Diabetes in pregnancy: a population-based study of incidence, referral for care, and perinatal mortality

During 1979 and 1980 in Washington State, 260 infants (live births plus fetal deaths greater than or equal to 20 weeks' gestation) were born to women with preexisting diabetes mellitus, the equivalent to a population-based incidence of 2.1 per 1000 total births. One quarter of these women had non-insulin-dependent diabetes prior to pregnancy. The perinatal mortality rate for all infants of diabetic mothers in this series was 108 per 1000, which was eight times the state perinatal mortality rate. Only 45% of births occurred in the five tertiary centers in the state, whereas 39% occurred in hospitals that had fewer than six deliveries per year complicated by overt diabetes. The mortality rate was slightly, but not significantly, lower among infants born in referral hospitals than among those born in primary-level hospitals. Congenital malformations accounted for 43% of the 28 perinatal deaths, and fetal losses between 20 and 27 weeks' gestation accounted for another 21%. During the 2-year study period there were only three cases in which antepartum care in nonspecialty centers may have contributed to a perinatal loss.     

Outcomes of pregnancies in women with pre-existing type 1 or type 2 diabetes, in an ethnically mixed population

OBJECTIVE: To compare the outcomes of pregnancies in women with pre-existing, type 1 and type 2, diabetes and to examine the influence of ethnicity on these outcomes. DESIGN: Prospective cohort study. SETTING: Large district hospital in Yorkshire with an ethnically mixed population. SAMPLE: Case series of all 202 pregnancies in women with pre-existing diabetes, ending in miscarriage, termination of pregnancy or delivery between January 1994 and December 2002. METHODS: Univariate and multivariate logistic regression analysis comparing outcomes in type of diabetes and in ethnic group. MAIN OUTCOME MEASURES: Fetal loss, perinatal and infant mortality and congenital anomaly. RESULTS: All 14 stillbirths and infant deaths and 13 of the 15 congenital malformations were to Asian women. Analysis within this ethnic group showed a very high rate of adverse birth outcome for type 1 diabetic women and for type 2 diabetic women on insulin before the pregnancy. Total pregnancy loss among type 1 diabetic women was 156 per 1000 and among type 2 diabetic women on insulin was 167 per 1000. Congenital abnormality rates were 156 per 1000 for type 1 diabetic women and 261 per 1000 for type 2 diabetic women on insulin. Asian type 2 diabetic women not on insulin prior to pregnancy had significantly better outcomes: Total pregnancy loss was 123 per 1000 and congenital abnormality rate was 32 per 1000. After adjustment for confounders, including type of diabetes, Asian women had significantly worse outcomes (combined perinatal loss and malformation) than Caucasian women [odds ratio (OR) 4.96, 95% confidence interval (CI) 1.16-21.1]. CONCLUSION: Ethnicity has a significant impact on the outcome of diabetic pregnancies, with worse outcomes for babies born to Asian mothers compared with Caucasian mothers. The use of insulin pre-pregnancy rather than type of diabetes appears to predict adverse outcome.     

Normal perinatal mortality in type 1 diabetes mellitus in a series of 300 consecutive pregnancy outcomes

Reports of outcomes of pregnancy in women with type 1 diabetes have consistently found increased perinatal mortality and morbidity. The primary objective of our study was to compare the perinatal mortality rate in type 1 diabetic pregnancies with that of the general population. The secondary objective was to compare the morbidities in these groups. A series of 247 women with type 1 diabetes had 300 consecutive pregnancy outcomes analyzed over a 10-year period. They were compared with the control population from the same hospital. Perinatal mortality was 6.6/1000 (95% CI, 0-17), which was significantly lower than the control population rate of 31/1000. There was an increased incidence of morbidity including maternal hypertension, cesarean section, preterm delivery, birth injury, large for gestational age infants, admissions to neonatal intensive care, neonatal hypoglycemia, and phototherapy. Pregnancies in type 1 diabetes can be associated with a normal perinatal mortality rate although morbidity remains elevated compared with controls.     

