Search

Background: Three 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. Methods: The 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. Discussion: The 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. [ABSTRACT FROM AUTHOR]

Introduction: Over 5 million perinatal deaths occur annually worldwide, with a significant proportion of them being preventable. The International Classification of Disease Perinatal Mortality (ICD‐PM) is the first globally developed classification system for categorizing the causes of perinatal deaths. The objective of this study is to identify and describe the experiences gained from the international utilization of ICD‐PM. Method: A scoping review based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐SCR) was conducted through a comprehensive search using relevant keywords in Web of Science, PubMed, and Scopus from January 2016 to April 20, 2022 to identify relevant studies. The selection of studies was based on predefined inclusion and exclusion criteria. After removing duplicate studies and reviewing titles, abstracts, and full texts, a total of 32 studies were included in the analysis. Results: The primary search ended up with 229 studies, of which 32 articles were included in the final analysis. Based on the results of the content analysis conducted on the selected studies, six main themes and eight strategies were identified. Conclusion: The findings suggest that the utilization of ICD‐PM on a global scale has been limited. The forthcoming advancement of ICD presents a chance to assess and enhance ICD‐PM to establish it as a universally recognized standard system for classifying perinatal mortalities. [ABSTRACT FROM AUTHOR]

Introduction: Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. Methods: This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case–control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. Results: A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors. Conclusion: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings. [ABSTRACT FROM AUTHOR]

A significant proportion of perinatal deaths are preventable. The most critical factor contributing to the failure of international programs aimed at reducing preventable perinatal deaths is the lack of sufficient and accurate information about the causes of these deaths. This deficiency hinders the ability of countries to develop effective interventions for reducing perinatal mortality rates. Various classification systems have been developed to categorize the causes of perinatal death, aiming to enhance understanding and prevention. However, these systems face several challenges, such as assigning a considerable portion of perinatal deaths to unknown causes and usability limitations in developing countries with high perinatal mortality rates. The need for a comprehensive and unified international system for classifying the causes of perinatal mortality is crucial due to the variety of current classification systems, which hinder data comparison at national and global levels. This editorial study aims to introduce the first classification system for the causes of perinatal mortality with international applicability developed by the World Health Organization. [ABSTRACT FROM AUTHOR]

Objective: 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. Methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Preventing mother-to-child HIV transmission is a strategy to eliminate new infections to move toward a world free of HIV/AIDS. The aim of this study is to assess the effectiveness of the perinatal infection prevention program in a single center from southeast Romania. Newborns of HIV-positive mothers from 2005 to 2020 were followed-up until the age of two in a retrospective study. The transmission rate from HIV-positive mothers to living children was zero, but neonatal mortality, preterm birth and birth defects were still high. The peculiarity of our study is the high proportion of mothers with a nosocomial pattern of HIV transmission. Intensifying the efforts for accurate implementing the interventions for the prevention of mother-to-child HIV transmission, a long time follow-up for HIV-exposed uninfected children and new research on related HIV pregnancies are necessary to reach the objective of a new generation free of HIV. [ABSTRACT FROM AUTHOR]

Background: The purpose of this project was to improve perinatal survival by introducing Moyo Fetal Heart Rate (FHR) Monitor coupled with neonatal resuscitation simulation training.Methods: The implementation was done at three district hospitals. We assessed health care workers' (HCW's) skills and perinatal death trends during implementation. Baseline data were collected from the hospitals before implementation. Newborn resuscitation (NR) skills were assessed before and after simulation training. Assessment of perinatal outcomes was done over 2 years of implementation. We used descriptive analysis; a t-test (paired and independent two-sample) and a one-way Anova test to report the findings.Results: A total of 107 HCW's were trained on FHR monitoring using Moyo and NR knowledge and skills using NeoNatalie simulators. The knowledge increased post-training by 13.6% (p <  0.001). Skills score was increased by 25.5 and 38.2% for OSCE A and B respectively (p <  0.001). The overall fresh stillbirths rate dropped from 9 to 5 deaths per 1000 total births and early neonatal deaths at 7 days from 5 to 3 (p <  0.05) deaths per 1000 live births over 2 years of implementation.Conclusion: There was a significant improvement of newborn resuscitation skills among HCW's and neonatal survival at 2 years. Newborn resuscitation training coupling with Moyo FHR monitor has shown potential for improving perinatal survival. However, further evaluation is needed to explore the full potential of the package. [ABSTRACT FROM AUTHOR]

