Number Of Perinatal Deaths Research Articles

Identifying avoidable causes of perinatal deaths in a district hospital in Lesotho.

Certain determinants can be associated with avoidable perinatal deaths, and audits are needed to establish what these determinants are, and what can be done to prevent such deaths. The study aimed at identifying and describing determinants associated with avoidable perinatal deaths at a district hospital in Lesotho and strategies to curb their occurrence. A retrospective descriptive study was conducted using 142 anonymised obstetric records from January 2018 to December 2020. A data collection tool was adopted from the Perinatal Problem Identification Programme. In this tool, avoidable determinants are referred to as 'factors' or 'problems'. A concerning number of perinatal deaths were secondary to avoidable patient factors, namely a delay in seeking medical care, inappropriate responses to antepartum haemorrhage, and inadequate responses to poor foetal movements. Medical personnel factors are also worth observing, namely incorrect use of partograph, insufficient notes to comment on avoidable factors and 'other' medical personnel problems. Ranking highest among administrative problems were the unavailability of intensive care unit beds and ventilators and inadequate resuscitation equipment. Administrative problems accounted for more perinatal deaths than the patient-related factors and medical personnel factors. There is an urgent need for periodic audits, health education for patients, staff competency and the necessary equipment to resuscitate neonates.Contribution:Avoidable determinants associated with perinatal deaths in a district hospital in Lesotho could be identified. This information provides an understanding of what can be done to limit avoidable perinatal deaths.

Perinatal deaths from birth defects in Hunan Province, China, 2010-2020.

To describe the perinatal mortality rate (PMR) of birth defects and to define the relationship between birth defects (including a broad range of specific defects) and a broad range of factors. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2010-2020. The prevalence rate (PR) of birth defects is the number of birth defects per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond). PMR is the number of perinatal deaths per 100 fetuses. PR and PMR with 95% confidence intervals (CI) were calculated using the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in PR and PMR by year, maternal age, income, education level, parity, and gestational age of termination. Crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with perinatal deaths attributable to birth defects. Our study included 1,619,376 fetuses, a total of 30,596 birth defects, and 18,212 perinatal deaths (including 16,561 stillbirths and 1651 early neonatal deaths) were identified. The PR of birth defects was 18.89‰ (95%CI: 18.68-19.11), and the total PMR was 1.12%(95%CI: 1.11-1.14). Birth defects accounted for 42.0% (7657 cases) of perinatal deaths, and the PMR of birth defects was 25.03%. From 2010 to 2020, the PMR of birth defects decreased from 37.03% to 2010 to 21.00% in 2020, showing a downward trend (χ2trend = 373.65, P < 0.01). Congenital heart defects caused the most perinatal deaths (2264 cases); the PMR was 23.15%. PMR is highest for encephalocele (86.79%). Birth defects accounted for 45.01% (7454 cases) of stillbirths, and 96.16% (7168 cases) were selective termination of pregnancy. Perinatal deaths attributable to birth defects were more common in rural than urban areas (31.65% vs. 18.60%, OR = 2.03, 95% CI: 1.92-2.14) and in females than males (27.92% vs. 22.68%, OR = 1.32, 95% CI: 1.25-1.39). PMR of birth defects showed downward trends with rising maternal age (χ2trend = 200.86, P < 0.01), income (χ2trend = 54.39, P < 0.01), maternal education level (χ2trend = 405.66, P < 0.01), parity (χ2trend = 85.11, P < 0.01) and gestational age of termination (χ2trend = 15297.28, P < 0.01). In summary, birth defects are an important cause of perinatal deaths. Rural areas, female fetuses, mothers with low maternal age, low income, low education level, low parity, and low gestational age of termination were risk factors for perinatal deaths attributable to birth defects. Future studies should examine the mechanisms. Our study is helpful for intervention programs to reduce the PMR of birth defects.