Pregnancy in women with type 1 diabetes: Have the goals of St. Vincent declaration been met concerning foetal and neonatal complications?

Abstract

Objective: In 1989 the St. Vincent declaration set a five-year target for approximating outcomes of pregnancies in women with diabetes to those of the background population. We investigated and quantified the risk of adverse pregnancy outcomes in pregnant women with type 1 diabetes (T1DM) to evaluate if the goals of the 1989 St. Vincent Declaration have been obtained concerning foetal and neonatal complications.

Methods: Twelve population-based studies published within the last 10 years with in total 14?099 women with T1DM and 4?035?373 women from the background population were identified. The prevalence of four foetal and neonatal complications was compared.

Results: In women with T1DM versus the background population, congenital malformations occurred in 5.0% (2.2–9.0) (weighted mean and range) versus 2.1% (1.5–2.9), relative risk (RR)?=?2.4, perinatal mortality in 2.7% (2.0–6.6) versus 0.72% (0.48–0.9), RR?=?3.7, preterm delivery in 25.2% (13.0–41.7) versus 6.0% (4.7–7.1), RR?=?4.2 and delivery of large for gestational infants in 54.2% (45.1–62.5) versus 10.0%, RR?=?4.5. Early pregnancy HbA_1c was positively associated with adverse pregnancy outcomes.

Conclusion: The risk of adverse pregnancy outcomes was two to five times increased in women with T1DM compared with the general population. The goals of the St. Vincent declaration have not been achieved.     

Sickle cell disease in pregnancy: twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia

OBJECTIVE: We compared pregnancy outcomes among women with sickle cell disease with outcomes for African American women without the disease. STUDY DESIGN: We selected 127 deliveries in women with sickle cell disease (hemoglobin SS or hemoglobin SC) that occurred between 1980 and 1999. A control group of 129 deliveries by African American women with normal hemoglobin (hemoglobin AA) was also selected. Evaluated pregnancy outcomes included low birth weight, prematurity, intrauterine growth restriction, antepartum hospital admission, preterm labor or preterm premature rupture of membranes, postpartum infection, preeclampsia, pyelonephritis, intrauterine fetal death, perinatal mortality, and maternal mortality. RESULTS: Compared with deliveries among women with hemoglobin AA, deliveries among women with hemoglobin SS or hemoglobin SC were at increased risk for intrauterine growth restriction, antepartum hospital admission, and postpartum infection. In addition, deliveries among women with Hb SS were more likely to be complicated by low birth weight, prematurity, and preterm labor or preterm premature rupture of membranes when compared with deliveries among women with hemoglobin AA. There were no significant differences among the groups (hemoglobin SS, hemoglobin SC, and hemoglobin AA) in terms of perinatal deaths; there were no maternal deaths in the study population. CONCLUSION: Those caring for women with sickle cell disease should be aware that they are at increased risk for pregnancy complications, although overall pregnancy outcome is favorable.     

Psychiatric illness and adverse pregnancy outcome.

OBJECTIVES: To identify the adverse effect of psychiatric illness during pregnancy on pregnancy outcome. METHODS: A large population-based study of deliveries (1988--2005) was conducted that compared women with and without psychiatric illness. Stratified analysis included multiple logistic regression models. RESULTS: Out of 181,479 deliveries, 607 (0.3%) women reported psychiatric illness: depressive and anxiety disorders (39%), schizophrenia (11%), or other psychiatric illness (50%). The psychiatric patients were significantly older, with higher prevalence of diabetes and hypertensive disorders. Perinatal mortality rate, congenital malformations, low Apgar scores, and low birth weight (<2500 g) were significantly increased. Multivariable logistic regression models determined that psychiatric illness during pregnancy is an independent risk factor for perinatal mortality (odds ratio [OR] 2.4; 95% CI, 1.5-3.7, P<0.001) and congenital malformations (OR 1.4; 95% CI, 1.01-1.9, P=0.03). CONCLUSIONS: Psychiatric illness is an independent risk factor for congenital malformations and perinatal mortality, and prenatal care should be adjusted accordingly.     

