Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Perinatal Mortality”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed1991

Perinatal mortality in southern Italy.

Perinatal deaths occurring in the Campania region of southern Italy in 1982 were analysed. The perinatal mortality rate was 17.6 per thousand (stillbirth rate 8.3, early neonatal mortality rate 9.3). Compared with Swedish data, our deaths excess does not seem attributable to an unfavourable birthweight distribution, but to high birthweight mortality rates in every birthweight category and particularly in the normal birthweight group (greater than 2500 g). This group of newborns, representing about 94% of the births, contributes 45.4% of perinatal deaths; this situation is not common in developed countries, where the normal birthweight newborns form a much smaller proportion of perinatal deaths. The analysis of the causes of perinatal mortality, even though autopsies are rarely executed in Campania, shows a high prevalence of events which should be prevented by good antenatal and perinatal care.

Cause of Death↗
PubMed1989

[Regional differences in perinatal mortality: the relationship with various aspects of perinatal care].

Regional differences in perinatal mortality in the period 1980-1984 were studied, and the associations with a number of aspects of perinatal care were investigated: percentage of home deliveries, percentage of deliveries supervised by a gynaecologist, and the presence of a 'level 2' or 'level 3' hospital. The analysis controlled for a number of possible confounding variables. For total perinatal mortality, the stillbirth rate and first-week mortality due to birth injury a negative association was found with the presence of a level 2 hospital. For the stillbirth rate a positive association was found with the percentage of home deliveries. The first-week mortality due to a group of 'other' causes of death was positively associated with the percentage of deliveries supervised by a gynaecologist.

Adolescent↗
PubMed1997

An European concerted action investigating the validity of perinatal mortality as an outcome indicator for the quality of antenatal and perinatal care.

In this paper the concepts, objectives, design, and data analysis procedures of the EuroNatal study are described. This study started in 1996 and is a concerted action including 14 countries in Europe. The EuroNatal study aims at determining the validity of national perinatal mortality rates as an outcome indicator for the quality of antenatal and perinatal care. It is based on a conceptual model describing the relationships between differences in quality of antenatal and perinatal care, maternal and infant risk factors, variation in applied definitions, reliability of registration procedures and practices, and the outcome in terms of "true" and "observed" differences in perinatal mortality. In the first part of the study data is collected at national and aggregate level; in the second part data is collected retrospectively on individual cases of perinatal mortality in a regional sample area. Analysis of the individual cases of perinatal mortality will be by means of a perinatal audit conducted by an international expert panel. The project builds upon the work done by the participants in their respective countries. By applying common research protocols, international comparability of data collection will be enhanced and will help to create a common body of knowledge in the area of perinatal epidemiology and perinatal care. Comparison between countries is likely to lead to new insights into the strengths and weaknesses of antenatal and perinatal care systems of individual countries.

Europe↗
PubMed1989

Perinatal mortality in Northern Ireland: where are we now?

Perinatal mortality in Northern Ireland has been declining over the last 30 years, but the factors which may account for this fall have not been clearly delineated. Crude perinatal mortality figures yield very little insight into the problem, and meaningful management statistics are urgently required if service performance is to be reasonably assessed. This paper sets out the case for birth-weight standardisation and explores the utility of a broad diagnostic taxonomy of causes of death.

Birth Weight↗
PubMed1990

Assessment of potentially avoidable perinatal mortality in a regionalized program.

To obtain data regarding factors that influence perinatal mortality, a comprehensive perinatal mortality review project was prospectively developed and implemented. The resulting data cover a 21-month period and include all perinatal mortality at two perinatal centers and ten community hospitals. For each case an assessment of potential avoidability was made using the following definition: if any factor was identified that might have altered the outcome, the case was judged potentially avoidable. All other mortality was classified as either unavoidable or undetermined (if sufficient data were not available). During the review period there were a total of 26,937 live births and 591 cases of perinatal mortality. We conclude that: (1) meaningful analysis of factors affecting perinatal mortality data can be obtained by review of all deaths using a standardized classification; (2) in 21% of perinatal mortality at least one potentially avoidable factor could be identified that might have altered the outcome, while 74% was unavoidable and 5% undetermined; and (3) implementation of the review process enabled the reviewers to recognize patterns of potentially avoidable perinatal deaths.