Background: Globally, the burden of perinatal mortality is high. Reliable measures of perinatal mortality are necessary for planning and assessing prenatal, obstetric, and newborn care services. However, accurate record-keeping is often a major challenge in low resource settings. In this study we aimed to assess the utility of delivery ward register data, captured at birth by healthcare providers, to determine causes of perinatal mortality in one specialized and one general hospital in south Ethiopia.Methods: Three years (2014-2016) of delivery register for 13,236 births were reviewed from July 12 to September 29, 2018, in two selected hospitals in south Ethiopia. Data were collected using a structured pretested data extraction form. Descriptive statistics assessed early neonatal mortality rate, stillbirth rate, perinatal mortality rate and causes of neonatal deaths. Factors associated with early neonatal deaths and stillbirths were examined using logistic regression. The adjusted odds ratios with a 95% confidence interval were reported to show the strength of the association.Result: The perinatal mortality ratio declined from 96.6 to 75.5 per 1000 births during the three-year study period. Early neonatal mortality and stillbirth rates were 29.3 per 1000 live births and 55.2 per 1000 total births, respectively. The leading causes of neonatal death were prematurity 47.5%, and asphyxia 20.7%. The cause of death for 15.6% of newborns was not recorded in the delivery registers. Similarly, the cause of neonatal morbidity was not recorded in 1.5% of the delivery registers. Treatment given for 94.5% of neonates were blank in the delivery registers, so it is unknown if the neonates received treatment or not. Factors associated with increased early neonatal deaths were maternal deaths and complications, vaginal births, APGAR scores less than 7 at five minutes and low birth weight (2500 g). Maternal deaths and complications and vaginal births were associated with increased stillbirths.Conclusion: Our findings show that an opportunity exists to identify perinatal death and newborn outcomes from the delivery ward registers, but some important neonatal outcomes were not recorded/missing. Efforts towards improving the medical record systems are needed. Furthermore, there is a need to improve maternal health during pregnancy and birth, especially neonatal care for those neonates who experienced low APGAR scores and birth weight to reduce the prevalence of perinatal deaths. [ABSTRACT FROM AUTHOR]

There have been gradual and continual improvements in maternity care in the UK. This has been paradoxically accompanied by increasing censure by authorities for adverse outcomes and public expression of dissatisfaction. Serious maternal and perinatal adverse outcomes have a devastating effect. Grieving families need an honest explanation, continued support and reassurance that lessons are being sought and learnt. Additionally, the public would welcome the acknowledgement of limitations of healthcare and the science itself; and that the adverse outcomes can be minimised but not eradicated. Blame culture is harmful to the clinicians, healthcare system and, ultimately, patients. The controversial issue of intrapartum fetal monitoring best illustrates the urgent need to reform mistaken science in addition to organisational and cultural improvements. Most enquiries do not critique bad science or guidelines but only birth attendants. The healthcare outcomes must continue to improve through investigations, reviews, openness, medical progress and by helping the clinicians to mitigate the limitations of scientific knowledge, resources and human factors. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Research indicated the prevalence of perinatal deaths of infants immediately or up to a week after birth and includes fresh and macerated stillbirths and neonatal deaths. Worldwide, there is a decline in perinatal deaths. However, in South Africa, it is not the case. Often the quality of maternity care is considered as the most important contributing factor for these deaths. However, maternal and neonatal factors can also contribute. Aim: The aim of the study was to determine the maternal and neonatal factors associated with perinatal deaths in a single selected district hospital within the Free State Province of South Africa. Setting: The maternity unit of the largest district hospital in the specific district in the Free State Province of South Africa. Method: A clinical audit design was used. Units of analysis comprised the Perinatal Problem Identification Programme (PPIP) database of neonates born during 2015, and their mothers. A random sample of 384 alive neonates and an all-inclusive sample of 43 deceased neonates were taken from a total of 2319. Descriptive statistics were reported and Cohen's effect sizes, d, were calculated to identify practically significant differences between the neonates in the alive and the deceased group, respectively. Results: Cohen's effect sizes and logistical regression analyses indicate that the Apgar score recorded 10 min after birth, gestational age, birth weight of neonate and the parity of the mother were the most practically significant factors influencing a neonate's chances of survival. Conclusion: Quality maternity care is not the only cause of perinatal mortality rates; maternal and neonatal factors are also contributors. [ABSTRACT FROM AUTHOR]

