Role of ethnicity in thrombotic and hemorrhagic complications of myeloproliferative neoplasms.

e18555 Background: Philadelphia-chromosome negative myeloproliferative neoplasms (MPN) are a group of hematologic malignancies with known complications of hemorrhage and thrombosis. Age and a previous history of thrombosis are well-documented risk factors for future vascular events. Variations in the rates of these complications among ethnicities and sexes have not been extensively explored. Methods: Our retrospective analysis included 301 adult patients with a diagnosis of MPN without a history of thrombosis or hemorrhagic event seen at the Indiana University Simon Cancer Center between 1992 and 2019. Relationships between ethno-racial backgrounds and vascular complications and disease outcomes were evaluated using multivariate logistic regression analysis and Cox regression models. Results: Two hundred seventy-one patients (90.0%) were Caucasian and 30 patients (10.0%) were non-Caucasian. Non-Caucasian patients were comprised of African America, Asian, and Middle Eastern ethnicities. Median age at diagnosis was 56 years, and 43.9% were male. No association was found between the incidence of thrombotic complications and ethnicity using the log-rank test ( p 0.68). The incidence of hemorrhagic events was significantly increased in non-Caucasian patients (OR = 4.33; 95% CI [1.15 – 16.36], p 0.03). Patients with higher hemoglobin concentration at diagnosis were at a significantly lower risk of bleeding complications (OR = 0.79; 95% CI [0.65 – 0.95], p 0.01). Non-Caucasian patients were at 2.98 times (95% CI [1.19 – 7.44], p 0.02) higher risk when vascular complications were pooled together. Our models also showed that male sex (OR = 0.14; 95% CI [.02 – .98], p 0.048) and a higher platelet count at the time of diagnosis (OR = 0.99; 95% CI [.993 –.999], p 0.03) had a marginally significant association with decreased rate of progression to acute myeloid leukemia. Conclusions: This study suggests that in patients without a history of thrombosis or bleeding, non-Caucasian ethnicity was associated with an increased adjusted risk of hemorrhagic complications in patients with MPN. This observation may inform future studies to further characterize those disparities in outcomes at the genetic or socioeconomic level.

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Ahmed glaucoma valve in vitrectomized eyes: An implantation technique to minimize early postoperative fluid-loss hypotony

European Journal of Ophthalmology ◽

10.1177/11206721211012200 ◽

2021 ◽

pp. 112067212110122

Author(s):

Paolo Arpa ◽

Cristina Arpa

Keyword(s):

Surgical Technique ◽

Anterior Chamber ◽

Previous History ◽

Implantation Technique ◽

Fluid Loss ◽

Ahmed Glaucoma Valve ◽

Intraocular Hemorrhage ◽

Hemorrhagic Complications ◽

History Of ◽

Choroidal Effusion

Purpose: To describe the application of a modified Ahmed glaucoma valve (AGV) surgical implantation technique in vitrectomized eyes, in order to minimize the risk of early postoperative hypotony, which leads to hemorrhagic complications. Materials and methods: Data of patients implanted with AGV using the surgical technique described were retrospectively reviewed. Inclusion criterion: glaucomatous eyes with previous history of pars plana vitrectomy. Intraocular pressure (IOP) measurement and ophthalmic examination were performed preoperatively and postoperatively weekly for 1 month for the detection of early hypotony, choroidal effusion/detachment, intraocular hemorrhage. The surgical technique consisted in creating a 5 mm long scleral tunnel with a 23 G needle reaching the anterior chamber at the iridocorneal angle, in which the Ahmed glaucoma valve tube was inserted. Results: Ten eyes of 10 patients were included. Median preoperative IOP was 30.5 mmHg [interquartile range (IQR) 28.3–33.0]; median postoperative IOP was 12.0 mmHg (IQR 9.3–13.0) at 1 week, and 12.5 mmHg (IQR 11.0–15.0) at 1 month. In no cases postoperative IOP was <8 mmHg. On the first postoperative day, five (50%) eyes showed few blood clots in the anterior chamber. On the second-week appointment, moderate choroidal effusion was observed in two eyes (20%). No hemorrhagic complications were observed. Conclusions: The creation of a long intrascleral tunnel with a 23 G needle for AGV implantation in vitrectomized eyes could be effective in decreasing leakage through the space between the valve tube and the sclerocorneal tissue. This technique is safe, easy to perform, feasible and fast. Due to its advantages and good postoperative results, it could also be adopted in non-vitrectomized eyes.

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Osteochondroma of the scapula associated with a subclavian artery pseudoaneurysm: Case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x18823089 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1882308

Author(s):

Ana Oljaca ◽

Daniela Hirzberger ◽

Marko Bergovec ◽

Kurt Tiesenhausen ◽

Stephan H Koter ◽

...

Keyword(s):

Subclavian Artery ◽

Clinical Status ◽

Previous History ◽

Vascular Complications ◽

Mechanical Compression ◽

Vascular Surgeon ◽

Artery Pseudoaneurysm ◽

Dorsal Aspect ◽

Multiple Exostoses ◽

History Of

Osteochondromas rarely induce vascular complications by mechanical compression. We present the case of a subclavian artery pseudoaneursym caused by an osteochondroma of the scapula in a 67-year-old male. The diagnosis was based on a previous history of multiple exostoses, computed tomography and magnetic resonance imaging, as well as the local vascular clinical status of the lesion. Surgical treatment consisted of vascular and orthopaedic intervention. First, the vascular surgeon implanted a bypass of the subclavian artery from the ventral aspect, enabling the orthopaedic surgeon to resect the osteochondroma from the dorsal aspect. The patient recovered with full function. Vascular pseundoaneurysms should be taken into consideration in patients with osteochondromas, especially with a known history of multiple hereditary exostoses.

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Argatroban Associated Bleeding Complications.

Blood ◽

10.1182/blood.v110.11.1867.1867 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1867-1867

Author(s):

David Berz ◽

Gerald A. Colvin ◽

Priya Mital ◽

Peter J. Quesenbery

Keyword(s):

Multivariate Logistic Regression Analysis ◽

Direct Thrombin Inhibitor ◽

Bleeding Complications ◽

Thrombin Inhibitor ◽

Time Interval ◽

Study Cohort ◽

Transfusion Therapy ◽

Major Hemorrhage ◽

Hemorrhagic Complications ◽

Thrombotic Complications

Abstract Background: Heparin induced thrombocytopenia (HIT) is a frequently observed side effect observed with heparin administration. Treatment for this condition includes direct thrombin inhibitor (DTI) therapy. Major hemorrhagic complications are considered rare events in this setting. Methods: This is a case series of patients diagnosed with HIT in a tertiary medical referral center. The diagnosis of HIT was established on the base of clinical criteria. All included patients had positive HIT ELISA based antibody testing during the time interval from July 2006 to July 2007 and all patients were treated with argatroban. A systematic review for hemorrhagic and thrombotic complications of argatroban therapy was performed. Major hemorrhage was defined as clinically identified bleeding with the demand for transfusion therapy. Thrombotic complications were defined as thrombosis evidenced by imaging studies developing during argatorban therapy. We performed bivariate and multivariate logistic regression analysis to identify demographic and clinical factors that influence the development of complications of argatroban therapy as treatment for HIT. Examined covariates were gender, age, type of service the patient was admitted under (surgical versus medical), amount of comorbidities, preexisting history of gastrointestinal bleeding, documented thrombotic or thrombembolic event at the time point of HIT diagnosis and coexisting coexisting coagulopathy other than HIT. Results: We identified 102 patients with the diagnosis of HIT. The median optical density (OD) of the ELISA HIT immunoassay was 1.23 (95% CI 0.93–1.43). We identified 11 (10.7%) major hemorrhagic events in patients on argatroban. Four patients (3.9%) died as a consequence of major hemorrhagic complications. No thrombotic events were identified in our study cohort. As statistically significant; predictors for clinically relevant hemorrhagic complications in our model remained male gender, preexisting GI bleeding history and being patient on a surgical service. Conclusion: The incidence of major hemorrhagic episodes with agatroban therapy is significantly higher then generally reported and the mortality rate is very disturbing. These data suggest that alternatives to standard direct thrombin inhibitor therapy should be aggressively pursued.

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Frequency and Determinants of Thrombotic and Bleeding Complications in Ph Negative Myeloproliferative Neoplasms (MPN): The Role of Adamts-13 and VWF Activities in an Italian Cohort 0f 88 Well Characterized Patients

Blood ◽

10.1182/blood.v120.21.3369.3369 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3369-3369

Author(s):

Augusto B. Federici ◽

Maria C Carraro ◽

Antonella Lattuada ◽

Chiara Vanelli ◽

Veronica Sciumbata ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Conflicts Of Interest ◽

Myeloproliferative Neoplasms ◽

Thrombotic Event ◽

Previous History ◽

Bleeding Complications ◽

Post Surgery ◽

Bleeding Episodes

Abstract Abstract 3369 Background: Patients with Ph-negative Myeloproliferative Neoplasms (MPN) such as Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF) can be exposed during the course of these MPN to thrombotic and bleeding complications, with increased morbidity and mortality. Age, previous history of thrombosis, increased White Blood Cell (WBC) and Jak2 allele burden have been proposed as risk factors for Venous (VTE) and Arterial (ATE) thromboses while bleeding has been previously associated with abnormalities of the von Willebrand factor (VWF). Aims: To investigate any significant role of ADAMTS-13 and VWF activities in the thrombotic and bleeding complications observed in a small but well characterized cohort of MPN patients. Patients and Methods: 88 consecutive patients were diagnosed at the Hematology and Transfusion Medicine Division, L.SACCO University Hospital of Milan, according to WHO criteria. Patients signed an informed consent to participate in this clinical study with a protocol approved by local IRB and they showed MPN type (%), mean age (range), gender M/F and Jak2 positivity (%) as follows: PV[n=42 (48%), 68 (36–86), 18/24; 85.7%]; ET [n=34 (38%), 66 (30–93), 10/24, 61.7%]; PMF [n=12 (14%), 67 (37–88), 7/5, 58%]. Thrombotic and bleeding episodes were recorded and managed from the time of diagnosis and associated with the use of aspirin (ASA) and of other MPN therapies. Among additional lab parameters, plasmatic ADAMTS-13 and VWF activities were also measured at enrolment as endothelial/platelet marker. These activities were assayed with Technozym ADAMTS-13 activity (Technoclone GmbH, Austria), Innovance VWF-GPIb activity (Siemens AG, Germany) and HemosIL-VWF antigen (Instrumentation Laboratory, USA). Multimeric analyses were also tested using very sensitive intermediate SDS-agarose gel electrophoresis. Statistical analyses were performed by SPSS-17.2. Results: 59/88 (67%) patients did not show any thrombotic or bleeding complications during the 6-year follow-up. In these cases mean (range) values of VWF:GPIb and VWF:Ag were 104 (29–202) and 133 (52–288) U/dL while ADAMTS-13 was 102 (63–143). 20/88 (23%) cases showed at least one thrombotic event (13ATE/7VTE): AMI (6), STROKE (6), TIA (2), PE (1), DVT (7). Patients with thromboses showed relatively higher values VWF:GPIb and lower ADAMTS-13 and this was confirmed in multivariate analysis especially for ET [VWF:GPIb=135 (61–237) U/dL, p=0.004 and ADAMTS-13=89(62–134), p=0.009]. Major bleeding episodes mainly mucosal (5 gastrointestinal, 3 post-surgery, 1 severe menorrhagia) requiring blood transfusions or hysterectomy were observed in 9/88 (10%) patients. At the multivariate analysis, major bleedings were significantly associated with lower VWF:GPIb [68 (25–111) U/dL, p=0.022), lower VWF:Ag [93 (35–146) U/dL, p=0.016] and to the ASA intake (p=0.006). Most of these bleeders showed also a relative loss of the highest molecular weight multimers. Conclusions: Based on these observations, we confirm that thrombotic events in MPN may certainly have multiple risk factors: however, lower ADAMTS-13 and higher VWF activities might play a role as additional risk factors especially in ET. Conversely, lower levels of VWF with loss of the largest multimers are important risk factors for bleeding in MPN especially in patients treated with ASA. Disclosures: No relevant conflicts of interest to declare.

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The associations between risk behaviour and reported history of sexually transmitted diseases, among young women: a population-based study

International Journal of STD & AIDS ◽

10.1258/0956462971920659 ◽

1997 ◽

Vol 8 (8) ◽

pp. 501-505 ◽

Cited By ~ 36

Author(s):

Monica Jonsson ◽

Roger Karlsson ◽

Ewa Rylander ◽

Ake Gustavsson ◽

Goran Wadell

Keyword(s):

Alcohol Consumption ◽

Sexually Transmitted Diseases ◽

Univariate Analysis ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Risk Behaviour ◽

Population Based ◽

Sexual Partners ◽

Sexually Transmitted ◽

History Of

The aim of this study was to determine the associations between risk behaviour and women's reported sexually transmitted diseases (STDs). All the women aged 19, 21, 23 and 25, residing in a specified housing area, were invited to answer a questionnaire regarding their sexual behaviour, smoking and alcohol consumption and previous history of STD. Of the 611 women participating, one out of 4 women had a history of at least one STD. In an univariate analysis, self-reported STD was found to be related to age, having more than 4 lifetime sexual partners, having practised intercourse at first date, inconsistent use of condoms, alcohol consumption of more than 3 bottles of wine per month and smoking. These factors were, however, not independent of each other and when subjected to a multivariate logistic regression analysis 2 factors, i.e. the lifetime number of sexual partners (more than 4 partners vs one; OR 7.94, (3.41-18.50)) and coitus on first date (practised more than once vs never, OR 2.99 (1.55-5.78)) emerged as independently associated with a previous STD.

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Increased levels of NETosis in myeloproliferative neoplasms are not linked to thrombotic events

Blood Advances ◽

10.1182/bloodadvances.2020004061 ◽

2021 ◽

Vol 5 (18) ◽

pp. 3515-3527

Author(s):

Stefan Schmidt ◽

Dimitri Daniliants ◽

Elisabeth Hiller ◽

Eberhard Gunsilius ◽

Dominik Wolf ◽

...

Keyword(s):

Clinical Data ◽

Myeloproliferative Neoplasms ◽

Philadelphia Chromosome ◽

Enzyme Linked Immunosorbent Assay ◽

Thromboembolic Complications ◽

End Points ◽

Mutational Status ◽

Healthy Donors ◽

History Of ◽

The Impact

Abstract Morbidity and mortality of Philadelphia chromosome–negative myeloproliferative neoplasms (MPNs) are mainly determined by thromboembolic complications. Thrombus formation is facilitated by a neutrophil-specific form of cell death linked to neutrophil extracellular trap (NET) formation (NETosis). Preclinical and clinical data suggested a potential link between NETosis and thrombosis in MPNs. In this study, we aimed to define the impact of NETosis on clinical end points in a large MPN cohort. NETosis was induced in vitro by ionomycin and quantified by enzyme-linked immunosorbent assay–based nucleosome release assays as well as fluorescent staining of free DNA in samples from 103 MPN patients and 28 healthy donors. NETosis rate was correlated with a broad set of clinical data, such as MPN subtype, mutational status, laboratory variables, history of thrombotic events, and treatment types. Triggered NETosis levels were clearly higher in MPN patients than in healthy donors. Positivity for JAK2 V617F or exon 12 as well as CALR mutations correlate with increased NET formation. However, neither JAK2 allelic burden nor history of thromboembolic complication nor the presence of other risk factors for thrombosis (eg, leukocytosis) were associated with the rate of NETosis. In addition, none of the analyzed laboratory parameters nor the type of treatment significantly impacted the rate of NETosis formation. The biology of MPNs has an impact on NET formation because genetic driver mutations favor induction of NETosis, but this does not seems to translate into important clinical end points such as thromboembolic complications. Therefore, NETosis may play a role in facilitating thrombosis, but it is not a sole causative determinant in MPN-associated thrombophilia.

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The possible role of mutated endothelial cells in myeloproliferative neoplasms

Haematologica ◽

10.3324/haematol.2021.278499 ◽

2021 ◽

Author(s):

Mirko Farina ◽

Domenico Russo ◽

Ronald Hoffman

Keyword(s):

Myeloproliferative Neoplasms ◽

Hematopoietic Cells ◽

Clinical Manifestations ◽

Vascular Complications ◽

Hematologic Malignancies ◽

Driver Mutations ◽

Vascular Events ◽

Hematopoietic Stem ◽

High Incidence

Myeloproliferative neoplasms (MPN) are chronic, clonal hematologic malignancies characterized by myeloproliferation and a high incidence of vascular complications (thrombotic and bleeding). Although MPN-specific driver mutations have been identified, the underlying events that culminate in these clinical manifestations require further clarification. We reviewed the numerous studies performed during the last decade identifying endothelial cell (EC) dysregulation as a factor contributing to MPN disease development. The JAK2V617F MPN mutation and other myeloid-associated mutations have been detected not only in hematopoietic cells but also in EC and their precursors in MPN patients, suggesting a link between mutated EC and the high incidence of vascular events. To date, however, the role of EC in MPN continues to be questioned by some investigators. In order to further clarify the role of EC in MPN, we first describe the experimental strategies used to study EC biology and then analyze the available evidence generated using these assays which implicate mutated EC in MPN-associated abnormalities. Mutated EC have been reported to possess a pro-adhesive phenotype as a result of increased endothelial Pselectin exposure, secondary to degranulation of Weibel-Palade bodies, which is further accentuated by exposure to pro-inflammatory cytokines. Additional evidence indicates that MPN myeloproliferation requires JAK2V617F expression by both hematopoietic stem cells and EC. Furthermore, the reports of JAK2V617F and other myeloid malignancy- associated mutations in both hematopoietic cells and EC in MPN patients support the hypothesis that MPN driver mutations may first appear in a common precursor cell for both EC and hematopoietic cells.

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Predictors of healthcare worker burnout during the COVID-19 pandemic

10.1101/2020.08.26.20182378 ◽

2020 ◽

Author(s):

Amy V Ferry ◽

Ryan Wereski ◽

Fiona E Strachan ◽

Nicholas L Mills

Keyword(s):

Healthcare Worker ◽

Online Survey ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Primary Outcome Measure ◽

General Anxiety ◽

Patient Health ◽

History Of ◽

Anxiety Depression ◽

History Of Depression

Objective We aim to provide a snapshot of the levels of burnout, anxiety, depression and distress among healthcare workers during the COVID-19 pandemic. Design, setting, participants We distributed an online survey via social media in June 2020 that was open to any healthcare worker. The primary outcome measure was symptoms of burnout as measured using the Copenhagen Burnout Inventory (CBI). Secondary outcomes of depression, anxiety and distress as measured using the Patient Health Questionnaire-9, General Anxiety Scale-7, and Impact of Events Scale-Revised were recorded along with subjective measures of stress. Multivariate logistic regression analysis was performed to identify factors associated with burnout, depression, anxiety and distress. Results Of 539 persons responding to the survey, 90% were female, and 26% were aged 41-50 years, 53% were nurses. Participants with moderate-to-severe burnout were younger (49% [206/424] versus 33% [38/115] under 40 years, P=0.004), and more likely to have pre-existing comorbidities (21% versus 12%, P=0.031). They were twice as likely to have been redeployed from their usual role (22% versus 11%; adjusted odds ratio [OR] 2.2, 95% confidence interval [CI] 1.5-3.3, P=0.042), or to work in an area dedicated to COVID-19 patients (50% versus 32%, adjusted OR 1.6, 95% CI 1.4-1.8, P<0.001), and were almost 4-times more likely to have previous depression (24% versus 7%; adjusted OR 3.6, 95% CI 2.2-5.9, P=0.012). A supportive workplace team and male sex protected against burnout reducing the odds by 40% (adjusted OR 0.6, 95% CI 0.5-0.7, P<0.001) and 70% (adjusted OR 0.3, 95% CI 0.2-0.5, P=0.003), respectively. Conclusion Independent predictors of burnout were younger staff, redeployment to a new working area, working with patients with confirmed COVID-19 infection, and being female or having a previous history of depression. Evaluation of existing psychological support interventions is required with targeted approaches to ensure support is available to those most at risk.

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Advanced forms of MPNs are accompanied by chromosomal abnormalities that lead to dysregulation of TP53

Blood Advances ◽

10.1182/bloodadvances.2018024018 ◽

2018 ◽

Vol 2 (24) ◽

pp. 3581-3589 ◽

Cited By ~ 11

Author(s):

Bridget K. Marcellino ◽

Ronald Hoffman ◽

Joseph Tripodi ◽

Min Lu ◽

Heidi Kosiorek ◽

...

Keyword(s):

Disease Progression ◽

Chromosomal Abnormalities ◽

Myeloproliferative Neoplasms ◽

Philadelphia Chromosome ◽

Primary Myelofibrosis ◽

Chromosome 17 ◽

Transcript Levels ◽

History Of ◽

Tumor Protein P53

Abstract The Philadelphia chromosome–negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and the prefibrotic form of primary myelofibrosis (PMF), frequently progress to more overt forms of MF and a type of acute leukemia termed MPN-accelerated phase/blast phase (MPN-AP/BP). Recent evidence indicates that dysregulation of the tumor suppressor tumor protein p53 (TP53) commonly occurs in the MPNs. The proteins MDM2 and MDM4 alter the cellular levels of TP53. We investigated in 1,294 patients whether abnormalities involving chromosomes 1 and 12, which harbor the genes for MDM4 and MDM2, respectively, and chromosome 17, where the gene for TP53 is located, are associated with MPN disease progression. Gain of 1q occurred not only in individuals with MPN-BP but also in patients with PV and ET, who, with further follow-up, eventually evolve to either MF and/or MPN-BP. These gains of 1q were most prevalent in patients with a history of PV and those who possessed the JAK2V617F driver mutation. The gains of 1q were accompanied by increased transcript levels of MDM4. In contrast, 12q chromosomal abnormalities were exclusively detected in patients who presented with MF or MPN-BP, but were not accompanied by further increases in MDM2/MDM4 transcript levels. Furthermore, all patients with a loss of 17p13, which leads to a deletion of TP53, had either MF or MPN-AP/BP. These findings suggest that gain of 1q, as well as deletions of 17p, are associated with perturbations of the TP53 pathway, which contribute to MPN disease progression.

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Magnitude and Determinants of Perinatal Mortality in Southwest Ethiopia

Journal of Pregnancy ◽

10.1155/2020/6859157 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Gurmesa Tura Debelew

Keyword(s):

Perinatal Mortality ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Mortality Data ◽

Skilled Attendant ◽

Southwest Ethiopia ◽

Danger Signs ◽

Pregnancy And Childbirth ◽

History Of ◽

Knowledge Of Danger Signs

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p<0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR=0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR=0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR=0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR=3.38; 95% CI: 1.90, 6.00), twin births (AOR=5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR=3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR=4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications.

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