Birth Weight↗
PubMed1986

Congenital syphilis and perinatal mortality.

About 6% of perinatal mortality in Addis Ababa, Ethiopia, is associated with congenital syphilis. We report on 65 autopsies and the accompanying maternal examinations and interviews. Congenital syphilis was most common in unwanted pregnancies, in women with previous stillborns, in those who had multiple sexual partners, and in those who did not seek antenatal medical care. Congenital syphilis causes enlargement of liver, spleen, and placenta; premature labor; and increased perinatal mortality. It is recognizable even in severely macerated stillborns.

Female↗
PubMed1991

Perinatal mortality rate in a south Indian population.

Perinatal mortality rate was assessed for 13964 consecutive births in SAT Hospital, Trivandrum, South India, during a period of one year. The overall perinatal mortality rate was 42.75, stillbirth rate 24.41 and early neonatal mortality rate 18.79. The perinatal mortality rate in multiple pregnancy was 156.65. Preventable causes of perinatal mortality still make a major contribution to perinatal deaths in developing countries.

Female↗
PubMed2002

Accidental out-of-hospital delivery as an independent risk factor for perinatal mortality.

OBJECTIVE: To determine maternal characteristics and perinatal outcomes of unattended out-of-hospital deliveries. STUDY DESIGN: A population-based study including all singleton deliveries between 1988 and 1999. Maternal characteristics and pregnancy outcomes of accidental out-of-hospital births were compared with those of women who delivered in the hospital. Multiple logistic regression analysis was performed to investigate independent risk factors for out-of-hospital deliveries. Another model was constructed to assess the independent risk of out-of-hospital delivery for perinatal mortality. RESULTS: The incidence of unattended, out-of-hospital deliveries was 2% (2,328/114,938). Multiparity, Bedouin ethnicity and lack of prenatal care were independently associated with out-of-hospital deliveries. Parturients who delivered out of hospital had a significantly lower rate of previous cesarean deliveries. Perinatal mortality was significantly higher among out-of-hospital deliveries, and those newborns were significantly more likely to be small for gestational age as compared to newborns with in-hospital births. In a multivariable model investigating risk factors for perinatal mortality, out-of-hospital delivery was an independent risk factor for perinatal mortality. Other significant risk factors were Bedouin ethnicity and lack of prenatal care. CONCLUSION: Accidental out-of-hospital birth, associated with multiparity, Bedouin ethnicity and lack of prenatal care, is an independent risk factor for perinatal mortality.

Accidents↗
PubMed1998

Perinatal mortality and morbidity rates among singleton, twin, and triplet gestations.

Objective: To determine rates of perinatal mortality and morbidity from 24 to 43 weeks gestation among singletons, twins, and triplets.Methods: Successfully linked data from 1992 Californian maternal and infant discharge records as well as birth and death certificates from acute care civilian hospitals were examined for perinatal mortality and morbidity. Perinatal mortality was defined as the sum of all stillbirths and neonatal deaths. Deliveries from 24 to 43 weeks gestation among singleton, twin, and triplet pregnancies were collected as separate data sets. Perinatal mortality was identified using birth certificate death indicators excluding deaths caused by congenital anomalies. Neonatal deaths were identified from death indicators found in the death certificates. For the purpose of this study, perinatal morbidities were identified by ICD-9 codes and limited to respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Perinatal mortality and morbidity rates were expressed as a percent of live births stratified by gestational age. Perinatal mortality data were expressed in log scale and perinatal morbidity rates were statistically compared.Results: There were 571,390 total births in California of which 527,677 (92%) were singleton, 12,535 (2%) were twin, and 367 (0.06%) were triplet gestations. Across gestation, the rate of RDS between triplets and twins was comparable (6.6% vs 6.8%). However, the rates of IVH and NEC were significantly greater in triplets than in twins (20% vs 8%, P <.0001, and 25% vs 9%, P <.0001, respectively). The perinatal mortality rates are shown below.Conclusions: Perinatal mortality rates were comparable among singleton, twin, and triplet gestations delivered between 24 and 30 weeks gestation. Unlike singletons and twins, the triplet perinatal mortality rate did not fall between 31 and 36 weeks gestation and remained at 2.6%. Twin perinatal mortality rate was equivalent to singletons until 36 weeks gestation. IVH and NEC were significantly greater among triplets regardless of gestational age. These data suggest that antepartum fetal surveillance of triplet pregnancies should start as early as 30 weeks gestation while testing for twin pregnancies can begin at 36 weeks gestation.