The role of multidisciplinary care for a pregnant woman with a positive cardiological history in everyday medical practice

Reducing maternal mortality is a global health goal of the World Health Organization. While the number of perinatal deaths from hemorrhage and infection is declining, the number of deaths related to heart disease is on the rise and is now the most important cause in Western countries. The aim of expert societies is to define contemporary, diagnostic-specific outcomes in pregnant women with heart disease. Knowing about your cardiovascular risk during pregnancy is crucial for pre-contraceptive counseling. In the process of organizing care for a pregnant woman with cardiovascular diseases, a multidimensional approach to the problem is important, involving close cooperation between the cardiological and gynecological teams. Despite numerous publications, more studies are still needed to broaden the knowledge of cardiological care in pregnant women. The data obtained from the registers created on the initiative of the European Society of Cardiology, headed by the ROPAC register, seem promising.

Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial

BackgroundThe AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness.MethodsA stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses.ResultsDirect costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year.ConclusionsPerinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services.Trial registrationThe trial was registered with www.ClinicalTrials.gov, number NCT01777022.

The impact of the Covid-19 pandemic on maternity services: A review of maternal and neonatal outcomes before, during and after the pandemic

ObjectiveTo explore any apparent trends in maternal or neonatal outcomes during the Covid-19 pandemic by comparing the maternity outcomes before, during and after the pandemic. Study designA retrospective review was performed of maternity statistics recorded on the hospital database of a large tertiary referral centre in Dublin with over 8000 deliveries per annum from 1st January to 31st July 2020. This time period represented the months prior to, during the peak and following the pandemic in Ireland. ResultsThere was no correlation between the monthly number of Covid deaths and the monthly number of perinatal deaths (r = 0.465, NS), preterm births (r = 0.339, NS) or hypertensive pregnancies (r = 0.48, NS).Compared to the combined numbers for the same month in 2018 and 2019, there were no significant changes in perinatal deaths or preterm births in the months when Covid deaths were at their height. The rate of preterm birth was significantly less common in January-July 2020 compared to January-July in 2018/2019 (7.4 % v 8.6 %, chi-sq 4.53, P = 0.03). ConclusionThe was no evidence of a negative impact of the Covid-19 pandemic on maternity services, as demonstrated by maternal and neonatal outcomes.

Pre-implantation genetic screening among women experiencing recurrent failure of in vitro fertilization.

To determine the efficiency of pre-implantation genetic screening (PGS) among women scheduled to undergo intracytoplasmic sperm injection who had experienced recurrent in vitro fertilization (IVF) failure. The present retrospective cohort study reviewed the medical records of consecutive women who had experienced recurrent IVF failure and had presented at a private IVF facility in Trabzon Province, Turkey, to undergo intracytoplasmic sperm injection between May 1, 2012, and December 31, 2014. Patient data and perinatal outcomes were compared between patients who underwent PGS and those who did not. There were 88 patients included in the study; 43 patients had undergone PGS and 45 had declined to do so. No differences were detected in the clinical pregnancy rate (P=0.846), spontaneous abortion rate (P=0.416), number of perinatal deaths (P=0.162), or the number of live deliveries (P=0.188) between the groups of patients. The pregnancies included in the study resulted in 25 neonates being delivered; 24 had normal karyotypes, and one neonate from the control group had a karyotype of 46, XX, 9ph. Among the 19 embryos that were not transferred, the most frequently encountered chromosomal anomalies were diploidy, monosomy X, and 2N/N/4N mosaicism, detected in 7 (37%), 2 (11%), and 2 (11%) embryos, respectively. PGS had no effect on perinatal outcomes among women experiencing recurrent IVF failure.

Smoke-free legislation and child health.

In this paper, we aim to present an overview of the scientific literature on the link between smoke-free legislation and early-life health outcomes. Exposure to second-hand smoke is responsible for an estimated 166 ,000 child deaths each year worldwide. To protect people from tobacco smoke, the World Health Organization recommends the implementation of comprehensive smoke-free legislation that prohibits smoking in all public indoor spaces, including workplaces, bars and restaurants. The implementation of such legislation has been found to reduce tobacco smoke exposure, encourage people to quit smoking and improve adult health outcomes. There is an increasing body of evidence that shows that children also experience health benefits after implementation of smoke-free legislation. In addition to protecting children from tobacco smoke in public, the link between smoke-free legislation and improved child health is likely to be mediated via a decline in smoking during pregnancy and reduced exposure in the home environment. Recent studies have found that the implementation of smoke-free legislation is associated with a substantial decrease in the number of perinatal deaths, preterm births and hospital attendance for respiratory tract infections and asthma in children, although such benefits are not found in each study. With over 80% of the world’s population currently unprotected by comprehensive smoke-free laws, protecting (unborn) children from the adverse impact of tobacco smoking and SHS exposure holds great potential to benefit public health and should therefore be a key priority for policymakers and health workers alike.