Objectives:There is a lack of studying vital registration and disease classification systems in low- and middle-income countries. This study aimed to assess health care professionals’ (HCPs’) level of awareness, knowledge, use, and perceived barriers of the International Classification of Diseases, 10th version (ICD-10) as well as their perceptions of the electronic neonatal death registration system. Participants and methods:A mixed method approach including descriptive cross-sectional quantitative and focus groups with HCPs (physicians, nurses, and midwives) was used to collect data from four major selected hospitals in Jordan. A total of 16 focus groups were conducted. Also, a survey, which included three case studies about the ability of nurses and physicians to identify cause of death, was completed using structured face-to-face interviews. Results:Overall, there was congruency between both the quantitative results and the qualitative findings. The majority of nurses and physicians in the four hospitals were not familiar with the ICD-10 coding system and hence reported minimal use of the coding system. Additionally, the majority of HCPs were not aware whether or not their departments used the ICD-10 to record perinatal mortality. These HCPs identified that lack of knowledge, time, staff and support, and an effective and comprehensive electronic system that allows physicians to accurately choose the exact cause of death were their main barriers to the use of the ICD-10 coding system. Conclusion:Our findings emphasize the importance of developing an effective and comprehensive electronic system which allows HCPs to accurately report and register all perinatal deaths. This system needs to account for the direct and indirect causes of death and for contributing factors such as maternal conditions at the time of perinatal death. Training HCPs on how to use the system is vital for the success and accuracy of the data registration process [ABSTRACT FROM AUTHOR]

Perinatal autopsy provides an opportunity to determine accurate cause of death, factors that may have a role in it along with the presence of congenital malformations in newborns. Such perinatal autopsies were conducted in this study to evaluate vivid causes of death, factors associated with it and presence of common congenital anomalies. Total 84 cases were studied. Pneumonia (32.14%) followed by septicaemia (19.04%) were the major contributors of mortality among natural causes and among unnatural deaths, head injury (3.57%) and thermal burns (2.38%) were noted. Preterm deliveries, low birth weight and poor socioeconomic conditions were the leading factors associated perinatal mortality. Tracheo-oesophageal fistula (4.76%) and anorectal malformations (2.38%) were most commonly observed. Cases where congenital anomalies were suspected but could not be confirmed clinically were confirmed on autopsy examination. Thus perinatal autopsy is valuable tool in retrieving the valuable information regarding paediatric mortality which subsequently is critical for planning of health services. [ABSTRACT FROM AUTHOR]