Journal Article↗
PubMed2006

Early access to prenatal care: implications for racial disparity in perinatal mortality.

OBJECTIVE: To investigate racial disparities in perinatal mortality in women with early access to prenatal care. METHODS: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002. A total of 35,529 pregnancies with early access to prenatal care were reviewed for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals. RESULTS: The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, preterm premature rupture of membranes, gestational diabetes, placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8). CONCLUSION: Racial disparities in perinatal mortality persist in contemporary obstetric practice despite early access to prenatal care. LEVEL OF EVIDENCE: II-2.

Black or African American↗
PubMed1986

Birthweight and perinatal mortality: III. Towards a new method of analysis.

Perinatal mortality is closely related to birthweight. We propose a model that summarizes this relationship and provides a basis for the analysis of perinatal mortality. The components of this model are the frequency distribution of birthweight and the curve of weight-specific mortality. Taken together, these two curves completely describe perinatal mortality for a given population. The perinatal mortality of two populations can be meaningfully compared by plotting each weight-specific mortality curve relative to its own birthweight distribution. By this means, the excess mortality in one population can usually be expressed as the sum of two excess mortalities--one that occurs uniformly over the whole birthweight distribution, the other due to an increased number of small births. To illustrate this method, we analyse differences between white and black infants. We find that the excess mortality of black infants is chiefly due to an excess of small black births, but also to higher mortality over all (adjusted) birthweights. In contrast to other methods of analysis, the proposed method does not assume a priori that a difference in the mean birthweight of two populations is the cause of any difference in perinatal mortality. Furthermore, the proposed method is unbiased; in particular, it is preferable to direct or indirect standardization for birthweight, previously shown to be biased.

Birth Weight↗
PubMedDate not supplied

[Perinatal mortality in the Hospital Juarez, S.S.A].

A retrospective analysis on perinatal mortality was carried out at "Hospital Juárez" in México City, between June 1975 and May 1976. The collected data shows a gross perinatal mortality rate of 89.7 per one thousand live borns with a late fetal mortality rate of 33.1 and early mortality rate of 56.6. A prospective study was planned in order to record the perinatal mortality rate between June the first 1976, to May 31, 1977 showing a perinatal mortality rate of 60.8, with a late fetal mortality rate of 25.4 and early neonatal mortality rate of 35.4. The significant decrease in the rate of perinatal mortality could be the result of an accurate perinatal clinical history, specifically designed for such purpose, allowing a better supervision of the pregnant mother, the fetus and the newborn, which permitted to disclose many diagnoses that otherwise would not be obtained and this also contributted to the establishment of better opportunities for treatment. Besides the establishment of routine practices in the handling of newborns, the better relationships between pediatrician and obstetrician and the redistribution of medical and nursing personnel in critical areas, allowed a better perinatal attention. The relationships between perinatal mortality with maternal age and number of pregnancies and the relationships between neonatal mortality with birth weight and gestational age are presented. The factors that have favored the high rates of perinatal mortality in this hospital are also reviewed and corrective measures are proposed.

Female↗
PubMed2003

Perinatal mortality rate--hospital based study during 1998-2001 at Hacettepe University.

