Trends In Perinatal Mortality Research Articles

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990.

To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.

Effects of Technologic and Sociocultural Changes on the Practice of Neonatal Medicine: A View From France

When one considers the changes that have occurred in trends of perinatal mortality or the proportion of severe handicap in infants or adults in most Western countries in the past 20 years, there has been a profound change in the prognosis for life and for long-term sequelae after perinatal distress. The technical reasons for this extraordinary progress are straightforward. But it is much more difficult to Understand the profound effects on the quality of the lives that have come into being as a result of these advances. Indeed, it is hard to assess the precise consequences directly related to the new technology, as opposed to effects related to the long separation of mother and child after an abnormal birth and in pathologic states of the newborn.

Trends in perinatal mortality and cerebral palsy in Western Australia, 1967 to 1985.

To analyse the trends in stillbirths, neonatal deaths, and cerebral palsy in all infants born in Western Australia from 1967 to 1985. To relate these trends to changes in perinatal care, particularly in relation to avoidance of intrapartum asphyxia in term infants and the increased survival of low birthweight infants. Descriptive epidemiological study calculating population rates for perinatal deaths and cerebral palsy according to year of birth and birth weight. Western Australia. All infants born after 20 weeks' gestation or weighing at least 400 g (live and stillborn). Stillbirths, neonatal deaths (from perinatal death certificates), and cerebral palsy (from a population based register). Overall stillbirth rates fell from 12.1/1000 total births in 1967-70 to 8.1 in 1983-5. Early neonatal mortality fell from 13.0/1000 live births to 4.4 over the same period whereas total cerebral palsy rates remained at around 2-2.5/1000 live births. Death rates fell in all birth weight categories, particularly in low birthweight infants between 1975 and 1985, the period when birthweight data were available. In contrast, cerebral palsy rates in infants under 1500 g rose significantly over this period (from 12.1 in 1968 to 64.9 in 1985). The rise was seen in all spastic categories, including severely and multiply handicapped children. Large increases in the use of interventions aimed at reducing birth asphyxia and handicaps had not (by 1985) resulted in lower rates of cerebral palsy. This suggests that birth asphyxia is not a major cause. The increased survival of low birthweight infants has resulted in more cerebral palsy in this group, due either to postnatal complications of immaturity or prenatal damage to the fetal brain. These findings have implications for planning perinatal care and for litigation for putative obstetric malpractice in cerebral palsy cases.

Trends in perinatal mortality attributed to congenital malformations in England and Wales during 1974–81: a study of the variations among regional Health Authority areas

Analysis of perinatal mortality attributed to congenital malformations in England and Wales, using data from birth and death registration over the years 1974-81 showed significant declines in England and Wales as a whole and in the individual Regional Health Authority (RHA) areas. A greater decrease in death rate from congenital malformations, particularly central nervous system malformations, was seen among stillbirths than among early neonatal deaths. There were marked regional differences in perinatal mortality due to central nervous system malformations over the period but not in cardiovascular system malformations or in other malformations. The highest mortality rates due to central nervous system malformations occurred in the North, North-West, West and South-West of England and in Wales, and the lowest rates in the South and South-East. The larger percentage reductions in the mortality rates were found in most of the regions which had had the highest rates. Possible explanations for the decline in regional rates are suggested.

The Comparison of Trends in Perinatal Mortality in Small Areas

Year to year changes in perinatal mortality rates for small populations are difficult to interpret. Because local rates are based on small numbers of events, they are subject to apparently large fluctuations. A technique for analysing trends in mortality, for detecting changes in trends and comparing variations in trends between areas is described. It is illustrated by an analysis of perinatal mortality rates for Area Health Authorities in the West Midlands Region of England from 1974-1981, but the same techniques could be used to analyse trends at other times and in other places.

Trends in Fetal Mortality in the Kingdom of Saudi Arabia: Lessons From 15 Years of Experience

ABSTRACT Using data on hospital deliveries published by the Ministry of Health, trends in fetal mortality in the Kingdom were investigated in this study. The study spanned 1391H through 1405H, corr...

The role of obstetric factors in perinatal mortality trends

In the Perinatal Unit of the New Jersey Medical School, Newark the combined neonatal mortality and stillbirth rates declined from more than 51 per 1000 to less than 17 per 1000 between 1971 and 1983. This change is comparable to the reduction of perinatal mortality rates nationwide since the Second World War. Because the improvement in the fetal and neonatal survival rates occurred in a static population and against well identifiable changes in the structure, equipment, policies and management patterns of the obstetric unit, it was possible to assess the impact of various factors upon perinatal outcome. In the environment of this institution adherence to conservative concepts of obstetric management, avoidance of manipulative and extraction procedures, an increase of the rate of cesarean sections from about 7 to 15% and emphasis upon infection control appeared to be the crucially important factors. Antepartum sonography and fetal stress and non-stress testing significantly impacted upon the results. The role of intrapartum electronic monitoring was less clearly definable and seemed to be effective only in the hands of experienced physicians. The results did not seem to be adversely affected by the fact that the program de-emphasized invasive procedures, including fetal scalp pH sampling.

