Abstract
This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.
Highlights
Stillbirth is one of the most common adverse perinatal outcomes worldwide, constituting a relevant indicator of prenatal and childbirth care
There is a wide variation in the stillbirth rate (SBR), with an unequal reduction in the world, being slower in low and middle-income countries, with values 10 times higher when compared to high-income countries[2,3]
About 22% of the Brazilian population is concentrated in the São Paulo State, which is located in the Southeast Region of Brazil, the most developed in the c ountry[16]
Summary
Stillbirth is one of the most common adverse perinatal outcomes worldwide, constituting a relevant indicator of prenatal and childbirth care. It is estimated that 2.6 million stillbirths occur per year in the third trimester of pregnancy Prevention of these deaths represents a great challenge, especially due to the disparities in their occurrence between countries and within them, especially in those of low and middle income, because they concentrate 98% of d eaths[1,2]. It is estimated that 3/4 of fetal deaths can be prevented with adequate access to quality care and early detection of risky pregnancies[7]. Avoidable stillbirths are considered “sentinel events” of care received. Given the heterogeneous context of São Paulo Municipality, represented by urban areas of high social inequality, more granular geographical levels and group non-neighboring areas with similar living conditions must be considered, even those located in different regions of the city. That conform to it, such as family composition and educational level, can contribute to the understanding of avoidable stillbirths in vulnerable a reas[14,15]
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