Twin gestation in older women: antepartum, intrapartum complications, and perinatal outcomes

The aim of this study is to present pregnancy and perinatal outcomes of twin gestations in older women and compare them with that for younger women. We conducted a retrospective cohort study of twin pregnancies in our department between 1988 and 2003. The women were classified into two groups by maternal age: women of age 35 years and older (study group) and women less than 35 years (control group). Population characteristics, complications during pregnancy and delivery, and neonatal outcomes were assessed. The Student's t-test, chi2 test, Fisher exact test, and binary logistic regression analysis were used to examine the relationship between maternal age and the different variables. A total of 238 twin pregnancies were enrolled (study group, 57 women; control group, 181 women). Spontaneous conceptions were significantly higher in the control group (P < 0.001), while conceptions after in vitro fertilization (IVF) were significantly higher in study group (P < 0.001). Mean figures of gestational age at delivery and birth weight for the older group did not differ significantly from the younger group. Although the antepartum and intrapartum complications were more common in the study group, they were not statistically significant compared to the control group. This was also true for the perinatal outcomes. Only the very low birth weight (VLBW < 1,500 g) rate was significantly higher in the study group. The number of perinatal deaths was similar on comparison by maternal age. Based on our study, advanced maternal age at twin gestation does not seem to affect significantly pregnancy complications and perinatal outcomes. VLBW was the only unfavorable perinatal outcome related to advanced maternal age.

Perinatal outcome of twin pregnancies after in vitro fertilization.

There are conflicting data concerning perinatal outcome of twin, in vitro fertilization (IVF) pregnancies. The aim of this study was to evaluate and compare perinatal and neonatal outcomes in twin IVF pregnancies to those of spontaneously conceived twin gestations. The medical files of 73 IVF and 148 naturally conceived twin pregnancies were studied retrospectively. Data concerning maternal characteristics, obstetric complications, and neonatal outcome were recorded and compared by chi2 test. The one-way analysis of variance (anova) was used to compare the means of groups. Mean maternal age, the proportion of nulliparous women, and the incidence of premature rupture of membranes, cesarean section, and premature delivery were significantly higher in the study group. The mean birthweight was significantly lower, the frequency of admission to the intensive care unit and the duration of hospitalization were significantly higher in the study group. The incidence of intraventricular hemorrhage was significantly higher in the IVF group. The number of perinatal deaths was similar. IVF twin pregnancies are at greater risk for obstetric complications and adverse neonatal outcome in comparison with naturally conceived twin gestations.

Mortalidad perinatal. Distribución según la edad gestacional y el peso al nacimiento. Causas más frecuentes. Revisión epidemiológica de 10 años

Objectives: To evaluate perinatal mortality (PM) during the last 10 years (1994-2003) in the Obstetric Department of the Miguel Servet Hospital in Zaragoza.Data are distributed in relation to gestational age, and weight. Both maternal and fetal possible causes of PM are analyzed.Material and methods: Of a total of 37665 newborns (NB) of more than 500 g weight, there were 368 who were either born dead or died within the first 28 days of life. Our Hospital is a tertiary care center with for the regions of Aragon and La Rioja and the province of Soria and also for those newborns or mothers with problems in the private hospitals.Results: Global perinatal mortality is 9.77%. For international comparison, perinatal mortality I (more or = 1000 g or 28 weeks gestational age and less or = 7 days of life) is 5.62%. According to gestational age, 72.28% are pre term deliveries and half (50%) are less than 32 weeks. By birth weight, 36.68% are lessthan 1000 g and 51.90% are less than 1500 g. The number of perinatal deaths in multiple pregnancies was 70 and all of them were pre term. Perinatal mortalityin multiple pregnancies is, globally, 46.51%, (42.79% in twins). The most common causes of fetal death: were intrauterine asphyxia or anoxia, extremeprematurity, less than 1000 g (16.30%) and respiratory pathology (12.22%). The most frequent maternal causes were: multiple delivery (19.02%), prematurerupture of membranes (12.22%), placental abruption and placental haemorrhage (10.05%).

