Impacts on Causes of Perinatal Death After Safer Baby Bundle Implementation in Victoria, Australia.

To determine the comparability between cause of death (COD) by a single physician coder and a two-physician panel, using verbal autopsy. The study was conducted between May 2007 and June 2008. Within a week of a perinatal death in 38 rural remote communities in Guatemala, the Democratic Republic of Congo, Zambia and Pakistan, VA questionnaires were completed. Two independent physicians, unaware of the others decisions, assigned an underlying COD, in accordance with the causes listed in the chapter headings of the International classification diseases and related health problems, 10th revision (ICD-10). Cohen's kappa statistic was used to assess level of agreement between physician coders. There were 9461 births during the study period; 252 deaths met study enrolment criteria and underwent verbal autopsy. Physicians assigned the same COD for 75% of stillbirths (SB) (K = 0.69; 95% confidence interval: 0.61-0.78) and 82% early neonatal deaths (END) (K = 0.75; 95% confidence interval: 0.65-0.84). The patterns and proportion of SBs and ENDs determined by the physician coders were very similar compared to causes individually assigned by each physician. Similarly, rank order of the top five causes of SB and END was identical for each physician. This study raises important questions about the utility of a system of multiple coders that is currently widely accepted and speculates that a single physician coder may be an effective and economical alternative to VA programmes that use traditional two-physician panels to assign COD.

Background:Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area.Aims:Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population.Study Design:Cross-sectional retrospective study.Methods:The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point) and 1988-1989 (2nd time point) were compared with the year 2008 (3rd time point). The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated.Results:Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades.Conclusion:Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for high risk pregnancies are needed.

To identify the major causes of perinatal mortality in South Africa. Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns and rural areas. Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa. A total of 8,085 perinatal deaths among babies weighing 1,000 g or more were reported from 232,718 births at the PPIP user sites. The perinatal mortality rates for the metropolitan, city and town, and rural groupings were 36.2, 38.6 and 26.7/1,000 births, respectively. The neonatal death rate was highest in the city and town group (14.5/1,000 live births) followed by the rural and metropolitan groups (11.3 and 10.0/1,000 live births respectively). The low birth weight rate was highest in the metropolitan group (19.6%), followed by the city and town group (16.5%) and the rural group (13.0%). The most common primary cause of perinatal death in the rural group was intrapartum asphyxia and birth trauma (rate 6.92/1,000 births) followed by spontaneous preterm delivery (5.37/1,000 births). The most common primary cause of death in the city and town group was spontaneous preterm delivery (6.79/1,000 births) followed by intrapartum asphyxia and birth trauma (6.21/1,000 births) and antepartum haemorrhage (5.7/1,000 births). The metropolitan group's most common primary causes were antepartum haemorrhage (7.14/1,000 births), complications of hypertension in pregnancy (5.09/1000 births) and spontaneous preterm labour (4.01/1,000 births). Unexplained intrauterine deaths were the most common recorded primary obstetric cause of death in all areas. Complications of prematurity and hypoxia were the most common final causes of neonatal death in all groups. Intrapartum asphyxia, birth trauma, antepartum haemorrhage, complications of hypertension in pregnancy and spontaneous preterm labour account for more than 80% of the primary obstetric causes of death.

To investigate causes of and contributors to newborn deaths in eastern Uganda using a three delays audit approach. Methods Data collected on 64 neonatal deaths from a demographic surveillance site were coded for causes of deaths using a hierarchical model and analysed using a modified three delays model to determine contributing delays. A survey was conducted in 16 health facilities to determine capacity for newborn care. Of the newborn babies, 33% died in a hospital/health centre, 13% in a private clinic and 54% died away from a health facility. 47% of the deaths occurred on the day of birth and 78% in the first week. Major contributing delays to newborn death were caretaker delay in problem recognition or in deciding to seek care (50%, 32/64); delay to receive quality care at a health facility (30%; 19/64); and transport delay (20%; 13/64). The median time to seeking care outside the home was 3 days from onset of illness (IQR 1-6). The leading causes of death were sepsis or pneumonia (31%), birth asphyxia (30%) and preterm birth (25%). Health facilities did not have capacity for newborn care, and health workers had correct knowledge on only 31% of the survey questions related to newborn care. Household and health facility-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently. Understanding why newborn babies die can be improved by using the three delays model, originally developed for understanding maternal death.

