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

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

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.

Analysis of factors associated with early neonatal deaths through linkage between SIM and SINASC, in Sergipe, Brazil

In Brazil, more than 70% of neonatal deaths are concentrated in the early neonatal period, with about 41.2% of them occurring in the first 24 hours of life. Thus, the objective of this study was to carry out an analysis of factors associated with early neonatal deaths that occurred in Sergipe, Brazil, through the linkage of records in the information systems: Live Birth Information System (SINASC) and Mortality Information System (SIM). This study was carried out in Sergipe, Brazil, in which an analysis was made of secondary data on children born and early neonatal deaths in Sergipe between 2006 and 2019 registered in the SINASC and in the SIM. A linkage was carried out between the databases, identifying 484,629 live births, 480,784 survivors and 3,845 who died with less than 7 days of life, with a low percentage of ignored data or absent. Maternal age was similar between groups. However, the newborns who died had lower weight, gestational age and Apgar in the first and fifth minutes than the survivor group. Regarding the newborn, there were more deaths in males and in congenital malformations. As for information about the mother and pregnancy, there were more deaths in single women, multiple pregnancies, lower gestational ages and vaginal delivery. There was an association between neonatal deaths and lower Apgar in the first and fifth minutes, lower weights, lower gestational ages, male gender, congenital malformations, women with multiple pregnancies, vaginal births and single mothers.

Linking a European cohort of children born with congenital anomalies to vital statistics and mortality records: A EUROlinkCAT study

EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine if reliable information on the survival of children born with a major CA between 1995 and 2014 can be obtained through linkage to national vital statistics or mortality records. Live birth children with a CA could be linked using personal identifiers to either their national vital statistics (including birth records, death records, hospital records) or to mortality records only, depending on the data available within each region. In total, 18 of 21 registries with data on 192,862 children born with congenital anomalies participated in the study. One registry was unable to get ethical approval to participate and linkage was not possible for two registries due to local reasons. Eleven registries linked to vital statistics and seven registries linked to mortality records only; one of the latter only had identification numbers for 78% of cases, hence it was excluded from further analysis. For registries linking to vital statistics: six linked over 95% of their cases for all years and five were unable to link at least 85% of all live born CA children in the earlier years of the study. No estimate of linkage success could be calculated for registries linking to mortality records. Irrespective of linkage method, deaths that occurred during the first week of life were over three times less likely to be linked compared to deaths occurring after the first week of life. Linkage to vital statistics can provide accurate estimates of survival of children with CAs in some European countries. Bias arises when linkage is not successful, as early neonatal deaths were less likely to be linked. Linkage to mortality records only cannot be recommended, as linkage quality, and hence bias, cannot be assessed.

BOH (Bad Obstetric History) – An Ayurvedic Perspective

Pregnancy is a crucial event in life that requires considerable physiological & psychological adjustment by the mother; by accepting which she starts an incredible journey of life. Rather the pregnancy loss is a frustrating & challenging problem for the couple as well as for obstetrician. It is associated with guilt, embarrassment and depressive states especially in cases where patient conceives with added concerns of primary or secondary infertility due to various causes. Such patient presents with bad obstetric history, this needs detailed consultation & proper line of treatment. In Ayurveda Putraghni Yonivyapad is described where repeated abortions or the early neonatal deaths are explained which are due to Artava Dosha, Rakta Dosha, Raktastrava and Raktakshaya. When we came across with descriptions given by different Acharyas we come to know that these all points came under the Bad Obstetric History described in modern science. As we all know that Ayurveda is a Science of life the management of Sadhya Vyadhi is explained in it, by following line of treatment through Ayurveda we can minimize the adverse outcome in BOH.

