Invited Commentary: The Impact on Prematurity on our Perinatal Mortality Rate 49 3. 2010;10:82. http://www.mpumalanga.gov.za/about/province.htm, http://creativecommons.org/licenses/by/4.0, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12884-015-0472-9, Pregnancy and childbirth in low and middle income countries, bmcpregnancyandchildbirth@biomedcentral.com. As expected, given the falling birth rate in England and Wales, this is the lowest number on record.The infant mortality rate also decreased from 3.9 deaths per 1,000 live births in 2017 to 3.8 deaths per 1,000 live births in 2018 (Figure 1). Pasha O, Goldenberg RL, McClure EM, Saleem S, Goudar SS, Althabe F, et al. PubMed  It is a major marker to assess the quality of health care delivery. We examined the frequencies of maternal and fetal or neonatal characteristics in late fetal deaths and analysed the relationship between maternal condition and fetal or neonatal outcomes. The data is collected and entered on site by trained data collectors, who have all been trained by a single person. It is used in statistics to calculate the perinatal mortality rate of different countries throughout the world. Lancet. Springer Nature. The rate of potential growth restriction in this population data was surprising and represents an area of obstetric care in LMICs to which attention is required. Country Report Millennium Development Goals. Using the coding rules of the 10th revision of the International classification of diseases and related health problems (ICD-10), WHO, in collaboration with partners, has developed The WHO application of ICD-10 to perinatal deaths: ICD-perinatal mortality (ICD-PM).7 This is closely modelled on the WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium: ICD-maternal mortality (ICD-MM), which aims to “facilitate the consistent collection, analysis and interpretation of information on maternal deaths”.8. 2009;22(3):183–90. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Only a few studies explored the determinants of high PNMR in Bangladesh, yet most of them were small-scale or conducted for stillbirths and early neonatal deaths separately. Epub 2010 Jan 13. Where there was a fresh stillborn as a result of labour related intrapartum asphyxia, meconium aspiration or traumatic delivery or an ENND as the result of hypoxic ischaemic encephalopathy (HIE) or meconium aspiration syndrome (MAS), we reviewed the avoidable factors identified in each death for factors that would indicate that the intrapartum event was a result of poor intrapartum care. Stillbirth: understanding and management. The overall perinatal mortality rate was 65.3 per thousand live births. Theron GB, Geerts L, Thompson ML, Theron AM. Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland.b. Saving the lives of South Africa’s mothers, babies, and children: can the health system deliver? From World Health Organization (2006) Neonatal and Perinatal Mortality. 2010;34(6):371–86. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. RCOG. Therefore, an area with many low birth weight infants (i.e. 2005;95(1):62–4. Maternal hypertension and obstetric haemorrhage were more likely in stillbirths (p = <0.01 for both conditions), whereas ENNDs were more likely to have a healthy mother (p < 0.01). Gabrysch S, Campbell OMR. 2014 Mar;121 Suppl 1:76–88. 3, 4 In countries with the highest mortality burden, limited or non-existent vital registration and medical records mean that perinatal deaths are often not recorded. Vogel et al. a poor community) usually has a high perinatal mortality rate … Outcome of very low birth weight infants with abnormal antenatal Doppler flow patterns: a prospective cohort study. We have no data on the rates of maternal events, birth weight for gestational age and factors suggesting poor intrapartum care in the cases without a perinatal death. 2014;133:4. doi:10.1542/peds. BMC Pregnancy Childbirth. Allanson ER(1,)(2,)(3), Muller M(4), Pattinson RC(5,)(6). The perinatal mortality rate is calculated as: (# of perinatal deaths / total # of births (still births + live births)) x 1000 A stillbirth is the death of a fetus weighing 500g or more, or of 22-weeks gestation or more if … We examined the frequencies of maternal and fetal or neonatal characteristics in late fetal deaths and analysed the relationships between maternal condition and fetal and/or neonatal outcomes. Geneva: World Health Organization; 2011. Allanson ER, Muller M, Pattinson RC. As 43% of deliveries in the least developed countries and only 68% of all deliveries globally occur in institutions [11] (and so facility based data on perinatal mortality is not necessarily reflective of the baseline obstetric population) it may be that these common causes are weighted differently in the total obstetric population. A total of 2,488 infant deaths occurred in England and Wales in 2018. Factors associated with and causes of perinatal mortality in northeastern Tanzania. BMC Pregnancy and Childbirth PubMed Google Scholar. The timing of a perinatal death may be the only piece of information captured when classifying a death in resource-poor settings. The Perinatal Problem Identification Program (PPIP) in South Africa is a software based quality of care audit system which allows users to capture perinatal deaths as well as potentially modifiable factors in perinatal mortality. 