Introduction: Usually Perinatal Mortality Rate [PMR] constitutes a proportion of IMR. But in Karnataka State of India it is almost equal to IMR. A field based study exploring and comparing the Maternal and Child Health Care Facilities in a well-developed district and backward district of Karnataka State would help in understanding the reasons behind this. So, this study was undertaken. Objectives: 1]. To know the infrastructure and facilities that exist for the perinatal care in two districts of Karnataka. 2]. To know the deficiencies in Infrastructure and facilities if any in the 2 districts. Methodology: A Field based study was conducted in 2 districts of Karnataka State. Maternal and Child Health Care Units which met our criteria in Dakshina Kannada and Koppal Districts were included. Checklists were developed to evaluate the facilities present in these health care units. Trained field workers collected the data from the health care facilities of both the districts. The collected data was scrutinized by the investigators. Results are presented as frequencies and proportions in appropriate tables. This being a qualitative data, the implications have been explained. Results: Totally 63 and 65 Health care facilities met the criteria in Dakshina Kannada and Koppal Districts respectively. Dakshina Kannada District showed a predominance of Private Health Care Facilities [52 out of 63]. Koppal District showed a predominance of Public Health Care Facilities [40 out of 65]. The deficiencies in Health care facilities of both the districts increase the chance of Perinatal Deaths. Conclusion: This study helped in understanding the deficiencies in Health Care facilities. But studies exploring the functioning of these facilities and the Health care Personnel would be necessary. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates of perinatal deaths, which include stillbirths and early neonatal deaths, but the extent is not well studied. This study examines patterns of antepartum complications and the risk of perinatal deaths associated with such complications in rural Bangladesh.Methods: We used data on self-reported antepartum complications during the last pregnancy and corresponding pregnancy outcomes from a household survey (N = 6,285 women) conducted in Sylhet district, Bangladesh in 2006. We created three binary outcome variables (stillbirths, early neonatal deaths, and perinatal deaths) and three binary exposure variables indicating antepartum complications, which were antepartum hemorrhage (APH), probable infection (PI), and probable pregnancy-induced hypertension (PIH). We then examined patterns of antepartum complications and calculated incidence rate ratios (IRR) to estimate the associated risks of perinatal mortality using Poisson regression analyses. We calculated population attributable fraction (PAF) for the three antepartum complications to estimate potential risk reductions of perinatal mortality associated them.Results: We identified 356 perinatal deaths (195 stillbirths and 161 early neonatal deaths). The highest risk of perinatal death was associated with APH (IRR = 3.5, 95% CI: 2.4-4.9 for perinatal deaths; IRR = 3.7, 95% CI 2.3-5.9 for stillbirths; IRR = 3.5, 95% CI 2.0-6.1 for early neonatal deaths). Pregnancy-induced hypertension was a significant risk factor for stillbirths (IRR = 1.8, 95% CI 1.3-2.5), while PI was a significant risk factor for early neonatal deaths (IRR = 1.5, 95% CI 1.1-2.2). Population attributable fraction of APH and PIH were 6.8% and 10.4% for perinatal mortality and 7.5% and 14.7% for stillbirths respectively. Population attributable fraction of early neonatal mortality due to APH was 6.2% and for PI was 7.8%.Conclusions: Identifying antepartum complications and ensuring access to adequate care for those complications are one of the key strategies in reducing perinatal mortality in settings where most deliveries occur at home. [ABSTRACT FROM AUTHOR]

Objectives (i) To determine the causes of deaths in perinatal period. (ii) To ascertain the sociobiological determinants of perinatal mortality. Material and Method: All perinatal deaths and live births in the one year study period were recorded. in rural and urban field practice areas of Department of Community Medicine, JNMC, Aligarh Muslim University, Aligarh (Uttar Pradesh) India. The cause of death was ascertained using verbal autopsy procedure. Results: In the study period, 700 live births and 31 perinatal deaths were recorded. The leading causes of still births were prematurity and complications of the placenta, cord and membranes whereas for early neonatal deaths, the major causes were prematurity including low birth weight and birth asphyxia. Conclusion: Most of the deaths especially early neonatal deaths are preventable if the issues like promotion of institutional deliveries, strengthening of the referral system, early recognition of danger signs by health workers through training and reporting of deaths is made mandatory and according to the system. [ABSTRACT FROM AUTHOR]

The Perinatal Problem Identification Programme ( PPIP) was designed and developed in South Africa as a facility audit tool for perinatal deaths. It has been used by only a few hospitals since the late 1990s, but since the country's commitment to achieve Millennium Development Goal 4-the use of PPIP is now mandatory for all facilities delivering pregnant mothers and caring for newborns. To date 588 sites, representing 73% of the deliveries captured by the District Health Information System for South Africa, provide data to the national database at the Medical Research Council Unit for Maternal and Infant Health Care Strategies in Pretoria. [ABSTRACT FROM AUTHOR]