Perinatal mortality in a large perinatal center: Five-Year review of 31,000 births

The perinatal mortality rate for 30,928 babies born at Medical Center Hospital, San Antonio, Texas, between 1978 and 1982, was 20.3/1,000 births. Neonatal and fetal mortality rates were, respectively, 10.1/1,000 live births and 10.4/1,000 births. Exclusion of babies who weighed less than 500 gm yielded adjusted fetal, neonatal, and perinatal mortality rates of, respectively, 9.2, 9.8, and 17.9. Birth weight-specific mortality rates were calculated by groups of 250 gm birth weight for all neonates and by increments of 100 gm for babies who weighed 500 to 1,499 gm. Male infants, intrauterine growth-retarded babies, and babies whose mothers were less than 15 years old contributed more deaths than would be expected from the characteristics of the obstetric population. Presumptive cause of fetal death was unknown in 32%, fetal anoxia in 21%, maternal pathologic conditions in 20%, inappropriate fetal growth in 13%, congenital malformations in 8%, and systemic fetal infections in 6%. Leading presumptive causes of neonatal death were immaturity (29%), congenital malformations (18%), hemorrhages (16%), and systemic infections (10%). Hyaline membrane disease and necrotizing enterocolitis contributed, respectively, 7% and 6% of deaths. Past and future trends of perinatal mortality are discussed.

Trends in perinatal mortality at a Hong Kong hospital

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the “P” list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970–1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre-eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.

PERINATAL OUTCOME IN WESTERN AUSTRALIA, 1968 TO 1975.; 2. SOCIAL AND BIOLOGICAL DETERMINANTS

Trends in perinatal mortality and low birthweight (percentage of livebirths under 2500 g) were analysed in relation to certain social and biological variables. Mothers at high risk of adverse perinatal outcome in terms of perinatal mortality and low birthweight were found to be very young and grand multiparous mothers, old primiparas, unmarried mothers, those with multiple pregnancies and mothers born in Asia.

PERINATAL OUTCOME IN WESTERN AUSTRALIA, 1968 TO 1975; 1. PERINATAL MORTALITY AND BIRTHWEIGHT

Trends in perinatal mortality and low birth-weight in Western Australia were analysed by means of a linked file of perinatal death and birth registration papers for the years 1968 to 1975. Stillbirth rates fell only slightly, and there was no improvement in low birthweight stillbirth rates. There was increased ascertainment of low birthweight stillbirths after 1968 when the definition changed. Neonatal mortality fell markedly after 1971, much of the fall being due to a shift in the birthweight distribution towards heavier babies, particularly in males. The proportion of babies with birthweights of less than 2500 g fell from nearly 6% to 5.3%. The impact of changes in the obstetric care of premature labour were minimal up to 1975, with rural (away from specialist care) low birthweights rates differing only slightly from metropolitan rates. Social and demographic differences probably account for the major differences in stillbirth rates between areas. Neonatal mortality rates in low birthweight babies showed a definite advantage for babies living close to neonatal intensive care facilities. However, decisions to expand neonatal intensive care facilities to rural areas need to take into account other adverse perinatal risk factors.

The Scottish perinatal mortality survey.

Perinatal deaths in single births that occurred in Scotland during 1977 were investigated by case-record analysis. Causes of death were divided into nine categories, an extended version of the Aberdeen classification being used. Out of 1012 single perinatal deaths, 265 were due to fetal abnormality, which in 140 cases was malformation of the central nervous system. Of the 747 normally formed infants, 446 weighed 1500 g or more, of whom 82 died intra partum and 154 were born alive. The largest single cause of death was low birth weight in normally formed babies whose mothers had no complications of pregnancy (302 cases). Of these babies, 103 (34%) were growth-retarded. Rhesus incompatibility (16 deaths) and maternal diabetes (seven deaths) were not major causes of perinatal loss. These results were thought to be valuable in illustrating the main causes of perinatal mortality and directing attention to important issues. Hence a modified version of the study is being continued to see whether yearly audit by regional assessors is a feasible and practical way of monitoring trends in perinatal mortality.

Perinatal mortality trends in an area of north-west England

Summary A 10-year survey of perinatal mortality in a circumscribed population of a quarter of a million is described. It was based on necropsy findings in 93% of all perinatal deaths irrespective of place of birth. Between 1957 and 1966 the trend of perinatal mortality in Blackpool has been similar to that in England and Wales. Our necropsy findings show that all major lesions, except intraventricular haemorrhage, have become less frequent. Factors which have played a part in lowering the mortality include an increasing proportion of young mothers, improved booking practice, a decline in severe toxaemia, better results in breech presentation, delayed cord ligation at premature deliveries, fewer babies of low birth weight, more successful prophylaxis of pneumonia and a decline in major central nervous system malformations.

Infant Mortality Problems in Norway, by Julie E. Backer, Ph.D., and Øystein Aagenaes, M.D. Washington, D.C.: Government Printing Office (PHS Publication Number 1000, Series 3, No. 8 of National Center for Health Statistics), 1967, 40 pp., $0.30

One of a group of studies designed to delineate the perinatal and infant mortality problem in the United States, this new report from the National Center for Health Statistics presents an analysis of the problem in Norway. The study focuses on the sizable decreases in late neonatal and postneonatal mortality rates and the considerably smaller decrease in the perinatal rate. Changes in several parameters of infant loss and their influences on the infant and perinatal mortality trends are discussed, including such risk factors as legitimacy status, maternal age and parity, seasonal, and urban-rural differences.