The utility of delivery ward register data for determining the causes of perinatal mortality in one specialized and one general hospital in south Ethiopia

Abstract 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.

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KEMATIAN PERINATAL DI BLU RSU PROF. DR. R. D. KANDOU MANADO

Jurnal e-Biomedik ◽

10.35790/ebm.1.1.2013.4585 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

Mercy Tumundo ◽

Hermie Tendean ◽

Eddy Suparman

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Perinatal Death ◽

Developed Countries ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Normal Birth ◽

Perinatal Mortality Rate ◽

Still Births ◽

Early Neonatal Deaths

Abstract: Perinatal death is a big problem especially in a developing country. Some of the hospitals in Indonesia have declared that the number of perinatal death in developing countries is higher than in developed countries. The purpose of this research is to determine the incidence of the factors that affecting perinatal mortality at Prof. DR. R. D. Kandou General Hospital Manado. This research used retrospective descriptive method through medical records of perinatal deaths patients. There were 164 cases of perinatal deaths found where 109 cases still births and 55 cases were early neonatal deaths in 2011, so the number of perinatal mortality rate was 40.17 per mil. The highest number of perinatal death was from multigravide mother, mother with age ≥ 35 years old, spontaneous parturition. There were unknown caused of still births cases (77,06%) and sepsis in early neonatal deaths. The normal birth weight is also with most include of perinatal deaths. Keywords: still birth, early neonatal death, perinatal deaths, perinatal mortality rate. Abstrak: Kematian perinatal merupakan masalah besar khususnya di negara sedang berkembang. Beberapa rumah sakit pendidikan di Indonesia melaporkan angka kematian perinatal yang tinggi dibandingkan dengan laporan angka kematian perinatal di negara – negara maju yang jumlahnya rendah. Tujuan penelitian untuk mengetahui angka kejadian kematian perinatal serta faktor – faktor yang mempengaruhinya. Penelitian ini menggunakan metode deskriptif retrospektif dengan menggunakan data catatan medik pasien. Hasil penelitian yaitu jumlah kematian perinatal pada tahun 2011 sebanyak 164 kasus dengan 109 kasus lahir mati dan 55 kasus kematian neonatal dini sehingga angka kematian perinatal pada tahun 2011 yaitu 40.17 per mil. Kematian perinatal paling banyak pada ibu multigravida, ibu dengan kelompok usia ≥ 35 tahun, menggunakan jenis persalinan spontan. Pada lahir mati 77.06 % penyebab kematiannya tidak diketahui sedangkan sepsis paling banyak menyebabkan kematian neonatal dini. Berat badan lahir normal juga menjadi salah satu faktor terjadinya kematian perinatal. Kata kunci: lahir mati, kematian neonatal dini, kematian perinatal, angka kematian perinatal.

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Reduction in Perinatal Mortality after Implementation of HBB Training at a District Hospital in Mali

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmz072 ◽

2019 ◽

Vol 66 (3) ◽

pp. 315-321

Author(s):

M Innerdal ◽

I Simaga ◽

H Diall ◽

M Eielsen ◽

S Niermeyer ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

District Hospital ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Live Births ◽

Early Neonatal Mortality ◽

Helping Babies Breathe ◽

Before And After

Abstract Background Mali has a high neonatal mortality rate of 38/1000 live births; in addition the fresh stillbirth rate (FSR) is 23/1000 births and of these one-third are caused by intrapartum events. Objectives The aims are to evaluate the effect of helping babies breathe (HBB) on mortality rate at a district hospital in Kati district, Mali. Methods HBB first edition was implemented in April 2016. One year later the birth attendants were trained in HBB second edition and started frequent repetition training. This is a before and after study comparing the perinatal mortality during the period before HBB training with the period after HBB training, the period after HBB first edition and the period after HBB second edition. Perinatal mortality is defined as FSR plus neonatal deaths in the first 24 h of life. Results There was a significant reduction in perinatal mortality rate (PMR) between the period before and after HBB training, from 21.7/1000 births to 6.0/1000 live births; RR 0.27, (95% CI 0.19–0.41; p < 0.0001). Very early neonatal mortality rate (24 h) decreased significantly from 6.3/1000 to 0.8/1000 live births; RR 0.12 (95% CI 0.05–0.33; p = 0.0006). FSR decreased from 15.7/1000 to 5.3/1000, RR 0.33 (95% CI 0.22–0.52; p < 0.0001). No further reduction occurred after introducing the HBB second edition. Conclusion HBB may be effective in a local first-level referral hospital in Mali.

