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PubMed1996

Perinatal mortality in twins and singletons matched for gestational age at delivery at > or = 30 weeks.

OBJECTIVE: Our purpose was to compare perinatal mortality between twins and singletons matched for gestational age at delivery with the hypothesis that perinatal mortality would be similar. STUDY DESIGN: A retrospective cohort study compared perinatal mortality in twins (790 babies) matched for gestational age at delivery at > or = 30 weeks with the next singleton. Perinatal mortality was also compared by expected growth (small and average for gestational age) and by the cause of the preterm delivery (medical indication, spontaneous preterm delivery, or preterm premature rupture of membranes with preterm delivery. RESULTS: Uncorrected perinatal mortality was significantly greater in singletons (56/1000) than in twins (26/1000) (p = 0.004). After major congenital anomalies were excluded, perinatal mortality remained significantly higher in singletons (25/1000) than in twins (11/1000) (p = 0.04). In preterm deliveries perinatal mortality was significantly greater in singletons (72/1000) than in twins (19/1000) (p = 0.0002). Perinatal mortality was significantly greater in small- compared with average-for-gestational-age neonates, whether singletons or twins (p = 0.005), and singleton small-for-gestational-age neonates had a significantly greater perinatal mortality (105/1000) than did twin small-for-gestational-age neonates (36/1000) (p = 0.02). Perinatal mortality was not significantly different between preterm singletons and twins delivered by spontaneous preterm labor. However, perinatal mortality in preterm singletons delivered for a medical indication (156/1000) was significantly greater than for twins (20/1000) (p = 0.0006). CONCLUSIONS: At > or = 30 weeks at delivery, twins either had a perinatal mortality similar to, or less than singletons matched for gestational age at delivery. This suggests that when preterm delivery is controlled for perinatal mortality is not greater in twins. In twins, without risk factors for perinatal death, routine antepartum testing may not be indicated.

Birth Weight↗
PubMed2006

[Analysis of stagnation of perinatal mortality in the Czech Republic].

OBJECTIVE: Analysis of stagnation of perinatal mortality level in the CR in 2000-2004. DESIGN: Retrospective nationwide epidemiological study of selected indicators of perinatal care level. SETTINGS: Institute for the Mother and Child Care, Prague, Czech Republic. METHODS: Comparison of selected indicators of perinatal care and conditions for such care during years period 2000-2002 and 2003-2004. RESULTS: Stagnation of perinatal mortality in the Czech republic since 2000 has been the result of two opposite process. On one side it is the continuous increase of newborns of low birth weight as a result of not only biological but also demographic and socio-economic risk factors, which create unfavorable envirement for provision of perinatal care. On the other side it is the improved professional care observed in two areas (prenatal diagnosis of congenital malformations and intensive care in newborns of extremely low birth weight). During 2003-2004 we were still able to observe odds of improvement of professional care against the deteriorating conditions which led to further decrease of perinatal mortality by 0.27 per thousand on average. However, there is a danger that negative factors will prevail in the near future, because reserves for the further improvement of professional care are exhausted and analyzed unfavorable factors are continuously on the rise. This could lead to an increase of the curently low perinatal mortality level. CONCLUSIONS: Stagnation of perinatal mortality in the Czech Republic during the last five years in a range of 4.0-4.4 per thousand is a result of two opposite processes. On one side it is due to improved level of professional care in prenatal diagnosis, and due to centralized intensive care of newborns of extremely low birth weight. However, the reserves in those two areas are already exhausted. On the other side there are the deteriorating conditions (demographic and social) for such care, which are continuously on rise. While the first process has been prevailing until now with the resulting minimal decrease of perinatal mortality by 0.4 per thousand, there is a danger that the ballance will change in the near future.

Birth Weight↗
PubMed2001

[Preventable perinatal mortality].