Total perinatal wastage. A clarification of priorities

The pregnancy outcome of 16,971 women carrying 17,352 living fetuses after 16 weeks gestation was studied. As well as recording perinatal deaths, all losses before 28 weeks and up to one year after delivery were recorded to give a total perinatal wastage rate of 21.6 per 1000 fetuses alive at 16 weeks compared with a perinatal mortality rate (stillbirths plus early neonatal deaths) of 7.8 per 1000 births. All deaths were then classified according to pathological sub-groups. The concept of auditing perinatal care using perinatal mortality was then compared with that using total perinatal wastage.     

Accidental out-of-hospital delivery as an independent risk factor for perinatal mortality

OBJECTIVE: To determine maternal characteristics and perinatal outcomes of unattended out-of-hospital deliveries. STUDY DESIGN: A population-based study including all singleton deliveries between 1988 and 1999. Maternal characteristics and pregnancy outcomes of accidental out-of-hospital births were compared with those of women who delivered in the hospital. Multiple logistic regression analysis was performed to investigate independent risk factors for out-of-hospital deliveries. Another model was constructed to assess the independent risk of out-of-hospital delivery for perinatal mortality. RESULTS: The incidence of unattended, out-of-hospital deliveries was 2% (2,328/114,938). Multiparity, Bedouin ethnicity and lack of prenatal care were independently associated with out-of-hospital deliveries. Parturients who delivered out of hospital had a significantly lower rate of previous cesarean deliveries. Perinatal mortality was significantly higher among out-of-hospital deliveries, and those newborns were significantly more likely to be small for gestational age as compared to newborns with in-hospital births. In a multivariable model investigating risk factors for perinatal mortality, out-of-hospital delivery was an independent risk factor for perinatal mortality. Other significant risk factors were Bedouin ethnicity and lack of prenatal care. CONCLUSION: Accidental out-of-hospital birth, associated with multiparity, Bedouin ethnicity and lack of prenatal care, is an independent risk factor for perinatal mortality.     

Perinatal mortality and antepartum risk scoring.

A simplified, numerical form for antepartum risk scoring was introduced as a component of the prenatal record for use in all pregancies in a large geographic area under a variety of collection practices. In a population of approximately 1,000,000 with 16,733 deliveries, 19% of the pregnant population scored greater than or equal to 3 and were designated as high risk on the basis of previous pilot studies. This group with high-risk scores had a perinatal mortality rate of 69/1000 compared to the low-risk group with a perinatal mortality of 7/1000 (P = less than 0.0001). The high-risk group accounted for almost 70% of the total perinatal deaths. The implications of being able to predict the statistical likelihood of perinatal deaths are discussed. It is suggested that the risk scoring system has its greatest potential as a screening process and as a method of recording regional statistical trends rather than in dictating the final management of the pregnancy.     

Levels and determinants of perinatal mortality in central Sudan

OBJECTIVES: To determine levels and risk factors for perinatal mortality in Central Sudan. METHODS: Hospital and community based studies were conducted during the period 1989–1990. Of 5328 births registered in the hospital, 197 stillborns and 812 live-born infants were included in a nested case-control study. In the community, a follow-up study was conducted on 1592 midwife-assisted home deliveries. Multivariate logistic regression analysis was used to identify predictors of perinatal mortality and adjusted population attributable risks were estimated to assess the contribution of each factor. RESULTS: The perinatal mortality rate was 85.4/1000 births in the hospital population and 29.4/1000 births in the community population. The major risk factors for perinatal mortality in the hospital and the community studies were similar and modifiable. CONCLUSIONS: To lower perinatal mortality, improvements in maternal nutrition, malaria treatment and control, avoidance of agricultural pesticides during pregnancy, and adequate antenatal and intrapartum care are recommended.     