Perinatal outcome of twin pregnancies after in vitro fertilization

Background. There are conflicting data concerning perinatal outcome of twin, in vitro fertilization (IVF) pregnancies. The aim of this study was to evaluate and compare perinatal and neonatal outcomes in twin IVF pregnancies to those of spontaneously conceived twin gestations. Methods. The medical files of 73 IVF and 148 naturally conceived twin pregnancies were studied retrospectively. Data concerning maternal characteristics, obstetric complications, and neonatal outcome were recorded and compared by χ2 test. The one-way analysis of variance (anova) was used to compare the means of groups. Results. Mean maternal age, the proportion of nulliparous women, and the incidence of premature rupture of membranes, cesarean section, and premature delivery were significantly higher in the study group. The mean birthweight was significantly lower, the frequency of admission to the intensive care unit and the duration of hospitalization were significantly higher in the study group. The incidence of intaventricular hemorrhage was significantly higher in the IVF group. The number of perinatal deaths was similar. Conclusion. IVF twin pregnancies are at greater risk for obstetric complications and adverse neonatal outcome in comparison with naturally conceived twin gestations.

Is there an association between female circumcision and perinatal death?

In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.

Perinatal Mortality Rates: Holland Versus The Hunter Valley

A public comment to the effect that Holland has a superior perinatal mortality rate to that in Australia prompted an analysis of this proposition. In the region of Newcastle and The Hunter Valley of New South Wales, detailed information on perinatal mortality over a 5-year period (1983-1987) was available. The data suggest that the perinatal mortality rate in this region is, in fact, superior to that in Holland. The definition of perinatal mortality differs greatly between the 2 countries; and this fact, perhaps unappreciated, might lead to the superficial perception that Holland's perinatal mortality rate is superior to our own.

Nutrition during pregnancy: the effects of an educational intervention program in Greece

An intervention program was undertaken to assess dietary habits and the impact of nutrition education among pregnant women in the rural county of Florina, northern Greece. Analysis of dietary habits, nutrient intake, hemoglobin, and serum vitamin concentrations in an intervention and control group indicated that the population was adequately nourished although nutrient intake was below recommended levels for pregnant women. Nutrition counseling was associated with improvements in dietary intake and significantly greater maternal weight gain (p less than 0.05). Mean birth weight was slightly higher in the intervention group but so was the incidence of low birth weight (4.5% vs 3.9%). The prematurity rate was marginally lower in the intervention group (p less than 0.04), as was the number of perinatal deaths (9 vs 11). The results indicate that nutrition counseling during pregnancy can improve dietary intake and maternal weight gain but the mediating influence on low frequency pregnancy outcomes is indeterminate in a population that is not nutritionally at risk.

Monitoring perinatal mortality rates: California, 1970 to 1976

Recent developments have emphasized the need to monitor perinatal mortality statistics by small geographic areas. A method is presented which separates county-specific perinatal mortality rates into a component reflective of socioeconomic, behavioral, and environmental variables, and a component that relates more directly to hospital-based intra- and postpartum care. Major differences in geographic variations were observed between the crude rate and the two components. An arbitrary index of the need for perinatal health services was created by combining the two components with the number of perinatal deaths in each county. Although there are some obvious limitations, the index serves as a useful guidepost for monitoring perinatal mortality on a statewide basis.

Suburbia: a small obstetric hospital in Brisbane.

In a small suburban obstetric hospital, during the period from July 1, 1963 to December 31, 1970, 3760 private and intermediate patients were delivered by suburban general practitioners. The number of perinatal deaths in hospital were nine deaths per 1000 births, both live and still. During the same period, 4873 private and intermediate patients were delivered by suburban general practitioners in the private/intermediate section of a large centrally sited obstetric teaching hospital. The number of perinatal deaths in hospital were 18.9 per 1000 births, live and still. The reason for, and the implications of, these results are discussed.