BACKGROUND: Using a critical systematic analysis of perinatal mortality, this study aims to examine, on the basis of current medical and scientific knowledge, whether there are still situations in which feto-neonatal death could be prevented and to define and evaluate the feasibility of realising this goal. METHODS: The concept of preventable feto-neonatal death refers to the number of individuals who could have survived with better pre-, intra and postnatal care. In other words, it indicates the number of deaths that could have been avoided in an almost perfect health organisation and therefore, by reference, the number of inevitable deaths (not preventable). In this field it is important to distinguish between clinically preventable, where there are preventable factors at the time of hospitalisation and during the clinical phase of the disease, and extra-clinically preventable when these factors, if potentially present during the preclinical phase of disease, disappear owing to the gravity of conditions at the time of hospitalisation. Using data from maternal and neonatal clinical records, death certificates and autopsy findings, the authors examined the perinatal mortality rate in Department B of the Gynecological and Obstetrics Clinic of Turin University during the period 1979-1998. The results of these two decades were compared in terms of clinical practice. RESULTS: The perinatal mortality rate fell significantly (p<0.01) during the period 1989-1998: 1.02 vs 1.77%. It is worth underlining that this was mainly the result of a marked reduction (over 50%) in late fetal mortality: 0.43 vs 0.98% (p<0.01). Early neonatal mortality also diminished, although not significantly (0.59 vs 0.79%). In order to evaluate preventable deaths, perinatal mortality was subject to a detailed critical analysis to analyse its chronological evolution: prenatal, intranatal, early neonatal. During the second period examined, the preventable nature of perinatal mortality, although slightly lower, applied to 36.35% of cases. It is important to underline that although clinically preventable deaths were unfortunately still present (approx. 10%), most cases (approx. 90%) referred to extra-clinically preventable deaths. CONCLUSIONS: On the basis of current medical and scientific knowledge, the authors outline the directives for medical and specialist obstetric and social care required in the specific fight against preventable perinatal deaths. Recent progress in basic scientific research, especially in the genetic field, may make a vital contribution to limit and reduce the coefficient of feto-neonatal pathology that is still beyond control.

Feasibility Studies↗
PubMed1982

Perinatal mortality in Scotland: 1970-9.

An examination of the recent decline in perinatal mortality in Scotland during the 1970s showed that despite substantial changes in fertility and the demographic pattern of births, differences in the age, parity, and social class composition of the obstetric population in this decade accounted for just 7% of the overall improvement in perinatal mortality between 1970 and 1979. The general pattern of relative risks associated with maternal age, parity, and social class remained largely unchanged. Marginal changes in the birthweight distribution, however, were sufficient to account for 13% of the reduction in perinatal mortality. The low birthweight infant, especially those weighing under 1500 g, assumed increasing importance as a factor in perinatal mortality owing to a progressive worsening in the relative risk of perinatal mortality associated with low birth weight. Although regional differences in perinatal mortality persisted over this period, there occurred some lessening of the traditional inequality between western and eastern parts of the country. Finally, registered causes of perinatal mortality are reviewed. In the absence of other explanations the results of this analysis, collectively, suggest that much of the recent decline in perinatal mortality was perhaps due to changes in obstetric practice and in the clinical management of neonatal morbidity.

Adolescent↗
PubMed1983

Birthweight and perinatal mortality: I. On the frequency distribution of birthweight.

Perinatal mortality is closely related to birthweight. Hence 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 frequency distribution of birthweight. This distribution is essentially Gaussian but with additional births in the lower tail. It can therefore be divided into two components--a predominant (Gaussian) distribution and a residual distribution. The complete distribution can be summarized by three parameters: the mean and the standard deviation of the predominant distribution, and the proportion of births in the residual distribution. This paper shows that the predominant distribution is composed largely of term births, while the residual distribution is composed almost entirely of small preterm births. It also shows that the three parameters together help to explain the apparent paradox that male infants suffer a higher perinatal mortality than females despite there being fewer light male births.

Birth Weight↗
PubMedDate not supplied

Perinatal mortality 1982-2001 at Vila Central Hospital, Vanuatu.

