Birthweight specific perinatal mortality in Greece

Data from the Greek Perinatal Study in April 1983 revealed an excessively high perinatal mortality rate of 21.6 per 1,000 total births among singletons despite a low birthweight rate of only 4.5%. Comparison of perinatal mortality rates with Danish mortality rates in 1983, revealed the Greek rates to be three times higher than those in Denmark. When divided by time of death, the Greek stillbirth rates were two times higher and the early neonatal mortality rates were four times higher than the corresponding Danish rates. Subdivision of the Greek perinatal deaths using the Wigglesworth classification showed that the biggest group (40%) consisted of deaths associated with intrapartum asphyxia. The incidence of such deaths was 10 times higher than that found in Denmark. We conclude that in reducing the excessively high perinatal mortality rate in Greece special attention should be made to improve intrapartum and resuscitation techniques.     

Causes of Perinatal Death at a Saudi Maternity Hospital

ABSTRACT. The time, cause and avoidahility of perinatal deaths were analyzed in infants who were delivered in the main Maternity hospital in Riyadh and who represented a large proportion of all births in the city. The crude perinatal mortality rate was 39.8 per 1000 births. Of all deaths 53 percent occurred either intrapartum or within 24 hours of birth. The mortality rate in this time period was 9 times higher, and the intrapartum mortality rate 16 times higher than the corresponding Swedish rates. The causes of death were classified according to Wigglesworth. Of all deaths, 37 percent were due to asphyxial conditions in labor, 32 percent to conditions associated with preterm birth, and 17 percent to malformations. The perinatal mortality rates caused by asphyxia, preterm birth and malformations were 14.7, 12.6 and 6.7 per 1000 births, respectively. 75 percent of infants who died from asphyxia were born at term, and nearly half of the preterm deaths were associated with severe asphyxia at birth. Avoidable factors were found in 74 percent of the deaths. The high rate of asphyxia indicated deficiences in the obstetric management and a high priority should be given to the strengthening of the obstetric service.     

Risk factors for perinatal deaths in Southern Japan: population-based analysis from 1998 to 2005

BACKGROUND: Some of the perinatal deaths are preventable. AIMS: To examine with accuracy perinatal deaths and their clinically relevant conditions to further reduce perinatal mortality rates. STUDY DESIGN: Population-based study. SUBJECTS: 356 perinatal deaths in Miyazaki Prefecture from 1998 to 2005. OUTCOME MEASURES: Causes and clinically associated risk factors of perinatal deaths in infants with congenital abnormalities and those of the non-malformed infants. METHODS: We performed a population-based study of 87,593 deliveries in Miyazaki from 1998 to 2005, where 356 perinatal deaths were reported. We also held peer-review audit conference twice a year to investigate causes and clinically associated risk factors of the perinatal deaths, where at least 7 obstetricians and 7 neonatologists congregated. RESULTS: Our perinatal mortality rate was 4.1/1000. 99% of the neonatal deaths and 85% of the stillbirths were examined by the peer-review audit conferences to validate the accuracy of causes. Three fourths were non-malformed perinatal deaths, in which stillbirths represented twice the number of neonatal deaths. Prematurity is the major factor attributable to neonatal deaths. Half of stillbirths were unexplainable but associated with overt or subtle fetal growth restriction. Intrapartum asphyxia after 32 weeks of gestation resulted in 10% of perinatal deaths. The audit conferences concluded that 13% (28/222) of the non-malformed infants had a potential of avoiding death. CONCLUSION: In the advanced region of perinatal medicine in Japan, we still have room to improve perinatal mortality. Most prevalent factors were fetal growth restriction, intrapartum asphyxia after 32 weeks of gestation, and sudden fetal deaths of undiagnosed diabetes near-term.     

Social deprivation and the causes of stillbirth and infant mortality.

AIMS: To investigate the relation between social deprivation and causes of stillbirth and infant mortality. METHODS: Stillbirths and infant deaths in 6347 enumeration districts in Wales were linked with the Townsend score of social deprivation. In 1993-98 there were 211 072 live births, 1147 stillbirths, and 1223 infant deaths. Poisson regression analysis was used to estimate the magnitude of effect for associations between the Townsend score and categories of death by age and the causes of death. The relative risk of death between most and least deprived enumeration districts was derived. RESULTS: Relative risk of combined stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most deprived compared with the least deprived enumeration districts. The early neonatal mortality rate was not significantly associated with deprivation. Sudden infant death syndrome showed a 307% (95% CI 197% to 456%) increase in mortality across the range of deprivation. Deaths caused by specific conditions and infection were also associated with deprivation, but there was no evidence of a significant association with deaths caused by placental abruption, intrapartum asphyxia, and prematurity. CONCLUSIONS: Collaborative public health action at national and local level to target resources in deprived communities and reduce these inequalities in child health is required. Early neonatal mortality rates and deaths from intrapartum asphyxia and prematurity are not significantly associated with deprivation and may be more appropriate quality of clinical care indicators than stillbirth, perinatal, and neonatal mortality rates.     

Perinatal mortality in south east Rajasthan

Of 4443 consecutive births over a 1-year period, the perinatal mortality rate was 105.78/1000, the stillbirth rate was 63.47/1000, and the early neonatal death rate was 42.31/1000 livebirths. Perinatal loss was 10 times higher among low birth weight babies (2500 g), 8 times higher in preterm babies (37 weeks gestation), 4 times higher in mothers with poor antenatal care, and 9 1/2 times higher among rural people. Multiparae and primiparae, mothers under age 20 and above age 30, those with abnormal presentations of fetus, and obstetrical interference during delivery were the main factors associated with higher perinatal mortality rates. Asphyxia neonatorum was directly or indirectly responsible for 58.9% of the perinatal deaths. Suggestions are made to reduce the perinatal morality rate.     