Objectives: To review the maternal and fetal outcome of triplet, quadruplet and quintuplet gestations following ART, which were managed at a hospital over 11 years. Study design: Retrospective chart review of 150 triplet, 27 quadruplet, and 6 quintuplet pregnancies between January 2001 and December 2011. 25 women aged 50-56 years with triplet pregnancies, were excluded due to lack of data. No prophylactic interventions were used. Results: 300 triplets, 108 quadruplets, and 30 quintuplets were born. The mean maternal age was 30.2 years (SD 4.2 years). Mean gestational age delivery was 32.2 weeks (SD 4.2 weeks). Maternal complications included preterm labor 114 (86 %), prematurity 115 (87 %), anemia 44 (33 %) gestational diabetes 35 (27 %), preeclampsia 33 (25 %), post partum hemorrhage 13 (10 %). Preterm labor was diagnosed in 84 (84 %) triplets, 32 (97 %) of quadru- and quintuplet pregnancies ( P > 0.05). Prematurity and preterm labor were major determinants. Of the 438 fetuses born there were 57 (13 %) still births, 77 (18 %) neonatal deaths. 32 (7 %) were early neonatal deaths, 45 (10 %) late neonatal deaths. The majority died due to extreme low birth weight. 75 (17 %) neonates had low apgar score of <7 at 5 min. 22 (5 %) infants had congenital anomalies. Severe respiratory distress syndrome, perinatal asphyxia, very early preterm delivery and perinatal mortality were higher in quadru- and quintuplets ( P < 0.05). Conclusion: Preterm labor and preterm prematurity were the commonest complications. Neonatal mortality and morbidity was significantly increased in quadru- and quintuplets. Prophylactic interventions were not used in an attempt to prevent preterm labor. [ABSTRACT FROM AUTHOR]

Background: Perinatal 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. Methods: We 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). Results: Overall 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 to5.5/1000). Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Autopsy findings play an important role in prevention of perinatal and neonatal deaths. Therefore, we attempted to reveal demographic and forensic features of these deaths in Turkey. We retrospectively reviewed autopsy reports for 184 cases of perinatal deaths released from Istanbul Forensic Medicine Institute Morgue between 2000 and 2002 and investigated demographic and medico-legal features of the cases. The mean age of the cases was 2.98 ± 6.41 days. Fifteen point two percent (15.2 2%) of the cases were of murder, 52.7% of the cases were illegitimate children and 41.3% had the ability to survive. It can be suggested that autopsy and post-mortem examinations should be performed in order to determine the real causes and contributing factors of perinatal and neonatal deaths. Data obtained in autopsies and postmortem examinations will make great contributions to the prevention of these deaths. [ABSTRACT FROM AUTHOR]

Objective: To investigate the causes and contributory factors of perinatal mortality by verbal autopsy in Maharashtra. Materials and Methods: Rural and urban areas in six districts in Maharashtra were selected by Probability proportional to size sampling. Verbal autopsies for perinatal deaths were conducted using standard tools and by visiting households; cause of death was assigned according to the International Classification of Diseases-10 using a standard algorithm. Statistical analysis was done using the SPSS-11 version software. Results: A total of 83 perinatal deaths (31 stillbirths and 52 early neonatal deaths) were investigated out of which cause of death for perinatal deaths could be assigned in 96.4% deaths. The leading causes of perinatal deaths were prematurity (19.3%) and complications of placenta, cord and membranes (12.9%) among stillbirths, while low birth weight (36%) and prematurity (26%) accounted for early neonatal deaths. [ABSTRACT FROM AUTHOR]

To review the outcome of high-order gestations at King Abdulaziz University Hospital (KAUH). A retrospective chart review of all high order multiple pregnancy delivered at KAUH. The ante partum and postpartum complications and the neonatal outcome had been studied. Thirty-six triplets, five quadruplets, and one set of quintuplets delivered during the period (1985–2005). The mean maternal age was 28.5 ± 5 years. The mean gestational age at delivery was 33.9 ± 2.5 weeks. The maternal complications included: first trimester bleeding 7 (15.4%), pre-eclampsia 5(19.2%), gestational diabetes 2 (3.8%), anemia 12 (23.1%), and preterm labor 29 (65.4%). Of 133 fetuses there were three stillbirths, seven neonatal deaths, six early neonatal deaths, and one late neonatal death, and all died because of extreme low birth weight. Fifteen babies had low APGAR score of < 7 at 5 min. Three babies had congenital anomalies. The outcome of high order gestations at our center is comparable to others, prematurity and extreme low birth weight being major determinants. [ABSTRACT FROM AUTHOR]