OBJECTIVE: To determine the perinatal mortality at Vila Central Hospital (VCH) and thereby make an estimate of Vanuatu's perinatal mortality. METHODS: Labour floor and nursery records from VCH, Vanuatu's only tertiary referral hospital, were examined and collated for the period 1982-2001. Death certificate books were also examined. The perinatal mortality rate was calculated as the sum of stillbirths (infants = 20 weeks and/or = 500 g) and neonatal mortality (deaths <28 days). Premature infants were recorded for infants less than 37 weeks gestation and small-for-gestational-age for infants less than 2500 g. RESULTS: The mean perinatal mortality rate for the period was 27/1000, (range 15-36/1000). The mean stillbirth rate was 15/1000, (range 8-22/1000). The neonatal mortality was 12/1000, (range 4-18/1000). Premature babies accounted for 37/1000 births, (range 11-80/1000). Small-for-gestational-age infants were recorded in 45/1000 births, (range 16-83/1000). The mean twinning rate was 12/1000. Seven spontaneous triplets, two quadruplets and two pairs of siamese twins were born. Sepsis, meconium aspiration and birth asphyxia were the commonest causes of neonatal death. CONCLUSION: Accurate data collection is difficult in Vanuatu. There is the risk of under-ascertainment however, the figure of 27/1000 represents the current best possible estimate of perinatal mortality at VCH over the last 20 years. VCH is Vanuatu's premier hospital and it is likely that the national figure for perinatal mortality is higher, probably in the range of 37-39/1000. This places Vanuatu's perinatal mortality at a level 30 years or more behind Australia. These figures represent the largest account of hospital based perinatal data collected from any Pacific island nation.

Australia↗
PubMed1982

Identifying the sources of the recent decline in perinatal mortality rates in California.

The perinatal mortality rate in California decreased rapidly in the 1970s; neonatal mortality fell about twice as fast as fetal mortality. Decreases in birth-weight-specific mortality accounted for 81 per cent of the decline in the perinatal rate, with only 19 per cent due to improvements in birth weight. No improvement was observed in the birth-weight distribution for blacks. The decrease in mortality rates was significantly faster for cesarean deliveries than for vaginal births. By 1977, all birth-weight-specific fetal mortality rates for cesarean sections were equal to those for vaginal deliveries or lower. For infants weighing less than 2000 g, perinatal mortality rates were also significantly lower for infants born by cesarean section than for infants delivered vaginally. These results suggest that much of the recent decrease in perinatal mortality rates can be attributed to the advent of neonatal intensive care and the increased rate of cesarean section.

Black or African American↗
PubMed1978

[Perinatal mortality in twin pregnancies (author's transl)].

Report on the perinatal mortality of 258 twin pregnancies at the department of obstetrics and gynecology of the University of Zürich, Switzerland from 1966 to 1976. The perinatal mortality of the twin deliveries was 11.6% compared to a general perinatal mortality of 2.9%. The perinatal mortality of second twins was 14.0% compared to 9.3% for the first twin. The high incidence of abnormal presentations and operative deliveries of the second twin is discussed. The incidence of prematurity under 37 weeks gestation was 48.4%. About 70% of the perinatal mortality in twins was due to prematurity with pulmonary causes leading in 44.5% of the deaths. The difficulties in the recognition of intra-uterine growth retardation in twin pregnancies is discussed.

Female↗
PubMed1997

Why perinatal mortality cannot be a proxy for maternal mortality.

In recent years, the perinatal mortality rate (PNMR) has been proposed as a proxy measure of maternal mortality, because perinatal deaths are more frequent and potentially more easily measured. This report assesses evidence for an association between these two statistics. This study, based upon data from Matlab, Bangladesh, shows that the maternal mortality ratio (MMR) and the PNMR do not vary together over time, and that the PNMR does not reliably indicate either the magnitude or the direction of change in the MMR from year to year. Statistical analysis shows that the correlation between the PNMR and the MMR is not significantly different from zero. An examination of the major causes of maternal and perinatal deaths indicates that the two measures cannot be expected to vary together. Almost half of perinatal deaths result from causes that do not pose a threat to the mother's life, and almost half of maternal deaths result from causes that do not lead to perinatal death. Monitoring of the PNMR can give an inaccurate picture of maternal mortality and should not be used as a proxy.

