Abstract
BackgroundDespite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates of perinatal deaths, which include stillbirths and early neonatal deaths, but the extent is not well studied. This study examines patterns of antepartum complications and the risk of perinatal deaths associated with such complications in rural Bangladesh.MethodsWe used data on self-reported antepartum complications during the last pregnancy and corresponding pregnancy outcomes from a household survey (N = 6,285 women) conducted in Sylhet district, Bangladesh in 2006. We created three binary outcome variables (stillbirths, early neonatal deaths, and perinatal deaths) and three binary exposure variables indicating antepartum complications, which were antepartum hemorrhage (APH), probable infection (PI), and probable pregnancy-induced hypertension (PIH). We then examined patterns of antepartum complications and calculated incidence rate ratios (IRR) to estimate the associated risks of perinatal mortality using Poisson regression analyses. We calculated population attributable fraction (PAF) for the three antepartum complications to estimate potential risk reductions of perinatal mortality associated them.ResultsWe identified 356 perinatal deaths (195 stillbirths and 161 early neonatal deaths). The highest risk of perinatal death was associated with APH (IRR = 3.5, 95% CI: 2.4–4.9 for perinatal deaths; IRR = 3.7, 95% CI 2.3–5.9 for stillbirths; IRR = 3.5, 95% CI 2.0–6.1 for early neonatal deaths). Pregnancy-induced hypertension was a significant risk factor for stillbirths (IRR = 1.8, 95% CI 1.3–2.5), while PI was a significant risk factor for early neonatal deaths (IRR = 1.5, 95% CI 1.1–2.2). Population attributable fraction of APH and PIH were 6.8% and 10.4% for perinatal mortality and 7.5% and 14.7% for stillbirths respectively. Population attributable fraction of early neonatal mortality due to APH was 6.2% and for PI was 7.8%.ConclusionsIdentifying antepartum complications and ensuring access to adequate care for those complications are one of the key strategies in reducing perinatal mortality in settings where most deliveries occur at home.
Highlights
Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high
Higher proportions of women with or without a maternal complication sought antenatal care and delivered in a facility or with a skilled attendant, but these proportions were low in both groups
Women who had experienced antepartum hemorrhage (APH) had a significantly higher likelihood of their fetus or neonate having an adverse outcome, either perinatal death (IRR = 3.5, 95% confidence intervals (CI) 2.4–4.9), stillbirth (IRR = 3.7, 95% CI 2.3–5.9), or early neonatal death (IRR = 3.5, 95% CI: 2.0–6.1) compared to those who did not experience APH
Summary
Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high These conditions contribute to high rates of perinatal deaths, which include stillbirths and early neonatal deaths, but the extent is not well studied. Up-to 10% of women experience hypertensive disorders of pregnancy [15] and this condition can be associated with stillbirths, preterm birth, and neonatal or maternal deaths [15, 16]. Maternal infections such as malaria, syphilis, urinary tract infection, and bacterial vaginosis are important causes of stillbirths [17,18,19] and important determinants of early neonatal deaths. Onset neonatal infections may be acquired vertically during pregnancy or during delivery [20, 21]
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