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Abstract 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 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 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 (χ 2 trend ) 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 (χ 2 trend = 373.65, P

Abstract 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 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 to 5.5/1000). 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.

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.