Bangladesh↗
PubMedDate not supplied

[Causes of perinatal mortality in twins].

The author analyses perinatal mortality in 244 twin pregnancies. In 80% the twins' Apgare score at birth was 10 to 8 and neonatal mortality in this group 1.26%. The slightly asphyxial group (Apgar 7 to 4) comprised 62 (38.75%) twins and the neonatal mortality in this group was 14.51%. There were 20 (12.5%) severely asphyxial (Apgar 3 or less) twins, their neonatal mortality amounting to 80.0%. Out of 193 twins weighing at birth less than 2500 g, 45 (23.31%) died, while in the twins weighing more than 2500 g there was not a single death. The perinatal mortality of twins up to the 37th week of pregnancy amounted to 17.37% and from the 38th week of pregnancy to 1.22%. The mean duration of pregnancy in twins was 38.1 +/- 2 SD 6.3 weeks. The most frequent cause of death in twins has proved to be immaturity and asphyxia at birth, leading to the development of hyaline membranes (80.0%). Other causes were far less frequent. The author concludes that in the perinatal mortality of twins their vitality at birth (assessed by the Apgar score), birth weight, and the duration of pregnancy play an important role.

Apgar Score↗
PubMed2002

The differentials and determinants of perinatal mortality in rural Bangladesh.

OBJECTIVE: In Bangladesh, the perinatal mortality is very high. This study examined the differentials and determinants of perinatal mortality in rural Bangladesh. METHODS: The study was based on the prospective data on maternal morbidity collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). This prospective study was conducted during the period November 1992 to December 1993. In this study, the factors associated with perinatal deaths were examined, employing differential and multivariate analyses. RESULTS: It was found that assisted delivery caused higher risks of stillbirth and death among live births during the first week of life. It was also observed that five or more pregnancies, prior to the index pregnancy, were positively associated with perinatal death. CONCLUSION: If the delivery is assisted or there are complications in delivery, then it is likely that the incidence of perinatal mortality will increase sharply. If the newborn baby was given colostrum, then perinatal mortality decreased to a great extent.

Adolescent↗
PubMed1993

Perinatal mortality in a northern Nigerian rural community.

87 perinatal deaths which occurred out of 1484 births in a rural area of Northern Nigeria over a 9 month period were reviewed. The perinatal mortality rate was 58.6 per 1000 births. Babies born to very young adolescent mothers aged between 10-14 years had the highest perinatal mortality of 375 per 1000 births. Statistically significant relationships were also established between perinatal mortality and parity, educational status of the mother and birth weight. The leading cause of perinatal death was birth trauma which accounted for 48% of all perinatal deaths. Strategies for the reduction of perinatal mortality in the rural community are highlighted.

Adolescent↗
PubMed1993

The relationship between absent end-diastolic velocities of the umbilical artery and perinatal mortality and morbidity.

To determine the perinatal mortality and neonatal morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery, the outcome of 120 fetuses, with a gestational age of 24 weeks or more and a birth weight of 500 g or more, with AEDV at the last Doppler examination, were analyzed. The study population came from 348 women who had pregnancies at high risk of placental insufficiency and had had Doppler velocimetry examinations. In all the women, the Doppler velocimetry result was withheld from the clinician managing the woman. Of the fetuses with AEDV, 57 (52%) died and only 26 (22%) babies had minimal or no neonatal morbidity. All 24 fetuses with AEDVs delivering before 28 weeks gestation and having a birth weight less than 750 g died. When compared with fetuses from the study population with end-diastolic velocities present, the gestational age and birth weight at delivery was significantly lower, and the perinatal mortality, neonatal morbidity and number of light for gestational age (LGA) babies was significantly higher in the AEDV group. The LGA babies from both groups were compared by gestational age category and the LGA babies with AEDV still had a significantly higher perinatal mortality. There was no difference in the pattern of neonatal complications or causes of neonatal deaths between the two groups.