AIMS: To determine the causes of perinatal mortality and to calculate perinatal mortality rates at Hacettepe University Hospital. MATERIAL AND METHODS: In 1998 the Perinatal Mortality Study Group was established at Hacettepe University. The study group was constituted by the Department of Pediatrics, Units of Pediatric Pathology, Pediatric Cardiology, Pediatric Surgery, Genetics and Neonatology and the Department of Obstetrics and Gynecology, Perinatology Unit. At the end of every month, each case (including autopsy results if available) was discussed among the group, and the cause of mortality was determined according to the Modified Wigglesworth Classification, by the consensus of the group members. Perinatal mortality rates at Hacettepe University were prospectively calculated. Perinatal mortality figures of two periods were compared (1998-1999: Group A and 2000-2001: Group B). RESULTS: Total number of births over 500 grams was 3173 in Group A and 3013 in Group B. Perinatal mortality rate was 33.72/1000 in Group A and 16.92/1000 in Group B. Of the perinatal deaths, 61.46% were intrauterine deaths and 38.54% were early neonatal deaths in Group A. In Group B, 58.83% were intrauterine deaths and 40% were early neonatal deaths. In Group A, 72% of the deaths were < 1500 grams, and 53.3% were 500-1000 grams. The most common cause of death during this period was prematurity (Modified Wigglesworth Group III) (29.3%), followed by lethal congenital malformations (Group II) (26.6%) and macerated intrauterine deaths (Group I) (22.9%). Autopsy was available in 70.7% of the cases and micronecropsy was available in 12%. Genetic studies were performed in 24% of the cases and termination of pregnancy was carried out for fetal anomalies in 10.7% of the cases. In Group B, 72.6% of the cases were < 1500 grams and 47.1% of the cases were 500-1000 grams. The most common cause of death during this period was lethal congenital malformations (Group II) (31.4%), followed by macerated intrauterine deaths (Group I) (21.5%) and specific causes (Group V) (21.5%). Autopsy was available in 70.17% of the cases and micronecropsy was obtained in 10.52% of the cases. 20% of the cases underwent genetic studies during pregnancy and termination of pregnancy was carried out in 19.29% of the cases. CONCLUSIONS: Perinatal mortality rate has decreased at Hacettepe University over the last two years. The authors believe that this is a result of the multidisciplinary work which has had an impact on perinatal and neonatal care. The most common cause of mortality has changed from prematurity to lethal congenital malformations in this period. Since our institution is a referral center, around 60% of mortality is due to intrauterine deaths and around 30% of the deaths are due to lethal congenital malformations. Unfortunately lethal congenital malformations are referred to our center at an advanced stage of pregnancy.

Birth Weight↗
PubMed1982

[Analysis of perinatal mortality and its consequences].

Perinatal mortality at Landesfrauenklinik Salzburg was recorded by annual analysis of 19,533 births for the period between 1972 and 1979. Differentiation of 374 perinatal deaths was undertaken by antepartum, intrapartum, and postpartum mortality as well as by weight groups above and below 2500 g. All 129 antepartum deaths were attributable to preclinical situations, since all cases concerned had been pregnancies with attention outside hospital and with stillbirths on first admission. All 45 intrapartum deaths were separately analysed by causes for the purpose of elucidating avoidable cases. Failures due to shortcomings in terms of personnel, equipment, and organisation were discussed for each year. Organisational consequences drawn from such evaluation are reported together with effects. Stepwise target-oriented re-organisation helped to reduce unpurified mortality from 24 to 7.7 per thousand (WHO) in the period under review, while purified perinatal mortality dropped from 12.5 to 1.0 per thousand.

Apgar Score↗
PubMed1986

[Definition and classification of perinatal mortality].

Analysis of problems related to the classification of perinatal mortality was made possible through the evaluation of data collected from the medical records of nine maternity hospitals in South-Hainaut. Medical records of 135 fetal and early neonatal deaths were investigated. Perinatal mortality statistics were compiled on the basis of five different definitions of perinatal mortality. Depending on which definition was used, perinatal mortality varied between 10.2% and 15.1%. This study shows that reporting of perinatal mortality in hospital registries according to the legal requirement is incomplete. Standard data should be collected for each pregnancy product, on the basis of clearly defined, national and international accepted definitions. It is suggested that the 1975 recommendations of the World Health Organization (International Classification of Diseases, 9th edition), be used for definition and classification of perinatal mortality.