2005;95(7). Adding additional years (three or five-year average annual rates) (Number of Resident Fetal Deaths of 28 or more weeks gestation + Sub-Saharan Africa’s mothers, newborns, and children: where and why do they die? Mutually exclusive clinical conditions that lead to the identification of a single cause of perinatal death are determined and linked with an ICD code. Department of Obstetrics, University Medical Center Groningen, Groningen, Netherlands.e. Communities, birth attendants and health facilities: a continuum of emergency maternal and new-born care (the global network’s EmONC trial). 2012;7, CD008136. Cochrane Database Syst Rev. Semin Perinatol. Perinatal Institute, Birmingham, England.c. The ratio of stillbirths to neonatal deaths was 2.7:1, indicating that maternal factors were dominant in causing the deaths. Levels and trends in child mortality: report 2013. Reviews of perinatal deaths are mostly facility based. Google Scholar. Causes of deaths were assigned by a pediatrician and neonatologist. Beck S, Wojdyla D, Say L, Bertran AP, Merialdi M, Requejo JH, et al. The maternal condition is defined as either healthy or the occurrence of a recognised medical or obstetric complication, categorised as coincidental conditions, medical and surgical disorders, non-pregnancy related infections, extrauterine pregnancy, pregnancy-related sepsis, obstetric haemorrhage, hypertension, anaesthetic complications, embolism, and acute collapse (cause unknown). S Afr Med J. Friberg I, Kinney MV, Lawn JE, Kerber KJ, Odubanjo MO, Bergh AM, et al. Doi:10.1186/1471-2393-10-82. There was a combined total of 147 FSB as a result of labour related intrapartum asphyxia, meconium aspiration or traumatic delivery and ENND as the result of hypoxic ischaemic encephalopathy or meconium aspiration syndrome. Analysis outcomes are summarised using risk ratios and 95% confidence intervals. This is particularly pertinent given the deaths with growth restriction were largely of a large enough weight and old enough gestation that one would expect a reasonable chance of survival if born alive [19,20]. Perinatal death has numerous causes, including preterm labor and fetal birth defects. PubMed Central  Am J Obstet Gynecol. While our rate of complication in ENNDs was almost identical, the late MSB and FSB in this population had almost double the maternal complication rate (composed almost exclusively of obstetric haemorrhage and hypertension), although still only half of women. 2013;50(9):847–52. 2 Ending preventable perinatal deaths is high on the international public health agenda. At these visits the patient files for the deaths are reviewed against the data entered in order to quality control, teach and provide feedback to the staff. BMC Pediatrics 2010;10(30) doi: 10.1186/1471-2431-10-30, Velaphi SC, Mokhachane M, Mphahlele RM, Beckh-Arnold E, Kuwanda ML, Cooper PA. This data is retrospective and the events surrounded the maternal and fetal story are only captured after the death has occurred. Bringing stillbirth and neonatal deaths together in a standardized system of definitions and coding rules improves comparability. The PPIP program has ethical approval from the University of Pretoria. There were 25 perinatal deaths out of a total of 500 deliveries in the 2 years. The PNMR refers to the number of perinatal deaths per 1,000 total births. BMC Pregnancy Childbirth. Gardosi J, Pattinson RC. National, regional, and worldwide estimates of stillbirth rates in 2015 with trends since 1995: a systematic analysis. Theron GB, Theron AM, Odendaal HJ, Bunn AE. Vogel JP, Lee ACC, Souza JP. Indicated umbilical artery Doppler studies in the developing world have been shown to be associated with increased perinatal mortality when absent or reversed [23] but the challenge for us is the significant number of perinatal deaths in this population where growth restriction was associated with a healthy mother. Control are live births surviving of the perinatal period' RESULT: A total of 219 newborns (73 cases and 146 controls) were included in the analysis. There is no perfect classification system, however ICD-PM adopts the features of many other systems in a way that allows applicability in all settings and encourages international comparisons. Bulletin of the World Health Organization 2016;94:79-79A. There were 23503 births and 687 late perinatal deaths (stillbirths of ≥ 1000gr or ≥ 28 weeks gestation and early neonatal deaths up to day 7 of neonatal life) in the study period. Mortality from CVD, cancer, diabetes or CRD between exact ages 30 and 70, female (%) Probability of dying among youth ages 20-24 years (per 1,000) Mortality rate, under-5, male (per 1,000 live births) doi:10.1371/journal.pmed.1000294. Determinants of perinatal mortality in Nigeria. It is estimated that globally, more than 2 million stillbirths1 occur each year, adding to 2.9 million neonatal deaths.2 Ending preventable perinatal deaths is high on the international public health agenda.3,4 In countries with the highest mortality burden, limited or non-existent vital registration and medical records mean that perinatal deaths are often not recorded.5 Thus the first step in addressing high perinatal mortality is the accurate capture and classification of the causes of those deaths across all settings. PM = SB + ENM Neonatal Mortality Rate: Neonatal mortality rate (NMR) is the number of deaths which Including maternal conditions as an integral part of the classification of perinatal death aligns with WHO action plans.3. The prevention and management of intrapartum asphyxia, hypertensive disorders and spontaneous preterm labour remain clear priority areas for reducing perinatal mortality. The PPIP program is funded through the South African Medical Research Council. http://dx.doi.org/10.1111/1471-0528.12633. 