Outcomes of pregnancies in women with type 1 diabetes in Scotland: a national population-based study

Objective To determine the outcomes of pregnancies in women with pre-existing, type 1 diabetes.
Design Prospective, population-based cohort.
Setting Scotland.
Population All 273 women with type 1 diabetes with a pregnancy ending (in miscarriage, abortion or delivery) during the 12 months (from April 1, 1998 to March 31, 1999).
Methods Pregnancies identified prospectively by clinicians in each hospital; outcome data collected from case records and from Scottish national data sets.
Main outcome measures Perinatal and infant mortality, congenital anomaly and birthweight.
Results Of the 273 pregnancies, 40 (14.7%) ended in miscarriage, 20 (7.3%) in abortion and 213 (78%) in delivery. Three deliveries were twin births, thus 216 babies were born. Stillbirth rate (4/216): 18.5 (95% CI 5.1–46.8) per 1000 total births; perinatal mortality rate (6/216): 27.8 (95% CI 10.2–59.4) per 1000 births. There were 13 verified congenital anomalies (in six abortions and seven live births), anomaly rate: 60 (95% CI 32–101) per 1000 total births. Among 208 singleton, live born infants, the mean birthweight was 3427 g. Standardised birthweight scores, relative to a reference population, showed a unimodal distribution, shifted to the right (mean, 1.57 SD).
Conclusions In an unselected population, adverse outcomes remain more common among the infants of mothers with type 1 diabetes than in the general population. The targets of the St Vincent Declaration of 1989 have not been met. Improvements may be gained by increases in provision of prepregnancy care and in the proportion of pregnancies that are planned. However, further research is needed to clarify the root causes of adverse outcomes in the pregnancies of women with diabetes.     

Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes

Objective  To describe recent trends in prevalence, outcomes and indicators of care for women with pre-existing type I or type II diabetes.
Design  Regional population-based survey.
Setting  All maternity units in the North of England.
Population  A total of 1258 pregnancies in women with pre-existing diabetes delivered between 1996 and 2004.
Methods  Data from the Northern Diabetic Pregnancy Survey. Outcome of pregnancy cross-validated with the Northern Congenital Abnormality Survey and the Northern Perinatal Mortality Survey.
Main outcome measures  Perinatal mortality, congenital anomaly and total adverse perinatal outcome (perinatal mortality and live births with congenital anomaly).
Results  The prevalence of pregestational diabetes increased from 3.1 per 1000 births in 1996–98 to 4.7 per 1000 in 2002–04 (test for linear trend, P < 0.0001), driven mainly by a sharp increase in type II diabetes. Perinatal mortality declined from 48 per 1000 births in 1996–98 to 23 per 1000 in 2002–04 ( P = 0.064). There was a significant reduction in total adverse perinatal outcome rate ( P = 0.0194) from 142 per 1000 in 1996–98 to 86 per 1000 in 2002–04. There were substantial improvements in indicators of care before and during pregnancy and in glycaemic control throughout pregnancy, but indicators of preconceptual care, such as use of folic acid, remained disappointing.
Conclusion  We observed improvements in pregnancy care and outcomes for women with diabetes in a region with an established audit and feedback cycle. There remains considerable scope for further improvement, particularly in periconceptual glycaemic control. The rising prevalence of type II diabetes presents a challenge to further improvement.     

Pregnancy outcome in women with pruritus gravidarum

OBJECTIVE: To investigate obstetric risk factors and pregnancy outcome in women with pruritus gravidarum who delivered during a 15-year period. METHODS: A population-based study comparing all pregnancies in women with and without pruritus gravidarum delivered between 1988 and 2002 was conducted. A multivariable logistic regression model was constructed in order to find independent risk factors associated with pruritus gravidarum. RESULTS: During the study period there were 159,197 deliveries, of which 376 (0.2%) occurred in patients with pruritus gravidarum. Using a multivariable analysis, the following conditions were found to be significantly associated with pruritus gravidarum: twin pregnancies, fertility treatments, diabetes mellitus and nulliparity. No significant differences were noted between the groups regarding perinatal outcomes, such as birth weight, low Apgar scores or perinatal mortality. Pruritus gravidarum was associated with higher rates of labor induction, and accordingly those fetuses were more likely to be delivered by cesarean delivery. CONCLUSION: Pruritus gravidarum, associated with multiple gestations, fertility treatments, diabetes mellitus and nulliparity, is not associated with adverse perinatal outcomes. However, there are higher rates of labor induction and cesarean delivery.     