Belgium↗
PubMedDate not supplied

Perinatal mortality in a rural district of south India.

Perinatal mortality is one of the most sensitive indices of maternal and child health. The perinatal mortality rate is an indicator of the extent of pregnancy wastage as well as of the quality and quantity of health care available to the mother and the newborn. A community based prospective study carried out on 13,214 births in South Kanara district between Oct. 1991-Sept. 1992 revealed a perinatal mortality rate (PNMR) of 44.65/1000 births. Among the various factors influencing perinatal mortality, breech deliveries and babies of multiple pregnancies had a very high perinatal mortality rate of 180.81/1000 births (adjusted odd's ratio: 4.90) and 128/1000 births (adjusted odd's ratio: 2.64). The previous bad obstetric history of the mother, parity and sex of the newborn were among the other important factors influencing the PNMR.

Adult↗
PubMed1998

The perinatal mortality rate as an indicator of quality of care in international comparisons.

The perinatal mortality rate is used as an indicator of the quality of antenatal and perinatal care, yet uncritical application of this indicator in international comparisons can be misleading. The perinatal mortality rate depends on a number of factors and important determinants that need to be assessed separately before reaching conclusions about quality-of-care issues. This article provides a conceptual model of the construction of the perinatal mortality rate. It illustrates the relationship between quality of antenatal and perinatal care and risk factors for perinatal mortality and how these lead to the perinatal mortality rate. It also indicates how differences in registration procedures and practices influence the final mortality figures published by individual countries. For international comparison, the first step is to apply common definitions. The rate can vary by 50% depending on the definition used. Also, sources of registration bias need to be examined, because they differ considerably by country. Underregistration is known to be as high as 20% of perinatal deaths. The next step is to correct perinatal mortality figures according to differences in known risk factors. The perinatal mortality rate then can serve as a reasonable indicator for the quality of antenatal and perinatal care. In western countries, perinatal mortality could be reduced by as much as 25% with improved standards of care. Policies and practices in individual countries concerning ethical issues related to termination of pregnancy and care of newborn infants with (very) poor prognosis need to be taken into account as well. They are not related to quality of care, but do have a relatively large impact on the perinatal mortality rate.

Bias↗
PubMed1993

Evaluating perinatal mortality rates: effects of referral and case mix.

OBJECTIVE: To evaluate perinatal mortality rates as a method of auditing obstetric and neonatal care after account had been taken of transfer between hospitals during pregnancy and case mix. DESIGN: Case-control study of perinatal deaths. SETTING: Leicestershire health district. SUBJECTS: 1179 singleton perinatal deaths and their selected live born controls among 114,362 singleton births to women whose place of residence was Leicestershire during 1978-87. MAIN OUTCOME MEASURE: Crude perinatal mortality rates and rates adjusted for case mix. RESULTS: An estimated 11,701 of the 28,750 women booked for delivery in general practitioner maternity units were transferred to consultant units during their pregnancy. These 11,701 women had a high perinatal mortality rate (16.8/1000 deliveries). Perinatal mortality rates by place of booking showed little difference between general practitioner units (8.8/1000) and consultant units (9.3-11.7/1000). Perinatal mortality rates by place of delivery, however, showed substantial differences between general practitioner units (3.3/1000) and consultant units (9.4-12.6/1000) because of the selective referral of high risk women from general practitioner units to consultant units. Adjustment for risk factors made little difference to the rates except when the subset of deaths due to immaturity was adjusted for birth weight. CONCLUSION: Perinatal mortality rates should be adjusted for case mix and referral patterns to get a meaningful result. Even when this is done it is difficult to compare the effectiveness of hospital units with perinatal mortality rates because of the increasingly small subset of perinatal deaths that are amenable to medical intervention.

Case-Control Studies↗