A study was conducted on 75 perinatal deaths with congenital anomalies through clinical, radiographic, cytogenetic, and autopsy evaluation, and the diagnoses of 72 patients (96%) were determined. In 11 patients with chromosomal anomalies, the cytogenetic study was sufficient to determine the diagnosis and the reproductive risk. In these cases, the value of the autopsy results resided above all in the description of the clinical variability. Radiographic evaluation was the best method to establish a diagnosis of skeletal dysplasias (14.7%). Furthermore, the X-rays showed small skeletal defects which are difficult to see on dissection. The clinical genetic evaluation with a detailed description of the phenotype and anthropometric exam, performed by a clinical geneticist, and the autopsy with gross and microscopic evaluation, facilitated the diagnoses of 50 cases (66.7%). We concluded that, in perinatal death with congenital anomalies, the teamwork of clinical geneticists and fetal pathologists increases the probability of determining the etiological diagnosis. This is essential to define the parents’ reproductive risk, thus contributing to primary prevention of congenital anomalies. [ABSTRACT FROM AUTHOR]

This study was conducted at a secondary level hospital at Ballabgarth, run by Centre for Community Medicine, All India Institute of Medical Sciences. The still birth rate during the study period 1987-1992 was 19.5 per 1,000 births. It showed a sudden decline during these six years probably reflecting the change in the admission policy of the hospital. A case control study of 72 still births and 144 controls was carried out to identify risk factors for still births. Maternal age, gravidity, previous history of still births or abortion were not found to be significantly associated with still births. Poor socio-economic status measured by parental literacy and occupation were significantly associated with still births. Lack of antenatal care [(OR 9.2 (2.5-37.9)], low birth weight (< 2500 gms) [OR-18.1 (4.4-74.5)], non-vertex presentation [(OR 41.2 (66-257.3)], maternal illiteracy [OR 2.75 (1.01-11.3)] were found to be the important predictors of still birth as identified by logistic regression analysis. The provision of good antenatal care and improvement of the socio-economic status, especially female literacy, will help in decreasing the still birth rate in the country. [ABSTRACT FROM AUTHOR]

A total of 1035 births to diabetic mothers were registered in Norway during the 10-year period 1967-1976. Perinatal mortality (from 16 weeks of gestation until 7 days after birth) decreased from 177.4 per 1000 births in 1967-68 to 60.7 in 1975-1976; for the total population the figures were 24.1 and 18.4. During the same period the duration of gestation increased from 35.5 weeks in 1967-1968 to 37.0 weeks in 1975-1976. The numbers of small and large infants decreased: in 1967-1968 53.3% weighed 2500-4000 grams, in 1975-1976 70.7%. Moreover, more births took place in university clinics and regional hospitals, 38.7% in 1967-1968 and 77.1% in 1975-1976. Malformations were 50% more common in children of diabetics. Cardiovascular and nervous system malformations accounted for this increase, being 5 times more frequent than in the general population. [ABSTRACT FROM AUTHOR]

The article discusses the effectivity of the community-based intervention packages in improving neonatal outcomes. Topics include the importance of healthcare professionals in improving the maternal health and the reduction of child mortality. Also discussed is the study that confirms the effectivity of the program wherein controlled trials have been conducted of pregnant women in developing countries wherein findings revealed reduction in child mortality was observed.

Background: Perinatal deaths account for 7% of the global burden of disease, with developing countries contributing about 98% of deaths. The aim of this study was to describe the prevalence and factors contributing to adverse pregnancy outcomes, particularly perinatal death, among women at Sakubva hospital, Mutare district, Zimbabwe from January to June 2014.Methods: We conducted a retrospective review of 346 patient records, of women who delivered at Sakubva hospital and those referred from Mutare district facilities to Mutare Provincial Hospital, between January and June 2014. Descriptive statistics was used to explore the contributors to stillbirths and early neonatal deaths in Mutare.Results: Of the 346 women, 54 (15.61%) experienced an adverse pregnancy outcome (stillbirth or early neonatal death). Contributing factors to adverse pregnancy outcomes included birthweight, gestational age, delivery complications and delivery methods. These factors are preventable if quality focused antenatal care, intrapartum care is provided. Identification of pregnancy complications and facilitation of proper method of delivery is key to improve quality of care. Caesarean section provision to all women who need it improves outcomes.Conclusions: High prevalence of adverse pregnancy outcomes in Mutare district could be reduced through the provision of quality antenatal care throughout the continuum of care, pre-, intra and postpartum. Further studies to explore risk factors associated with high adverse outcomes are recommended. [ABSTRACT FROM AUTHOR]