12. Maternal mortality

Summary. There were 238 maternal deaths. Five deaths occurred after delivery among booked women who had no antenatal complications (0.4 deaths per 1000 deliveries); 14 deaths were among booked women who developed complications during pregnancy (3.7 per 1000); and 219 deaths were in the emergency admissions (28.6 per 1000). Bacterial infections, eclampsia, anaemia, haemorrhage and disproportion together with its consequences, were the leading causes. The principal high-risk factors were lack of antenatal care, early teenage pregnancy, high parity and high child mortality rate from previous births. In the emergency admissions the operative delivery rate was 25% in the women who survived and 49% in those who died. In severe eclampsia and in neglected obstructed labour, a high haematocrit (≥0.45) and, to a lesser extent, a low haematocrit (≥0.14) were of ominous significance, mortality rate being 25–60% in such cases compared with <10% in most other obstetric complications. Measures to reduce maternal mortality should aim to lower the proportion of high-risk women (40% at present) and also make it possible for operative deliveries, especially caesarean section, to be performed as soon as the need arises.     

Complications in women with pre-gestational diabetes and glycemic control estimated by general glycemic control index (GCI)

Pre-gestational diabetes is a serious risk factor in pregnancy and delivery. Complications during pregnancy in this group of women depend on the glycemic control and on the clinical course of diabetes. MATERIAL AND METHOD: On the period of 1991-2001, 186 pregnant women with diabetes diagnosed before pregnancy were hospitalized in Ob/Gyn Department, Medical University of Bydgoszcz. In this study, 178 deliveries and 8 abortions were analyzed. The selected glycemic control indices-GCI (General Control Index) were analyzed in diabetic women with non-complicated pregnancies and in women with complications during pregnancy. RESULTS: The most frequent complications during pregnancy were premature delivery (32%) and hypertension (13%). Deliveries before the end of 37 week of pregnancy were more frequent in women with more complicated diabetes. Glycemic control in diabetic mothers who delivered prematurely was worse then in women with normal outcome. An increased rate of congenital malformations (6.7%) in the newborns were noted in women with very poor glycemic control in the first months of pregnancy. Perinatal mortality was higher than that of the non-diabetic population, and was at the level of 3.4%. CONCLUSIONS: 1. Glycemic control in women with diabetes diagnosed before pregnancy who delivered prematurely, was worse then in women who delivered at the term. 2. High rate of the congenital malformations (6.7%) in the newborns was observed in patients with very poor glycemic control in the first months of pregnancy.     

Obstetrics and perinatal outcome of pregnancies after the age of 45.

We set out to describe the maternal and perinatal outcome of pregnancies in women >/= 45 years old at the time of delivery. A retrospective review of hospital deliveries after 28 weeks of pregnancy was performed at the Princess Badeea Teaching Hospital (PBTH) in North Jordan for patients delivered between 1 April 1994 and 31 December 1997. During the study period, there were 114 women aged >/= 45 years at delivery at the PBTH. The incidence was 3.3 per 1000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45-46 years old. Maternal ages were 45 (n =64), 46 (n =29), 47 (n =9), 48 (n =8), 49 (n =2) and 50 (n =2) years. Median gravidity was 10, median parity was seven. Forty-four (38.6%) patients had obstetric complications. The most frequent complication was diabetes mellitus (9.6%), followed by hypertension (4.4%). Caesarean section was performed in 32.5%. There were nine stillbirths and four early neonatal deaths, the perinatal mortality rate was 114/1000 births. We conclude that women >/= 45 years old at delivery have high perinatal mortality rate and we also noted a higher incidence of placental abruption, placenta praevia and caesarean delivery, compared with a younger group of women.     

Pregnancy in sickle cell disease in Bahrain.