Birth Weight↗
PubMed2006

[No correlation between rates of caesarean section and perinatal mortality in Iceland].

INTRODUCTION: Caesarean section rates have increased over the past decades without a concomitant decrease in perinatal mortality. In Iceland the same trend has been seen while at the same time perinatal mortality rate has remained low. Most caesarean sections are done at term. Crude perinatal mortality rates give limited information about whether the increase in section rates leads to a lower perinatal death rate among term non-malformed singleton infants. The relation between caesarean section and perinatal mortality rates in singleton, non-malformed infants of birthweight > or =2500 g in Iceland during 1989-2003 was studied. MATERIALS AND METHODS: Information about gestational length, birthweight, parity, onset of labour and previous caesarean section was collected on all singleton births > or =2500 g from the Icelandic Birth Registration and from maternity case records. The same data were obtained for all perinatal deaths > or =2500 g excluding malformed infants irrespective of mode of delivery. The caesarean section and perinatal mortality rates were calculated and the relation between these evaluated by Pearson s correlation coefficient. RESULTS: The total number of deliveries in the study period was 64514 and the mean perinatal mortality rate 6.4/1000 (range: 3.6-9.2/1000). A significant increase was found in the overall caesarean section rate, from 11.6% to 18.2% (p<0.001). There were 61633 singleton infants > or =2500 g and 8332 were born by caesarean section. There were 111 perinatal deaths among this cohort giving a mean perinatal mortality rate (PNMR) of 1.8/1000 (range 0.8-4.1/1000). While for singleton non-malformed infants the caesarean section rate increased from 10.4% to 16.7% (p<0.001), the PMNR did not decrease significantly. For primiparous women the caesarean section rate increased from 12% to 18% with no correlation with the PNMR (0.6/1000). CONCLUSION: Despite a 60% rise in the caesarean section rate during the study period, no reduction of the perinatal mortality rate among infants > or =2500 g was found in this population with a prior low perinatal mortality, neither among primi- nor multiparous women.

Cesarean Section↗
PubMed2004

[Regional differences in perinatal mortality rates in Japan--an investigation based on vital statistics].

OBJECTIVE: This study investigated whether regional differences in perinatal mortality rates are related to distances to medical resources for perinatal care, such as the Neonatal Intensive Care Unit (NICU). METHODS: Using the census for Japan in 2000, all municipalities in Japan were classified into four groups based on population size: municipalities of 1,000,000 people or more (Group 1), municipalities between 350,000 and 1,000,000 people (Group 2), municipalities between 10,000 and 350,000 people (Group 3), and municipalities of less than 10,000 people (Group 4). Then, using the vital statistics, perinatal mortality rates for all groups were calculated. In addition, setting the perinatal mortality rate in Group 1 as a referent, we calculated the differences in the rates to detect regional differences in perinatal mortality in Japan. Finally, we compared the distances between the municipality center and the closest NICU among the four groups by one-way ANOVA. RESULTS: The perinatal mortality rates of Groups 1, 2, 3 and 4 were 5.38, 5.58, 5.88 and 6.31, respectively. The perinatal mortality rate ratios (95%CI) were 1.04 (0.96-1.12), 1.09 (1.03-1.16), and 1.17 (1.05-1.31), respectively. The perinatal mortality rate differences (95%CI) were 0.20 (-0.24-0.64), 0.50 (0.15-0.84), and 0.93 (0.23-1.62), respectively. The distances (95%CI) between the center of the municipalities and the closest NICU for Groups 1, 2, 3 and 4 were 2.61 (1.56-3.66) km, 4.23 (2.74-5.72) km, 20.79 (17.68-23.90) km and 38.07 (31.65-44.48) km, respectively. All of the differences among the groups were significant (p < 0.001), except for the difference between Group 1 and Group 2. CONCLUSION: There are regional differences in perinatal mortality rates in Japan. This study suggests that the difference is associated with the uneven distribution of NICUs.

