified a wide range of risk factors for perinatal death. Different inclusion criteria may be responsible for some of the apparent inconsistencies between study findings, but unravelling the complex web of interrelated factors remains a major epidemiologic challenge. Recent studies of clinical management highlight the role of the delivery of health care in determining outcome. However, they also underline the difficulties of assessing contrasting approaches to clinical management in this field. There is a welcome continuing impetus to develop the systematic review of perinatal death as an indicator of effectiveness in the delivery of maternity care.

Humans↗
PubMed1996

Perinatal mortality in term and post-term births.

Our aim was to compare the fetal mortality rate (FMR), early neonatal mortality rate (ENMR) and perinatal mortality rate (PMR) of post-term and term births, 2) to examine trends in the incidence and perinatal mortality rates of post-term and term births. We used data from Spanish Perinatal Mortality Survey of 1980, 1986, 1989 and 1992. The data include 40,863 post-term births (42 weeks and over) and 517,060 term births (37-41 weeks). Perinatal mortality rates of post-term and term births were compared. The incidence of post-term births was 7.3%. The relative risk (RR) of FMR for post-term compared to term births was 1.1 (95% confidence interval [CI] 0.9-1.3), of ENMR was 1.6 (95% CI 1.4-2.0) and of PMR was 1.3 (95% CI 1.1-1.5). From 1980 to 1992 there was a significant reduction in the incidence of post-term births (8.1% vs 5.0%), in the FMR (4.5/1000 vs 1.9/1000), ENMR (4.3/1000 vs 2.0/1000) and PMR (8.7/1000 vs 3.9/1000) of post-term births. There was no significant difference in the FMR between post-term and term in each year studied. Post-term births had a significantly higher ENMR and PMR than term births in 1980, and they were equivalent from 1983 to 1992. The incidence of post-term births, its FMR, ENMR and PMR have been significantly reduced during the whole period studied.

Female↗
PubMed1977

Perinatal mortality in Cape Town.

Perinatal mortality in Cape Town has progressively decreased in all racial groups over the past 60 years. The perinatal mortality rate for Coloureds and Blacks, however, remains at 20 per 1 000 more than for Whites. While the stillbirth rate approximates the early neonatal death rate in Whites, the stillbirth rate for Coloureds and Blacks is double the rate for early neonatal deaths. Although there is a significantly higher early neonatal death rate for Coloureds and Blacks, the major component of perinatal loss is stillbirth and 80% of stillbirths occur before the onset of labour. Focus should be on the detection of the fetus at risk, with, perhaps, earlier intervention.

Black or African American↗