Background: Identifying causes of perinatal death is important to reduce perinatal mortality rate. Objectives: To determine trend of perinatal mortality rate (PMR), ascertain causes, and find out changes in causes of death over period of seven years. Methods: This retrospective study, conducted after ethical approval, included stillbirths and early neonatal deaths at Manipal teaching hospital from April 2014 to April 2021, after 28 weeks of gestation or of foetuses weighing more than 1000 grams. Perinatal mortality rate of each year was calculated. Cause of death was assigned according to International Classification of Disease – Perinatal Mortality classification. Data analysis was done to find out trends and causes of perinatal mortality using SPSS v.21. Frequency and percentages were used to calculate causes of deaths. Results: Perinatal mortality rate decreased from 35.5 to 21.1 per 1000 births over seven years. Antepartum hypoxia (103, 45%) was commonest cause of antepartum deaths, commonly associated with maternal medical conditions. This remained as main cause of antepartum death over years. Acute intrapartum events resulted in three-fourths of intrapartum deaths; were associated with complications of labour and delivery. Decline in this has resulted in overall decrease in intrapartum deaths. Low birth weight and prematurity (73, 42.2%) was the common cause of neonatal deaths and has remained same over years. Conclusion: Perinatal mortality has decreased over years. Antepartum hypoxia as cause of antepartum deaths and prematurity as cause of neonatal deaths remained same over years. There is decrease in intrapartum deaths due to declining acute intrapartum events.

To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster-randomised crossover trial in Papua New Guinea. Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty-seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi-organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty-six avoidable factors were identified among 26 deaths, including delays in care-seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.

SummaryBackgroundPreterm birth remains the major cause of neonatal death worldwide. South Asia contributes disproportionately to deaths among preterm births worldwide, yet few population-based studies have assessed the underlying causes of deaths. Novel evaluations, including histological and bacteriological assessments of placental and fetal tissues, facilitate more precise determination of the underlying causes of preterm deaths. We sought to assess underlying and contributing causes of preterm neonatal deaths in India and Pakistan.MethodsThe project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe) was a prospective cohort study done in three hospitals in Davangere, India, and two hospitals in Karachi, Pakistan. All pregnant females older than 14 years were screened at the time of presentation for delivery, and those with an expected or known preterm birth, defined as less than 37 weeks of gestation, were enrolled. Liveborn neonates with a weight of 1000 g or more who died by 28 days after birth were included in analyses. Placentas were collected and histologically evaluated. In addition, among all neonatal deaths, with consent, minimally invasive tissue sampling was performed for histological analyses. PCR testing was performed to assess microbial pathogens in the placental, blood, and fetal tissues collected. An independent panel reviewed available data, including clinical description of the case and all clinical maternal, fetal, and placental findings, and results of PCR bacteriological investigation and minimally invasive tissue sampling histology, from all eligible preterm neonates to determine the primary and contributing maternal, placental, and neonatal causes of death.FindingsBetween July 1, 2018, and March 26, 2020, of the 3470 preterm neonates enrolled, 804 (23%) died by 28 days after birth, and, of those, 615 were eligible and had their cases reviewed by the panel. Primary maternal causes of neonatal death were hypertensive disease (204 [33%] of 615 cases), followed by maternal complication of pregnancy (76 [12%]) and preterm labour (76 [11%]), whereas the primary placental causes were maternal and fetal vascular malperfusion (172 [28%] of 615) and chorioamnionitis, funisitis, or both (149 [26%]). The primary neonatal cause of death was intrauterine hypoxia (212 [34%] of 615) followed by congenital infections (126 [20%]), neonatal infections (122 [20%]), and respiratory distress syndrome (126 [20%]).InterpretationIn south Asia, intrauterine hypoxia and congenital infections were the major causes of neonatal death among preterm babies. Maternal hypertensive disorders and placental disorders, especially maternal and fetal vascular malperfusion and placental abruption, substantially contributed to these deaths.FundingBill & Melinda Gates Foundation.

Because of differences in reporting criteria throughout the world, comparing perinatal mortality rates and identifying areas of concern can be complicated and imprecise. To detail the systematic approach to reporting perinatal deaths and to identify any significant differences in outcomes in the Australian Capital Territory (ACT). Review of perinatal deaths from 2001 to 2005 in the ACT using the Australian and New Zealand Antecedent Classification of Perinatal Mortality (ANZACPM) and the Australian and New Zealand Neonatal Death Classification (ANZNDC) systems. ACT residents' perinatal mortality rate was 10.6 per 1000 total births, fetal death rate 7.5 per 1000 total births and neonatal death rate 3.2 per 1000 live births. The three leading antecedent causes of perinatal death were congenital anomalies, spontaneous preterm birth and unexplained antepartum death. The three leading causes of neonatal death were extreme prematurity, cardiorespiratory disorders and congenital anomalies. Multiple births attributed to 20% (65 of 321) of perinatal deaths. Perinatal autopsy was performed in 50% of cases, but in only 64% of unexplained antepartum deaths. Causes of perinatal death for the ACT and surrounding New South Wales region are similar to other states using this classification system. The following are considered important lessons to promote accurate perinatal mortality reporting: (i) a universal reporting system for Australia utilising a multidisciplinary team; (ii) a high perinatal autopsy rate, especially in the critical area of antepartum death with no identifiable cause; and (iii) standardised definitions for avoidability. Attention to these areas may prompt further research and changes in practice to further reduce perinatal mortality.