Health Services Accessibility↗
PubMed1991

West Midlands perinatal mortality survey, 1987. An audit of 300 perinatal autopsies.

As part of the West Midlands regional perinatal mortality survey an audit of perinatal autopsies was performed in 10 of 20 districts in the region. Autopsy reports were available from 300 of the 426 deaths (70%) reported in these districts. These were coded for 8 aspects including the clinical summary, body measurements, descriptive content, organ weights, post mortem radiology and microbiology, histology and other relevant investigations e.g., biochemistry, cytogenetics. Overall 44% of the autopsies failed to attain an arbitrary minimum score of 300, the mean score being 299. Excluding those autopsies performed at the regional centre these figures were 50% and 268 respectively. These data indicate that a high autopsy rate does not necessarily reflect a high quality of service and further emphasise the concerns that have been expressed by obstetricians, paediatricians, geneticists, parents and parliamentarians about the perinatal pathology services in the United Kingdom.

Autopsy↗
PubMed1984

Perinatal mortality with particular reference to the Singapore situation.

Perinatal mortality rates have been gradually declining in all countries. The initial decline mainly resulted from improvements in the late foetal mortality rates. Later with improvements in neonatal care, early neonatal mortality rates also improved. The developed countries have consistently shown better results than the developing countries, an indication of the higher standard of living, general health as well as the delivery of health care in these countries. In the Singapore situation, a rapid improvement in perinatal mortality was initially observed due to improvements in the late foetal mortality, followed later by reduction in the early neonatal mortality due to upgrading of neonatal intensive care. The perinatal mortality rate is lowest in the Chinese compared to the Indians and Malays, most likely due to the dietary practices of the three ethnic groups in Singapore; while the Chinese encourage extra nutrition in the pregnant female, the Malays and Indians tend to practise dietary restriction during this period. The improved nutrition of the pregnant mother is a factor in improving the perinatal mortality.

Adult↗
PubMed2002

The heavier the better? Birthweight and perinatal mortality in different ethnic groups.

BACKGROUND: Mother's ethnicity is associated with her baby's birthweight and risk of perinatal mortality. Given the close relation between birthweight and perinatal mortality, we explored whether ethnic differences in birthweight explain ethnic differences in perinatal mortality. METHODS: Data on all births to mothers born in Norway (808 658), Pakistan (6854), Vietnam (3283) and North Africa (1461) from 1980 to 1995 were obtained from the Medical Birth Registry of Norway. The associations between birthweight and perinatal mortality among ethnic groups were analysed using univariate and multivariate methods. RESULTS: Mean birthweights were low for Vietnamese and Pakistani mothers (3202 g, 3244 g) and high for Norwegian and North African mothers (3530 g, 3559 g). Mean birthweights were largely unrelated to perinatal mortality, which was lowest for Vietnamese (8.2/1000, 95% CI: 5.1-11.3) and highest for Pakistanis (14.9/1000, 95% CI: 12.0-17.7). Intermediate perinatal mortality rates were found among Norwegians (9.5/1000, 95% CI: 9.3-9.7) and North Africans (9.6/1000, 95% CI: 4.6-14.6). Further comparison of weight-specific mortality rates between the two largest ethnic groups showed the low birthweight paradox, where among low-weight births, perinatal mortality was lower among Pakistani than among Norwegian babies. However, adjustment to a relative birthweight scale (units of standard deviations from population-specific mean value) revealed higher rates of weight-specific mortality among Pakistanis across the entire range of birthweights. Multivariate adjustment for relative birthweight and other factors did not change these results. CONCLUSIONS: Differences in perinatal mortality between the ethnic groups were not explained by differences in mean birthweight. Paradoxical differences in birthweight-specific mortality rates could be resolved by adjustment to a relative scale.

Adult↗