Abstract
Abstract Objectives: to investigate the causes and the factors associated to fetal death in Cuiaba, Mato Grosso, 2006-2010. Methods: a population based case-control study in a ratio of 1:3 (300:900), was based on secondary data on Live Births and Mortality Information Systems. A hierarchical logistic regression was used. Results: remains independently associated to fetal death: low maternal schooling (OR=1.58, CI95%=1.02;2.47), low weight (OR=5.59, CI95%=3.22;9.70) gestational age <37 weeks (OR=9.34, CI95%=5.38;16.21), previous fetal death (OR=6.65, CI95%=4.35;10.15). The type of cesarean delivery remained as a protective factor (OR=0.35, CI95%=0.24;0.54). The main causes of fetal deaths were by unspecified cause (15.4%), followed by maternal hypertensive disorders (14.7%). The fetal mortality rate (TMF) decreased from 10.0 in 2006 to 7.5 deaths per thousand births in 2010 (decreased 24.5%). The TMF during the study period was below the goal set for 2030 by the World Health Organization. Conclusions: approximately one third of fetal deaths causes were potentially avoidable. Factors such as low maternal schooling, low birth weight, prematurity and previous fetal death history constitute as main determinants for fetal deaths in Cuiaba and suggests that socioeconomic situation still determines quality care for pregnant women and that actions should be directed to improve prenatal care.
Highlights
In Brazil, there are few studies available that analyze separately the fetal period, perhaps by subnumeral of deaths and low completeness.[9,14,16]. Despite such relevance in the period of 2003 to 2013, there are no publications of any articles on fetal deaths in the Midwest region, this study aimed to investigate the causes of fetal and the factors associated to deaths in a capital in the region of this country
Maternal characteristics and assistances related to fetal mortality were represented mostly by maternal age belonging to the age group of 20 to 34 years (67.5 %) being the minimum age of 12 years and the maximum of 43 years, schooling greater than or equal to 8 years (64.4 %), type of pregnancy (96.0%), type of vaginal delivery (69.4%), gestation less than 37 weeks (74.2%) and predominantly as place of occurrence as the hospital (98.3%) (Table 1)
The main basic causes of fetal deaths in this study were “cause of fetal death not specified" (15.4%), “fetus and newborn affected by maternal hypertension disorders (14.7%), “fetus and newborn affected by other forms of placenta abruption and bleeding” (11.9%) and 15.2% for “other causes” (Table 2)
Summary
In recent decades there have been significant progress in the health of mothers and children around the world,[1] especially after the goals were established in the Millennium Development Goals (ODM) which closed in 2015.2 these goals were not contemplated to prevent fetal deaths.[2,3] The Ministry of Health of Brazil considers fetal death as a conception product with weight greater than or equal to 500g and/or gestational age greater than or equal to 22 weeks, while the fetal mortality rate (TMF) is expressed by the number of fetal deaths divided by the number of total births added to fetal deaths and multiplied by one thousand.[4]It is estimated that around 2.6 million of fetal deaths occur per year in the world and that 98% of these deaths occur in low and middle income countries.[5]. In recent decades there have been significant progress in the health of mothers and children around the world,[1] especially after the goals were established in the Millennium Development Goals (ODM) which closed in 2015.2 these goals were not contemplated to prevent fetal deaths.[2,3] The Ministry of Health of Brazil considers fetal death as a conception product with weight greater than or equal to 500g and/or gestational age greater than or equal to 22 weeks, while the fetal mortality rate (TMF) is expressed by the number of fetal deaths divided by the number of total births added to fetal deaths and multiplied by one thousand.[4]. The cause of low visibility in the political agenda, few investments in the countries and incompleteness of vital registered information, a reduction on fetal deaths occurs at a slower pace than the reduction of deaths of children under five years of age and maternal deaths.[2,8] part of the causes of these deaths are considered avoidable,[9] in other words, preventable, totally or partly, by effective actions of the health services that are accessible in a determined location and time.[10]
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