BackgroundThree million babies die in the early neonatal period while 2.6 million are stillborn per year worldwide, and one of three deaths can be prevented. The perinatal mortality rate in Nepal is around 31 per 1000 births. Although the perinatal and neonatal death rates have decreased recently, it still poses a major challenge to the health system of Nepal. The objective of the study is to determine the causes of perinatal deaths by integrating Minimally Invasive Tissue Sampling (MITS) in hospital perinatal deaths and incorporating verbal autopsy in community deaths in Kaski district of Nepal.MethodsThe study will be conducted among the perinatal deaths reported in the five hospitals implementing the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Kaski district of Nepal. We will also conduct verbal autopsy (VA) among community perinatal deaths reported in the district. All the perinatal deaths reported in the study sites will be enrolled in the first stage of the study. Minimally Invasive Tissue Sampling (MITS) will be conducted among the consenting cases of perinatal deaths to retrieve relevant tissue samples and specimens. The specimens will undergo standard histopathological, microbiological, biochemical, and molecular tests. The “Cause of Death Panel” will finalize MITS informed cause of death following the customized protocol for the project and the cause so derived will be compared with that obtained by the review of deaths by the MPDSR committees of the hospitals. The Female Community Health Volunteers will be trained and mobilized to identify community perinatal deaths and trained personnel will conduct VA. Community engagement activities will be conducted to provide awareness to prevent perinatal deaths.DiscussionThe mechanism of counting and accounting for deaths in a systematic manner is important and it can provide evidence to determine changes in clinical practice and to develop guidelines and training packages for preventive measures. The outcome will be helpful to standardize methods to establish the accurate causes of perinatal deaths and develop strategies to minimize the deaths. The selected pathological investigations can be integrated into the existing death surveillance system in order to effectively determine the causes of death.

Perinatal mortality is a sensitive indicator of health status of a community and is also highly amenable to intervention. The causes of perinatal deaths in developing countries are often difficult to establish. Verbal autopsy has been used in several countries for children and adults, but seldom for perinatal cause. To establish the cause of perinatal deaths using verbal autopsy. Community-based cross-sectional, retrospective study to identify perinatal death over a one year period from July 1996-June 1997. Comparison was made with hospital records. An algorithm of signs and symptoms was used by trained personnel to identify the cause of perinatal death. The duration of collection of data was six months (August 1996-January 1997). Hai district of Kilimanjaro region in Tanzania. All perinatal deaths within one year. The perinatal mortality was 58 per 1000 (121 deaths and 2088 live births). Verbal autopsy could establish the cause of death in 105 of the 121 deaths. Hospital records showed 79 deaths indicating that 42 deaths probably occurred at home. Among the 79 available hospital records, the cause of death could be established in only 30 (38%). The causes of postnatal death were compared between the verbal autopsy and hospital records. There was a good correlation between the same, however only 18 records were available from hospital among the total 31 postnatal deaths. The specificity of determining cause of death using verbal autopsy was 100% and sensitivity 61%. The commonest causes of perinatal deaths were related to obstetric care, therefore interventions to curb perinatal mortality should be directed to improvement of obstetric care. Verbal autopsy is a simpler and more sensitive tool in establishing the cause of perinatal death than hospital records in a rural district of Tanzania. Large-scale studies are needed to validate this.

IntroductionThe present study was conducted with the aim of evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after an expert panel review.MethodThe present study was a mixed methods observational study conducted at Umm al-Benin Hospital, the sole specialized obstetrics and gynecology center affiliated with Mashhad University of Medical Sciences. The study comprised three distinct stages: (1) Collecting primary ICD-PM codes assigned to perinatal death certificates, along with other relevant information, from October 2021 to March 2022; (2) Examining the circumstances of each perinatal death case and re-identifying the causes of death through a consensus process involving a panel of experts comprising pediatricians, obstetrics and gynecology specialists, and nursing and midwifery experts; presenting the new ICD-PM code; (3) Comparing the ICD-PM codes assigned to perinatal death certificates before and after the expert panel’s evaluation.ResultDuring the study period, a total of seven specialized panels were conducted to examine perinatal deaths. Out of the 71 cases, 41 were carefully reviewed by experts. These cases included 32 stillbirths and nine neonatal deaths. The examination process followed specific inclusion and exclusion criteria. The findings revealed that there were no significant changes in the causes of neonatal deaths. However, it was notable that 80% of the previously unknown causes of stillbirths were successfully identified. Notably, the occurrence of stillbirths increased by 78% due to maternal causes and conditions.ConclusionConvening panels of experts to discuss the causes of perinatal deaths can effectively reduce the percentage of unknown causes, as classified by ICD-PM. This approach also guarantees the availability of essential data for implementing effective interventions to decrease preventable perinatal deaths.