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Multiple Pregnancy as a High-Risk Pregnancy. Medical statistical data from the German Democratic Republic

Acta geneticae medicae et gemellologiae ◽

10.1017/s1120962300024197 ◽

1972 ◽

Vol 22 (S1) ◽

pp. 3-6 ◽

Cited By ~ 1

Author(s):

I. Leetz

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Multiple Pregnancy ◽

Bed Rest ◽

Multiple Birth ◽

Neonatal Deaths ◽

Early Neonatal Mortality ◽

Risk Pregnancy ◽

Early Neonatal Mortality Rate ◽

Early Neonatal Deaths

In 1969 children of a multiple birth in the GDR made up 1.9% of livebirths and 15.3% of early neonatal deaths. The early neonatal mortality rate of children from a multiple birth was 95.7‰, that of all live-births 12.4‰. The cause was the low birth weight of children from a multiple birth (56.2% vs. 5.8% of all livebirths). Their low birth weight is the result of a hypotrophic development caused by malnutrition. The loss of children from a multiple birth (stillbirths, early neonatal and postneonatal deaths) was 143‰. International experience has shown that such heavy losses can be largely prevented by bed rest of the woman with a multiple pregnancy. We therefore strongly recommend early diagnosis and early in-patient care of women with multiple pregnancy.

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Perinatal Mortality in Retrospect and Prospect

Scottish Medical Journal ◽

10.1177/003693306901400306 ◽

1969 ◽

Vol 14 (3) ◽

pp. 89-94

Author(s):

J. Thomson

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

No Reduction ◽

Maternity Hospital ◽

Early Years ◽

National Data ◽

Maternal Deaths ◽

Neonatal Deaths ◽

Marked Decline ◽

The Subject

Little interest was displayed in perinatal mortality until the work of Ballantyne in the early years of this century. Scotland has had national figures available for causes of stillbirths since 1939 and also for neonatal deaths since 1958. The National Perinatal Mortality rate has dropped by 50 per cent since 1939 but the mortality rate for the first 24 hours of life has shown no improvement. Comparison of national data with figures from a maternity hospital shows a greatly increased number of deaths from unknown causes in the national data: it is suggested that the national data do not present a true picture due to inadequate certification. Study of the hospital figures over a period of 15 years shows little change in the total deaths, the marked decline in the number of stillbirths being balanced by a marked increase in first-day deaths. Difficult labour and birth injury are decreasing as causes of perinatal mortality. Deaths from malformations, toxaemia, placental haemorrhage and unknown causes show little or no reduction. It is suggested that perinatal deaths should be the subject of an inquiry such as that for maternal deaths. The changing pattern of perinatal mortality calls for constant reassessment.

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Perinatal Mortality in Twins, Australia, 1973-1980: II. Maternal Age, Lethal Congenital Malformations and Sex

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000003913 ◽

1988 ◽

Vol 37 (3-4) ◽

pp. 321-329 ◽

Cited By ~ 3

Author(s):

John D.H. Doherty

Keyword(s):

Birth Weight ◽

Mortality Rate ◽

Sex Ratio ◽

Perinatal Mortality ◽

Congenital Malformations ◽

Maternal Age ◽

Teenage Mothers ◽

Neonatal Deaths ◽

Perinatal Mortality Rate

AbstractThe influence of maternal age and congenital malformations on perinatal mortality in twins in Australia from 1973 to 1980, is described. Stillbirths and neonatal deaths in twins fell with advancing maternal age. For teenage mothers, the twin perinatal mortality rate was 127.15/1,000. The sex ratio in twins is closer to unity than in singletons. Perinatal mortality due to malformation fell as maternal age increased up to 35 years. The role of zygosity and the distribution of birth weight with maternal age are discussed.

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Perinatal factors associated with early neonatal deaths in very low birth weight preterm infants in Northeast Brazil

BMC Pediatrics ◽

10.1186/s12887-014-0312-5 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 8

Author(s):

Eveline Campos Monteiro de Castro ◽

Álvaro Jorge Madeiro Leite ◽

Maria Fernanda Branco de Almeida ◽

Ruth Guinsburg

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Very Low Birth Weight ◽

Northeast Brazil ◽

Perinatal Factors ◽

Neonatal Deaths ◽

Factors Associated ◽

Early Neonatal Deaths

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Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

BMJ Open ◽

10.1136/bmjopen-2018-027504 ◽

2020 ◽

Vol 10 (7) ◽

pp. e027504

Author(s):

Victoria Nakibuuka Kirabira ◽

Mamuda Aminu ◽

Juan Emmanuel Dewez ◽

Romano Byaruhanga ◽

Pius Okong ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Perinatal Mortality ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Stillbirth Rate ◽

Neonatal Mortality Rate ◽

Neonatal Deaths ◽

Early Neonatal Mortality ◽

Early Neonatal Mortality Rate

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary outcome measuresPrimary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.Results526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.ConclusionThe introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.