OBJECTIVE: To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls. DESIGN: A case-control study. SETTING: Ministry of Health hospitals in Bahrain. SUBJECTS: 147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity. MAIN OUTCOME MEASURES: The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statistics in the index and control women. RESULTS: Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anaemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity. CONCLUSION: Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.     

An increased risk for non allo-immunization related intrauterine fetal death in RhD-negative patients.

OBJECTIVE: To investigate immediate perinatal outcome of RhD-negative patients carrying RhD-positive fetuses who received antenatal Rh immunoglobulin for the prevention of RhD-mediated hemolytic disease of the fetus and newborn. METHODS: A retrospective population-based analysis was conducted comparing pregnancies of all RhD-negative women who received antenatal Rh immunoglobulin prophylaxis (anti-D), to RhD-positive parturients, during the years 1988-2003. All women were RhD-negative without evidence of RhD sensitization. Patients received anti-D during the 28-30th week of pregnancy, and an additional dosage within 72 hours following delivery after confirmation of the newborn's RhD status. RESULTS: Of 145,437 deliveries during the study period, 6.8% were of RhD-negative women (n = 9961). Perinatal mortality rate was significantly higher among the RhD-negative women who received antenatal prophylaxis rhesus immunoglobulin as compared with the controls (17/1000 vs. 12/1000, OR = 1.3, 95%CI 1.2-1.6; p < 0.001). This higher mortality rate was related to a higher rate of intrauterine fetal demise (IUFD) (10/1000 vs. 6/1000, OR = 1.5, 95%CI 1.2-1.9; p < 0.001). The association remained significant after controlling for RhD isoimmunization leading to hydrops fetalis, using the Mantel-Haenszel technique (weighted OR = 1.3; 95% CI 1.1-1.5; p = 0.001). The rate of RhD isoimmunization was 0.6% (n = 58). Using a multivariable analysis with IUFD as the outcome variable, controlling for known confounders for fetal demise, RhD-negative status was an independent risk factor for IUFD. CONCLUSION: RhD-negative women carrying RhD-positive newborns are at an increased risk for IUFD despite Rh immunoprophylaxis.     

A 10-year population-based study of uterine rupture

OBJECTIVE: To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province. METHODS: Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10-year period 1988-1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail. RESULTS: Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence). Thirty-six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical. Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery. Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000. There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P =.025). Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5-minute Apgar scores (P <.001) and asphyxia, needing ventilation for more than 1 minute (P <.01). CONCLUSION: In 92% of cases, uterine rupture was associated with previous cesarean delivery. Uterine dehiscence was associated with minimal maternal and perinatal morbidity. In contrast, complete uterine rupture was associated with significantly more maternal blood transfusion and neonatal asphyxia.     

Determinants of perinatal mortality in Nigeria

Objective

To determine risk factors for perinatal mortality among hospital-based deliveries in Nigeria.

Methods

The WHO Global Maternal and Perinatal Health Survey was implemented in Nigeria as a first step in establishing a global system for monitoring maternal and perinatal health. Twenty-one health facilities with more than 1000 deliveries annually were selected by a stratified multistage cluster sampling strategy. Information was recorded on all women who delivered and their neonates within a 3-month period.

Results

Overall, there were 9208 deliveries, comprising 8526 live births, 369 fresh stillbirths, 282 macerated stillbirths, 70 early neonatal deaths, and 721 perinatal deaths. The stillbirth and perinatal mortality rates were, respectively, 71 and 78 per 1000 deliveries; the early neonatal death rate was 8 per 1000 live births. Approximately 10% of all newborns weighed less than 2500 g, and 12.3% were born at less than 37 weeks of gestation. Predictors of perinatal mortality were mother's age, lack of prenatal care, unbooked status, prematurity, and birth asphyxia.

Conclusion

The perinatal mortality rate remains unacceptably high in Nigeria. Fresh stillbirth accounted for most perinatal deaths. Interventions to improve the utilization and quality of prenatal care, in addition to the quality of intrapartum care, would considerably reduce perinatal death.