Abstract
BackgroundReviews of perinatal deaths are mostly facility based. Given the number of women who, globally, deliver outside of facilities, this data may be biased against total population data. We aimed to analyse population based perinatal mortality data from a LMIC setting (Mpumalanga, South Africa) to determine the causes of perinatal death and the rate of maternal complications in the setting of a perinatal death.MethodsA secondary analysis of the South African Perinatal Problems Identification Program (PPIP) database for the Province of Mpumalanga was undertaken for the period October 2013 to January 2014, inclusive. Data on each individual late perinatal death was reviewed. We examined the frequencies of maternal and fetal or neonatal characteristics in late fetal deaths and analysed the relationships between maternal condition and fetal and/or neonatal outcomes. IBM SPSS Statistics 22.0 was used for data analysis.ResultsThere were 23503 births and 687 late perinatal deaths (stillbirths of ≥ 1000gr or ≥ 28 weeks gestation and early neonatal deaths up to day 7 of neonatal life) in the study period. The rate of maternal complication in macerated stillbirths, fresh stillbirths and early neonatal deaths was 50.4%, 50.7% and 25.8% respectively. Mothers in the other late perinatal deaths were healthy. Maternal hypertension and obstetric haemorrhage were more likely in stillbirths (p = <0.01 for both conditions), whereas ENNDs were more likely to have a healthy mother (p < 0.01). The main causes of neonatal death were related to immaturity (48.7%) and hypoxia (40.6%). 173 (25.2%) of all late perinatal deaths had a birth weight less than the 10th centile for gestational age.ConclusionA significant proportion of women have no recognisable obstetric or medical condition at the time of a late perinatal death; we may be limited in our ability to predict poor perinatal outcome if emphasis is put on detecting maternal complications prior to a perinatal death. Intrapartum care and hypertensive disease remain high priority areas for addressing perinatal mortality. Consideration needs to be given to novel ways of detecting growth restriction in a LMIC setting.
Highlights
Reviews of perinatal deaths are mostly facility based
As 43% of deliveries in the least developed countries and only 68% of all deliveries globally occur in institutions [11] it may be that these common causes are weighted differently in the total obstetric population
Where there was a fresh stillborn as a result of labour related intrapartum asphyxia, meconium aspiration or traumatic delivery or an ENND as the result of hypoxic ischaemic encephalopathy (HIE) or meconium aspiration syndrome (MAS), we reviewed the avoidable factors identified in each death for factors that would indicate that the intrapartum event was a result of poor intrapartum care
Summary
Reviews of perinatal deaths are mostly facility based. Given the number of women who, globally, deliver outside of facilities, this data may be biased against total population data. Accurate population data is necessary to identifying the causes of perinatal mortality and this doesn’t exist in much of the global obstetric population [7,8]. As 43% of deliveries in the least developed countries and only 68% of all deliveries globally occur in institutions [11] (and so facility based data on perinatal mortality is not necessarily reflective of the baseline obstetric population) it may be that these common causes are weighted differently in the total obstetric population. More than 90% of women in the province of Mpumalanga, South Africa, give birth in a health care facility [12], and so we have a unique opportunity to assess perinatal mortality in a population that is reflective of the total obstetric population
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