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The magnitude of perinatal mortality rate and associated risk factors among deliveries at Dilla University Referral Hospital, Southern Ethiopia: A case-control study

Healthcare in Low-resource Settings ◽

10.4081/hls.2021.9960 ◽

2022 ◽

Vol 9 (1) ◽

Author(s):

Kefale Lelamo Legu ◽

Alemu Tamiso Debiso ◽

Kaleb Mayisso Rodamo

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Perinatal Mortality ◽

Case Control Study ◽

Case Control ◽

Neonatal Deaths ◽

Perinatal Mortality Rate ◽

Associated Risk Factors ◽

Early Neonatal Deaths ◽

Control Study

The perinatal mortality rate is the sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration. In Ethiopia, the death rate was 33 deaths/1000 total births in 2016. We aimed to identify the perinatal mortality rate and associated risk factors among deliveries in Dilla University Referral Hospital; January, 2016 - December, 2018. A hospital based retrospective case-control study was conducted using subgroup binary logistic regression analysis including 138 cases and 296 control group. The proportion of hospital perinatal deaths was 30% with 90% of the deaths were occurred as a result of stillbirths and antepartum hemorrhage. Adjusted odds ratios revealed that history of still birth, very low birth weight, short interval and nonuse of partograph found to be independent predictors of both stillbirths and early neonatal deaths besides to pregnancy induced hypertension and antepartum hemorrhage. The risk of perinatal mortality may be increased by not treating chronic illnesses, obstetrics complications and risk factors causing low birth weight as well as short birth intervals and not using partograph during labour.

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Preterm labour in multiple pregnancies

Fetal and Maternal Medicine Review ◽

10.1017/s0965539500000784 ◽

1993 ◽

Vol 5 (2) ◽

pp. 105-119 ◽

Cited By ~ 2

Author(s):

James P Neilson ◽

Caroline A Crowther

Keyword(s):

Perinatal Mortality ◽

Preterm Labour ◽

Multiple Pregnancy ◽

High Rate ◽

Fetal Malformation ◽

Multiple Pregnancies ◽

Neonatal Deaths ◽

Late Abortion ◽

Early Neonatal Deaths ◽

Singleton Pregnancies

Multiple pregnancy is associated with a high rate of perinatal loss – mainly due to preterm labour but with important contributions from fetal malformation, intrauterine growth retardation and twin-twin transfusion syndrome. The overall perinatal mortality rate is consistently around six times that of singleton pregnancies but the rate rises progressively with the number of fetuses. Rates of 63,164,200,214 and 416 per 1000 births have been recently reported for twins, triplets, quadruplets, quintuplets and sextuplets respectively. In addition to these alarming figures, it should be emphasized that the restricted concept of perinatal mortality obscures the real extent of loss. If we include late abortion (after 20 weeks), late neonatal deaths and deaths in infancy from perinatal causes, as well as the usual indices of perinatal mortality (stillbirths and early neonatal deaths) we find that the total loss rate from twin pregnancy alone doubles and may be close to 10%. Although the rate of loss from multiple pregnancies is now substantially higher than that associated with the pregnancies of diabetic women, the challenge of multiple pregnancy has not been met with the same commitment or organisation of specialized perinatal services as has diabetes.

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Explanation of Perinatal Mortality Rate in Collaborative Study

PEDIATRICS ◽

10.1542/peds.52.6.891 ◽

1973 ◽

Vol 52 (6) ◽

pp. 891-891

Author(s):

Arnold S. Goldstein ◽

Henry H. Mangurten

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Umbilical Artery ◽

Collaborative Study ◽

The United States ◽

Mortality Rates ◽

Single Umbilical Artery ◽

Neonatal Deaths ◽

General Mortality ◽

Future Management

The article by Froehlich and Fujikura1 on the prognosis of single umbilical artery is a much needed and highly informative addition to the literature. It presents a great deal of information and some important implications as to future management. We question the mortality rates quoted. They are given as percentages, and include stillbirths and neonatal deaths, i.e., perinatal mortality. The figure given as the general mortality rate is 3.8% or 38 per 1,000 births. Previous figures cited for perinatal mortality in the United States have varied from approximately 19 per 1,000 to approximately 26 per 1,000.2-4 We wonder how the figure of 38 per 1,000 was determined.

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