Differences in Postmortem Investigation Following Perinatal Death

Objective The study aimed to describe the postmortem investigation patterns for perinatal deaths and compare the degree of investigation between stillbirths and early neonatal deaths. Study Design We conducted a single-center retrospective review of all perinatal deaths from 2011 to 2017. Perinatal death was defined as intrauterine fetal death at ≥20 weeks' gestation, plus neonatal deaths within the first 7 days of life. Rates of postmortem investigation were compared. Results There were 97 perinatal deaths, with 54 stillbirths (56%) and 43 neonatal deaths (44%). Stillbirths were significantly more likely to receive autopsy (p = 0.013) and postmortem genetic testing (p = 0.0004) when compared with neonatal deaths. Maternal testing was also more likely in stillbirths than neonatal deaths. A total of 32 deaths (33%) had no postmortem evaluation beyond placental pathology. Conclusion Investigation following perinatal death is more likely in stillbirths than neonatal deaths. Methods to improve postmortem investigation following perinatal death are needed, particularly for neonatal deaths. Key Points

The impact of implementing the 2016 WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience on perinatal deaths: an interrupted time-series analysis in Mpumalanga province, South Africa

ObjectivesTo investigate if the implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience reduced perinatal mortality in a South African province. The recommendations were implemented which included increasing the number of contacts and also the content of the contacts.MethodsRetrospective interrupted time-series analysis was conducted for all women accessing a minimum of one antenatal care contact from April 2014 to September 2019 in Mpumalanga province, South Africa. Retrospective interrupted time-series analysis of province level perinatal mortality and birth data comparing the pre-implementation period (April 2014–March 2017) and post-implementation period (April 2018–September 2019). The main outcome measure was unadjusted prevalence ratio (PR) for perinatal deaths before and after implementation; interrupted time-series analyses for trends in perinatal mortality before and after implementation; stillbirth risk by gestational age; primary cause of deaths (and maternal condition) before and after implementation.ResultsOverall, there was a 5.8% absolute decrease in stillbirths after implementation of the recommendations, however this was not statistically significant (PR 0.95, 95% CI 0.90% to 1.05%; p=0.073). Fresh stillbirths decreased by 16.6% (PR 0.86, 95% CI 0.77% to 0.95%; p=0.003) while macerated stillbirths (p=0.899) and early neonatal deaths remained unchanged (p=0.499). When stratified by weight fresh stillbirths >2500 g decreased by 17.2% (PR 0.81, 95% CI 0.70% to 0.94%; p=0.007) and early neonatal deaths decreased by 12.8% (PR 0.88, 95% CI 0.77% to 0.99%; p=0.041). The interrupted time-series analysis confirmed a trend for decreasing stillbirths at 0.09/1000 births per month (−0.09, 95% CI −1.18 to 0.01; p=0.059), early neonatal deaths (−0.09, 95% CI −0.14 to 0.04; p=<0.001) and perinatal mortality (−1.18, 95% CI −0.27 to −0.09; p<0.001) in the post-implementation period. A decrease in stillbirths, early neonatal deaths or perinatal mortality was not observed in the pre-implementation period. During the period when additional antenatal care contacts were implemented (34–38 weeks), there was a decrease in stillbirths of 18.4% (risk ratio (RR) 0.82, 95% CI 0.73% to 0.91%, p=0.0003). In hypertensive disorders of pregnancy, the risk of stillbirth decreased in the post-period by 15.1% (RR 0.85; 95% CI 0.76% to 0.94%; p=0.002).ConclusionThe implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience may be an effective public health strategy to reduce stillbirths in South African provinces.

Are infant mortality rates increasing in England? The effect of extreme prematurity and early neonatal deaths

Background Infant mortality has been rising in England since 2014. We examined potential drivers of these trends. Methods We used aggregate data on all live births, stillbirths and linked infant deaths in England in 2006–2016 from the Office for National Statistics. We compared trends in infant mortality rates overall, excluding births at &lt;24 weeks of gestation, by quintile of SES and gestational age. Results Infant mortality decreased from 4.78 deaths/1000 live births in 2006 to 3.54/1000 in 2014 (annual decrease of 0.15/1000) and increased to 3.67/1000 in 2016 (annual increase of 0.07/1000). This rise was driven by increases in deaths at 0–6 days of life. After excluding infants born at &lt;24 weeks of gestation, infant mortality continued to decrease after 2014. The risk of infant death was 94% higher in the most versus least deprived SES quintile, which reduced to a 55% higher risk after adjusting for gestational age. Conclusions The observed increase in infant mortality rates since 2014 is wholly explained by an increasing number of deaths at 0–6 days of age among babies born at &lt;24 weeks of gestation. Policies focused on improving maternal health to reduce preterm birth could substantially reduce the socio-economic gap in infant survival.