173 (25.2%) of all late perinatal deaths had a birth weight less than the 10th centile for gestational age. The WHO application of ICD-10 to perinatal deaths: ICD-perinatal mortality (ICD-PM). http://dx.doi.org/10.1016/S0140-6736(11)60064-0. Causes of maternal mortality The major direct causes of maternal morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour. Article  Article  UNDP 2013. Epub 2011 Apr 13. Cooper PA. Case study 1. Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, et al. Third, ICD-PM links contributing maternal conditions with perinatal deaths, given that a maternal condition is frequently found in the context of a perinatal death.12,13 Capturing the chain of maternal and fetal events that led to perinatal death can inform preventative and therapeutic measures. Privacy All the perinatal deaths during a 2 year period in a small town are recorded. The aims of the MNI-CORP are to collect, analyse and report national surveillance data and conduct national confidential enquiries in order to stimulate and evaluate improvements in health care for … Eighty nine (60.5%) had one of the avoidable factors related to poor intrapartum care identified as contributing to the outcome. There continues to be slow progress in preventing stillbirths. Fisher’s exact test on bivariate correlation was used to interrogate the relationship between maternal conditions and obstetric causes of death and the timing of late perinatal death. Perinatal mortality is a medical term used to describe the death of a late term fetus or newborn less than seven days old. Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. A significant proportion of women have no recognisable obstetric or medical condition at the time of a late perinatal death; we may be limited in our ability to predict poor perinatal outcome if emphasis is put on detecting maternal complications prior to a perinatal death. Given the number of women who, globally, deliver outside of facilities, this data may be biased against total population data. The average birth weight of these babies was 2884gr, with an average gestational age of 37.3 completed weeks. hypertension) or clinical scenario (e.g. Frequency distributions were performed for outcome summaries. Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. S Afr Med J. The leading causes of early neonatal death were birth asphyxia (22.3%) and respiratory distress (20.8%), while those of late neonatal death were sepsis (29.1%) and respiratory distress (20.0%). Perinatal mortality was 27% (95%IC = 23.7–29.6%). The factors we examined were fetal distress not detected intrapartum, management of the second stage prolonged or inappropriately managed, delay in medical personnel calling for assistance, no or inadequate response to maternal hypertension, delay in accessing anaesthetic, delay in referring patient for secondary or tertiary care, under or over-estimation of fetal size by medical personnel and inadequate neonatal resuscitation. In 23 out of 29 centres, the causes of death were clearly determined. 2012;91:1061–8. PLoS Med. This study determined causes and contributory factors of maternal mortality in Ogun statefollowing a periodic State-widematernal and perinatal deaths surveillance and response (MPDSR) review. BJOG. Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, Geneva 27, Switzerland. A journal article on the causes of perinatal mortality in Zimbabwe. Google Scholar. The neonatal mortality rate was 3.7/1000 during 2006–2010 and 10.4/1000 during 2011–2015, both periods indicating a stagnant trend in the years between. The authors declare that they have no competing interests. Acta Obstet Gynecol Scand. Detailed individual data is entered on each death; births are recorded as amalgamated data. Google Scholar. Author information: (1)School of Women and Infants Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia. Perinatal Problems Identification Program. The perinatal mortality rate reflects the standard of perinatal care while the low birth weight rate reflects the socioeconomic status of the community and is little influenced by health care. Every newborn: an action plan to end preventable deaths. Terms and Conditions, intrapartum care) can benefit both mother and baby. Global strategy for women's, children's and adolescent's health 2016–2030. Republic of South Africa. doi:10.2471/BLT.08.062554. the cause of death 44 Autopsy Placental Examination Specific Placental Conditions Other Examinations Performed Genetic Investigation in Chromosomal Disorders 2. That the majority of FSB and ENND following an intrapartum event had an avoidable factor relating to intrapartum care and that ENNDs were more likely to have a healthy mother is very concerning. When autocomplete results are available use up and down arrows to review and enter to select. Causes of perinatal mortality and associated maternal complications in a South African province: challenges in predicting poor outcomes. Zhang J, Merialdi M, Platt LD, Kramer MS. Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health. Mortality rates in the perinatal period are used to evaluate the outcome of pregnancy and monitor the quality of perinatal (prenatal and neonatal) care. The clinical team at each site perform a death review in the immediate period after a perinatal death has occurred and determine by a consensus decision the primary obstetric cause of death, the primary neonatal cause of death and the maternal condition at the time of perinatal death. Second, ICD-PM applies a multilayered approach to the classification of cause of death, such that it reflects varying levels of available information depending on the setting. Lancet. Many classification systems have been used to identify the cause of perinatal deaths, highlighting the need for a unifying global system. TERMINOLOGY. There is no clear evidence that symphysis fundal height is able to predict growth restriction [21], however this is currently the sum total of our toolkit for screening. In the 271 early neonatal deaths, the main final neonatal causes of death were immaturity related and hypoxia (Table 4). Identifying causes and the interplay of maternal and perinatal condition are important in narrowing this focus. It is usually reported on an annual basis. Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths—what is progressing and what is not? Avoidable factors are identified as a part of the death review by the on site team in each individual case. on behalf of the WHO Multicountry Survey on Maternal and Newborn Health Research Network. This seems to be the group where we have some ability to predict poor perinatal outcomes. Where there is a recognised maternal condition, obstetric haemorrhage (particularly abruption) and hypertension (particularly pre-eclampsia) are more likely to contribute to late stillbirths than ENNDs. Geneva: World Health Organization; 2015. Intrapartum care and management of hypertension and obstetric haemorrhage remain high priority areas for reducing perinatal mortality in a LMIC setting. By using this website, you agree to our BMC Pregnancy Childbirth 15, 37 (2015). The rate of intrapartum asphxyia in our data is not disimilar to studies in similar settings [16,17], however the structure of PPIP allows us to consider the role of avoidable factors in these deaths. 5 Thus the first step in addressing high perinatal mortality is the accurate capture and classification of the causes … 2008;98(4):270–1. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. California Privacy Statement, Indian Pediatr. Geneva: World Health Organization; 2012. A great deal of consideration has gone into ensuring ICD-PM is applicable in low-resource settings where the burden of perinatal mortality is greatest, as well as in high-resource settings, where perinatal mortality is lower but present across all perinatal periods.11 Accordingly, the ICD-PM approach for classification of cause of death allows investigations such as postmortem or placental histology to be captured, in settings where they are available. New York: UNICEF; 2009. Classification of stillbirth: a global approach. Perinatal mortality rates, by race and Hispanic origin of mother: 49 states and the District of Columbia, 2014-2016 10.59 5.39 5.04 10.53 5.43 4.97 10.66 5.35 4.98 0 2 4 6 8 10 12 Non-Hispanic black Hispanic Non-Hispanic white 2014 2015 2016 Rate per 1,000 … Given that nearly two thirds of the deaths where growth restriction was found also had a healthy mother, consideration also needs to be given to the ability to detect growth restriction in a well and, quite likely, otherwise low risk population in LMICs. UNICEF. most common perinatal mortality cause was respiratory distress and before birth asphyxia. Our dataset represents total population data (all levels of facilities in a province where >90% of women deliver in a facility) and, given the numbers of babies born globally outside facilities with as many deliveries as in the WHOMCS set [26,27], it is important that we do not lose focus on training all care providers in both the detection of maternal complication and the routine and emergency care of healthy, apparently low risk women who are having poor perinatal outcomes. Achievement of Millennium Development Goals (MDG) 4 and 5 requires a focus on antenatal, intrapartum and postpartum perinatal and maternal care [3]. The fetal/neonatal and maternal characteristics are presented in Table 1. Google Scholar. Mothers in the other late perinatal deaths were healthy. Perinatal mortality rates in three time periods by WHO Regions. Learn about infant mortality in the United States, including causes and differences in rates among population groups. Why? The ideal early dating and other antenatal imaging require human and physical resources which are outside of the capability of our setting. 2014;121 Suppl 1:76–88 doi: 10.1111/1471-0528.12633 [Erratum in press: BJOG 2014 doi:10.1111/1471-.528.13236]. Many classification systems have been used to identify the cause of perinatal deaths, highlighting the need for a unifying global system.6 The World Health Organization (WHO) is developing a system to enable comparisons within and between diverse settings, including low-, middle- and high-income countries.