Background Perinatal mortality remains a challenge worldwide, particularly in developing countries. Although significant achievements have been made to reduce neonatal mortality worldwide, in the last two decades there was a total of 5.3 million neonatal deaths and stillbirths each year. This study aims to assess the magnitude of perinatal mortality and its contributing factors among births at the Jimma University Medical Centre in Ethiopia. Method A facility-based cross-sectional study was conducted between January and April 2017. Convenience sampling was used to select study participants and data were collected using interviewer-administered pretested structured questionnaires. Descriptive statistics were used to analyse the data, with the chi-square test used to assess the relationship between each factor and outcome. Statistical significance was set at P<0.05. Results The rate of perinatal death was 107 per 1000 births, of which 39.2%, 25.9% and 34.9% were fresh stillbirths, macerated stillbirths and early neonatal deaths respectively. The majority (77.8%) of stillbirths occurred before the study participant reached the hospital and 64.3% of stillbirths had low birth weight. Hyaline membrane disease (27.6%) and meconium aspiration syndrome (20.7%) were the two most common causes of early perinatal death. Obstetric complications contributed to 89.6% of perinatal deaths. Stillbirth was significantly associated with a lack of education (P=0.036). The rate of perinatal mortality was high among women with their first pregnancy (53.0%) and those who had no previous pregnancy-related problems (79.5%), and was significantly associated with mechanical causes and antepartum haemorrhage (P=0.015). Conclusions The findings indicated that the rate of perinatal mortality was high at the Himma University Medical Centre. Improving maternal education and health services in rural areas are important steps to prevent poor perinatal outcomes. Facilitating transport and improving referral procedures may help to prevent mechanical complications, which are the most common cause of perinatal death, particularly fresh stillbirths which, in the present study, often occurred before a participant arrived at the hospital.

Background: Every year, 2.7 million stillbirths occur worldwide, mostly in developing countries. The United Nations Sustainable Development Goals (SDGs) include reducing childhood mortality under five years of age. Perinatal death audit is an intervention to reduce preventable neonatal mortality. The aim of this study was to determine the Perinatal Mortality Rate (PMR) and the factors responsible for perinatal deaths at a Tertiary Care Hospital in Karachi-Pakistan. Methodology: This was a prospective study of all the stillbirths and early neonatal deaths in Abbasi Shaheed Hospital Karachi, Gynecology Unit I. Details of each perinatal death were filled in the standard form. We used Aberdeen Obstetric classification to classify causes of perinatal deaths. Results: There were 1627 deliveries and 43 perinatal deaths during the study period. Our study's perinatal mortality rate was 27.14/1000 births, and the stillbirth rate was 13.25/1000 births. Antepartum hemorrhage (APH), pregnancy-induced hypertension (PIH) and anemia were the common causes of perinatal deaths. Conclusion: Antepartum hemorrhage, pregnancy-induced hypertension and anemia are the leading causes of perinatal deaths. Most of these complications can be reduced by educating women and providing effective antenatal care.

To analyze the causes of perinatal death and related factors from the perspective of forensic medicine, and to provide references for reducing perinatal mortality and guidance for forensic identification. A retrospective analysis was performed on 102 cases of perinatal autopsy with clinical data from the Department of Forensic Medicine of Chongqing Medical University in 2004-2016. Of the 102 cases of perinatal deaths, 66 （64.71%） were neonatal deaths, 24 （23.53%） were stillborn foetuses, and 12 （11.76%） were stillbirths. Among the 66 neonatal death cases, 39 （59.09%） died within 1 d, 19 （28.79%） died within 1-3 d, and 8 （12.12%） died within >3-7 d of birth. The top 3 causes of neonatal death were pulmonary diseases, congenital malformation, umbilical cord and placental abnormalities. The causes of stillborn foetus and stillbirth were mainly umbilical cord and placental abnormalities, and intrauterine asphyxia. Pulmonary diseases, umbilical cord and placental abnormalities, and congenital malformations are the main causes of perinatal death. In order to reduce the perinatal mortality, pre-pregnancy examination and prenatal care should be strengthened, and the knowledge of pregnancy care should be popularized.

BackgroundPerinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths.MethodsWe studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE).ResultsOverall perinatal mortality was 57.7/1000 (1958 out of 33 929), of which 1219 (35.9/1000) were stillbirths and 739 (21.8/1000) were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Obstructed/prolonged labour was the leading condition (251/303, 82.8%) among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2%) among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths), perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal conditions (from 8.5 to 5.5/1000).ConclusionThe distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths.