Perinatal Death Surveillance and Response: A Secondary Analysis of Nepal’s Efforts

This paper presents Nepal’s experience regarding perinatal death surveillance and the country’s response in reducing preventable perinatal deaths. In developing this paper, evidence of perinatal mortality in Nepal is brought from secondary sources, mainly the assessment report of Maternal and Perinatal Death Surveillance and Response (MPDSR) system. As of 2019, this initiative has been implemented in 77 hospitals across Nepal. Challenges and barriers in implementing the MPDSR system need to be brought to attention, as the system is being scaled up to 110 hospitals. Data from the Perinatal Death Review revealed that 72% of the maternal deaths occurred during the post-partum period, due to (i) post-partum haemorrhage, (ii) hypertensive disorder, (iii) pregnancy-related infections, and (iv) non-obstetric causes. In 70% of the cases such deaths could have been prevented. Majority of perinatal deaths, at 71%, were stillbirths, mainly due to low child weight of less than 2500 grams. In conclusion, there is urgent need for the national guidelines for MPDSR system to be amended, additional and continued training provision to the health workforce, improvement in the coordination and feedback mechanism, and strengthening of the information management system. Key words: MPDSR system; Perinatal Death Review; Nepal; Perinatal Mortality; Stillbirth

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Perinatal Mortality Review in a Tertiary Care Hospital: Way Forward to Address SDG Health Goal 3

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v18i1.21738 ◽

2019 ◽

Vol 18 (1) ◽

pp. 69-74

Author(s):

Manisha Bajracharya ◽

Ang Tshering Sherpa ◽

Ajay Dhakal ◽

Sunita Bhandari ◽

Heera Tuladhar ◽

...

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Congenital Anomalies ◽

Perinatal Death ◽

Tertiary Care ◽

Well Being ◽

Hypertensive Disorder ◽

Care Hospital ◽

Perinatal Deaths ◽

Perinatal Mortality Rate

Introduction: Sustainable development goal 3 targets at ensuring healthy lives and promoting well-being for all at all ages. One of the component for achievement of this goal is improvement of maternal and child health; the indicators of which is perinatal mortality rate. The aim of this study was to evaluate the cause of perinatal death in a tertiary care medical centre, which may help to reduce the incidence of perinatal death and improve the quality of care. Methods: A prospective study was done over a period of one year from April 2016 to March 2017. Causes of perinatal deaths based on PSANZ classification were recorded along with patients demographics and also avoidable factors were evaluated. Results: Out of total 1275 deliveries, there were 21 perinatal deaths including three intrauterine foetal deaths, one still birth and seven early neonatal deaths. The perinatal mortality rate was 16.27 per 1000 birth. Majority of perinatal deaths (19%) occurred due to congenital anomalies followed by (14%) hypertensive disorder in pregnancy, intrapartum hypoxia (14%), unexplained causes (14%), 9.5% cord prolapse, antepartum haemorrhage (9.5%), 5% due to intrauterine growth restriction, gestational diabetes mellitus or preterm labour. Most of the mothers whose baby had perinatal deaths had ANC outside. Most of the deaths occurred in between gestational age of 37 to 41 weeks. Perinatal mortality was more in multigravida. Delay to seek health care and inadequate antenatal checkups were the most common avoidable factors. Conclusions: Congenital anomalies and hypertensive disorders during pregnancy were the most common causes of perinatal death. Delay in health seeking behaviour was the most common avoidable factors for perinatal death. We recommend early identification of high risk pregnancy through proper antenatal screening, educating pregnant women to identify danger signs of pregnancy, creating public awareness about importance of antenatal checkups, vigilant labour monitoring for foetal distress, to reduce some categories of deaths.

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Characteristics overview of mother with perinatal death at Dr. Soetomo Hospital in 2015

Majalah Obstetri & Ginekologi ◽

10.20473/mog.v24i3.4575 ◽

2017 ◽

Vol 24 (3) ◽

pp. 105

Author(s):

Yulisa Haslinda ◽

Budi Prasetyo

Keyword(s):

Birth Weight ◽

Perinatal Mortality ◽

Gestational Age ◽

Pregnancy Complications ◽

Maternal Age ◽

Perinatal Death ◽

Descriptive Study ◽

Perinatal Deaths ◽

Maternal Characteristic ◽

Characteristic Features

Objectives: to determine the frequency distribution of perinatal mortality and maternal characteristic features in terms of age, parity, gestational age and pregnancy complications in Dr.Soetomo Hospital Surabaya in 2015. Materials and Methods: A descriptive study conducted by collecting data on patients who experienced perinatal mortality of infants born from January to December 2015 in Dr. Soetomo, Hospital Surabaya. Samples were collected using total sampling. The samples must meet the following criteria: mothers of infants with perinatal mortality in Dr. Soetomo Hospital, Surabaya, from January to December 2015.Results: There were 206 perinatal deaths out of 1018 births in Dr. Soetomo during 2015, of which 58% was live birth and 42% was stillbirth. Most of perinatal mortality found in the preterm gestational age as much as 78%, and gestational age 28-<37 weeks (58%). Most of perinatal mortality occured in infants with less than 1500 grams birth weight, which was as much as 53% of all perinatal deaths and infant whose birth weight from1500 to 2500 grams was about 29%. Most perinatal mortality found in multigravida (54%) and in infants whose mothers experienced preeclampsia in pregnancy complications (35%), followed by infant mortality in women with non-obstetric complications (23%).Conclusion: Perinatal mortality in Dr. Soetomo Hospital was mostly found in multigravida mothers, 16-35 years old maternal age, 28-37 weeks gestational age and those with complications of preeclampsia.

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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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A qualitative perinatal audit at a rural health facility in Eldoret, Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20200413 ◽

2020 ◽

Vol 7 (2) ◽

pp. 449

Author(s):

Kimbley Omwodo

Keyword(s):

Rural Health ◽

Perinatal Mortality ◽

Health Facility ◽

Perinatal Death ◽

Gestational Hypertension ◽

Medical Condition ◽

World Health ◽

Maternal Condition ◽

Perinatal Deaths ◽

Perinatal Audit

Background: Objectives of the study were to ascertain the pattern of occurrence of perinatal mortality by applying the World Health Organization (WHO), International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period, ICD perinatal mortality (ICD-PM), following the introduction of a qualitative perinatal audit process at a rural health facility in Kenya.Methods: A single centre retrospective analysis demonstrating the application of the WHO, ICD-PM. Data pertaining to perinatal deaths for the period from 1st May 2017 to 31st August 2018 was obtained from Plateau Mission Hospital perinatal audit records.Results: There were 22 perinatal deaths during the study period, 17 were included in the study. The overall perinatal death rate was 11 per 1000 births. Antepartum deaths were as a consequence of fetal growth related problems (33.3%), infection (33.3%) or unexplained (33.3%) with pregnancy-related hypertensive disorders (gestational hypertension, pre-eclampsia and eclampsia) being the most frequent medical condition associated with the mortalities. Neonatal deaths (47.1%) were the most frequent in the study and were a consequence of low birth weight and prematurity (25.0%), Convulsions and disorders of cerebral status (25.0%). The maternal condition in most of these cases being complications of placenta, cord and membranes. Acute intrapartum events and were least in this setting accounting for 17.4% of deaths.Conclusions: The ICD-PM is generalizable and its use in perinatal death classification emphasises focus on both mother and baby. Our study showed the majority of perinatal deaths occurred in the early neonatal period & affected mostly preterm infants.

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Study of obstetric factors in perinatal morbidity and mortality at a tertiary centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175845 ◽

2017 ◽

Vol 7 (1) ◽

pp. 198

Author(s):

Sanjaykumar G. Tambe ◽

Yogesh A. Thawal ◽

Tania Anand ◽

Dipak Suresh Kolate

Keyword(s):

Perinatal Mortality ◽

Health Care Providers ◽

Perinatal Death ◽

Golden Rule ◽

Vital Statistics ◽

Safe Motherhood ◽

Care Providers ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Tertiary Center

Background: Safe motherhood and child survival have always been a concern for the policymakers but perinatal mortality, especially stillbirths, have not received due attention. There are 5.9 million perinatal deaths worldwide, almost all of which occur in developing countries. Stillbirths account for over half of all perinatal deaths. This study was aimed to determine perinatal mortality rate and related obstetrics risk factors. Perinatal mortality is only a tip of the iceberg, morbidity being much higher. Vital statistics obtained through this study may serve an important source of information to guide the public health policy makers and health care providers in future.Methods: Present observational study was undertaken in a tertiary center to look into various maternal factors and possible cause of perinatal death. All perinatal deaths including stillbirths (SBs) and early neonatal deaths (ENNDs) within 0-7 days of birth after 28 weeks of gestation were analysed. The data was collected through a pre-designed proforma.Results: Perinatal mortality is 66.27/1000 births in our centre, where 37% were intrauterine deaths, 34% were neonatal deaths and 29% were still births. Preterm, pregnancy induced hypertension; abruptio placentae remain the most important factors for perinatal loss.Conclusions: One of the reasons for high perinatal mortality in tertiary centres is because of poor antenatal care at peripheral centres and late referrals. Early detection of obstetric complications and aggressive treatment is one of golden rule to reduce perinatal loss.

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Effects of maternity waiting homes on perinatal deaths in an Ethiopian hospital. A case-control study

European Journal of Public Health ◽

10.1093/eurpub/ckz185.435 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

T Dalla Zuanna ◽

M Fonzo ◽

M Sperotto ◽

C Resti ◽

A Tsegaye ◽

...

Keyword(s):

Perinatal Mortality ◽

Case Control Study ◽

Perinatal Death ◽

Case Control ◽

Medical Facility ◽

Final Model ◽

Perinatal Deaths ◽

Rural Ethiopia ◽

Maternity Waiting Home ◽

Control Study

Abstract Background A Maternity Waiting Home (MWH) is a residential facility located near a medical facility, where women with high risk pregnancies can await and be transferred to the medical facility shortly before delivery or earlier if a complication arise. MWH are widespread in the developing countries, to reduce the long distances to reach health facilities. The aim of this study was to investigate whether MWH was an effective strategy in reducing perinatal deaths at Wolisso Hospital in Ethiopia, from 2014 to 2017. This hospital is supported by the Italian NGO Doctors With Africa CUAMM, with a strong commitment to reduce maternal and child mortality. Methods Through a case-control study, we compared perinatal mortality among women admitted via MWH and women admitted directly to the hospital. Cases were mothers who experienced at least a perinatal death before discharge. For each case, two mothers who gave birth to one or more babies alive until discharge were selected as controls. 3 groups of confounding variables were considered: maternal conditions or related to the current pregnancy, variables related to the delivery and neonatal characteristics. A regression model was built adjusting for each group. Statistically significant variables were combined in a final model. Results 1175 cases and 2350 controls were included. Women admitted through MWH showed a OR 0.49 (95%CI:0.33-0.71; p < 0.000) for perinatal mortality when adjusted for the maternal/current pregnancy conditions, and a OR 0.60 (95%CI:0.40-0.90, p = 0.013) when adjusted for the delivery variables. In the final model the risk of perinatal mortality for women admitted to MWH was 54% less than those admitted directly to the hospital (OR = 0.46, 95%CI:0.30-0.70; p < 0.000). Conclusions Our results show a more than halved risk of perinatal death cases for women admitted to the hospital through a MWH in rural Ethiopia, and support the policy implemented by the government in building such structures nearby each hospital. Key messages Maternity Waiting Home is a structure near a health facility, where pregnant women at risk wait for their delivery. MWH is an easy and effective tool to reduce perinatal deaths in rural Ethiopia.

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Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2014-005652 ◽

2014 ◽

Vol 4 (10) ◽

pp. e005652 ◽

Cited By ~ 21

Author(s):

Martine Eskes ◽

Adja J M Waelput ◽

Jan Jaap H M Erwich ◽

Hens A A Brouwers ◽

Anita C J Ravelli ◽

...

Keyword(s):

Cohort Study ◽

The Netherlands ◽

Perinatal Mortality ◽

Perinatal Death ◽

Perinatal Care ◽

Internal Audit ◽

Population Based ◽

Perinatal Deaths ◽

Organisation Of Care ◽

Perinatal Audit

ObjectiveTo assess the implementation and first results of a term perinatal internal audit by a standardised method.DesignPopulation-based cohort study.SettingAll 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG).PopulationThe population consisted of 943 registered term perinatal deaths occurring in 2010–2012 with detailed information, including 707 cases with completed audit results.Main outcome measuresParticipation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour.ResultsAfter the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001).ConclusionsThe perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality.

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Assisted Reproductive Technology and Perinatal Mortality: Selected States (2006–2011)

American Journal of Perinatology ◽

10.1055/s-0041-1732451 ◽

2021 ◽

Author(s):

Jeani Chang ◽

Yujia Zhang ◽

Sheree L. Boulet ◽

Sara B. Crawford ◽

Glenn E. Copeland ◽

...

Keyword(s):

Assisted Reproductive Technology ◽

Perinatal Mortality ◽

Health Care Providers ◽

Perinatal Death ◽

Mortality Rates ◽

Reproductive Technology ◽

Care Providers ◽

Perinatal Deaths ◽

Adjusted Risk ◽

Adjusted Risk Ratio

Objective This study aimed to compare trends and characteristics of assisted reproductive technology (ART) and non-ART perinatal deaths and to evaluate the association of perinatal mortality and method of conception (ART vs. non-ART) among ART and non-ART deliveries in Florida, Massachusetts, and Michigan from 2006 to 2011. Study Design Retrospective cohort study using linked ART surveillance and vital records data from Florida, Massachusetts, and Michigan. Results During 2006 to 2011, a total of 570 ART-conceived perinatal deaths and 25,158 non-ART conceived perinatal deaths were identified from the participating states. Overall, ART perinatal mortality rates were lower than non-ART perinatal mortality rates for both singletons (7.0/1,000 births vs. 10.2/1,000 births) and multiples (22.8/1,000 births vs. 41.2/1,000 births). At <28 weeks of gestation, the risk of perinatal death among ART singletons was significantly lower than non-ART singletons (adjusted risk ratio [aRR] = 0.46, 95% confidence interval [CI]: 0.26–0.85). Similar results were observed among multiples at <28 weeks of gestation (aRR = 0.64, 95% CI: 0.45–0.89). Conclusion Our findings suggest that ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation, which may be explained by earlier detection and management of fetal and maternal conditions among ART-conceived pregnancies. These findings provide valuable information for health care providers, including infertility specialists, obstetricians, and pediatricians when counseling ART users on risk of treatment. Key Points

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Factors Associated with Perinatal Mortality: A Descriptive Observational Study

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1060 ◽

2010 ◽

Vol 2 (1) ◽

pp. 49-51

Author(s):

MB Bellad ◽

K Srividhya ◽

Kangle Ranjit ◽

SM Dhaded

Keyword(s):

Observational Study ◽

Perinatal Mortality ◽

Perinatal Death ◽

Perinatal Deaths ◽

Factors Associated ◽

Medical College ◽

Hospital Referral ◽

Common Causes ◽

The Common ◽

Jawaharlal Nehru

ABSTRACT Objective The objective of this study was to find out various causes of perinatal mortality and the factors associated with perinatal death. Methods A descriptive observational study done in a teaching hospital (Referral hospital at district) attached to Jawaharlal Nehru Medical College, Belgaum. All perinatal deaths during the period between December 2007 to May 2009 were included in the study. Results There were 3904 deliveries and 193 perinatal deaths during the study period. Perinatal mortality rate (PNMR) was 49.4/1000 births. The stillbirth rate was 43/1000 births. Antepartum hemorrhage and severe pre-eclampsia were the common causes of perinatal deaths. Conclusion Antepartum hemorrhage and pregnancy induced hypertension are leading causes of perinatal deaths. Majority of these complications occur in the later part of pregnancy increased vigilance during antenatal care can reduce these deaths.

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