Postneonatal mortality among normal birth weight infants in Alabama, 1980 to 1983

To identify reasons for the racial differential in postneonatal deaths and possible intervention strategies, Alabama's linked birth-death file was used to evaluate causes of postneonatal mortality for the 1980 to 1983 cohorts of normal birth weight infants. Causes were aggregated into six categories, and cause-specific rates were compared by race and by urban-rural residence. Both total and cause-specific postneonatal mortality rates among black infants were two or more times higher than for white infants, except for congenital anomalies. The greatest differential was for infection-related deaths. Rural residence increased both the risk of postneonatal death and the magnitude of the racial differential. The risks were especially elevated for deaths due to infection and "systemic causes" (including those in the perinatal category). Only 26% of postneonatal deaths were probably not preventable, and nearly one third were clearly preventable. Potential prevention strategies include injury control, prevention of infectious diseases, and prompt treatment of infectious diseases.     

Social deprivation and the causes of stillbirth and infant mortality

AIMS—To investigate the relation between social deprivation and causes of stillbirth and infant mortality.METHODS—Stillbirths and infant deaths in 6347 enumeration districts in Wales were linked with the Townsend score of social deprivation. In 1993-98 there were 211 072 live births, 1147 stillbirths, and 1223 infant deaths. Poisson regression analysis was used to estimate the magnitude of effect for associations between the Townsend score and categories of death by age and the causes of death. The relative risk of death between most and least deprived enumeration districts was derived.RESULTS—Relative risk of combined stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most deprived compared with the least deprived enumeration districts. The early neonatal mortality rate was not significantly associated with deprivation. Sudden infant death syndrome showed a 307% (95% CI 197% to 456%) increase in mortality across the range of deprivation. Deaths caused by specific conditions and infection were also associated with deprivation, but there was no evidence of a significant association with deaths caused by placental abruption, intrapartum asphyxia, and prematurity.CONCLUSIONS—Collaborative public health action at national and local level to target resources in deprived communities and reduce these inequalities in child health is required. Early neonatal mortality rates and deaths from intrapartum asphyxia and prematurity are not significantly associated with deprivation and may be more appropriate quality of clinical care indicators than stillbirth, perinatal, and neonatal mortality rates.     

Perinatal mortality trends in a referral hospital

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992–93 (Group B). The perinatal mortality rate (PMR) in Group A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.     

Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51% of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70% to the rest of the time period when the post-mortem rate was only 40%. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40% of deaths overall and 59% of deaths in infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20% of deaths. Sixty percent of the infants in this group weighed less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.     

Use of Wigglesworth pathophysiological classification for perinatal mortality in Malaysia.

A one year prospective study of perinatal deaths was conducted to test the feasibility of using the Wigglesworth pathophysiological classification in the Malaysian health service. Four regions with high perinatal mortality rates were selected. Deaths were actively identified. Nursing staff were trained to use the classification and every death was reviewed by a clinician. A total of 26,198 births and 482 perinatal deaths were reported. The perinatal mortality rate was 18.4. Only 14 (2.9%) deaths had their Wigglesworth category reclassified. Most deaths were in the normally formed macerated stillbirths (34.4%), asphyxial conditions (26.8%), and immaturity (20.1%) subgroups. The results were compared with data from other countries that used this classification. This study has shown that the Wigglesworth pathophysiological classification can be applied to perinatal deaths in the existing Malaysian health service.     

Neonatal mortality determinants in Jamaica

The Jamaican Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths (Wigglesworth Classification), and the determination of characteristics of both mother and infant that are associated with increased mortality. A death questionnaire was completed on babies who were born between September 1986 and August 1987, and who died in the neonatal period throughout the island of Jamaica. The neonatal mortality rate was 17.9 per 1000 live births with early and late rates of 16.0 and 1.9 per 1000, respectively. The major contributors to neonatal demise were prematurity and intrapartum asphyxia (74 per cent). Twins had a seven-fold greater risk of dying than singletons. Babies born to mothers under 15 years had a four-fold greater risk of dying than those of mothers 25-29 years. The neonatal mortality rate for Jamaica is high, with room for improvement, particularly in the prevention of perinatal asphyxia.     

Perinatal mortality in Vellore Part I: A study of 21,585 infants

At Christian Medical College Hospital, Vellore, there were 21,585 consecutive births during a five year period of 1979–1983. The overall perinatal mortality rate was 40·7, stillbirth rate was 23·6 and early neonatal mortality rate was 17·5. Although the perinatal mortality rate was only half that reported from other teaching hospitals in India, it is three times the rate reported for Avon area hospitals providing special and intensive care. The highest perinatal mortality rate 45·5 was noted in 1979; the lowest 38·6 in 1982. The highest stillbirth rate 26·6 was noted in 1980, the lowest 19·3 in 1981 (p<·05). Throughout it was consistently higher than early neonatal mortality rate. The highest early neonatal mortality rate 20·8 was noted in 1979 the lowest 13·9 in 1980 with 33 per cent reduction; (p<·05) however in 1983 it was 17·1. At the end of five years perinatal mortality rate, stillbirth and early neonatal mortality rates were not reduced significantly. If 223 unsalvagable infants, 131 with congenital lethal malformation and 92 others with birth weight below 1000 gm were excluded, then all the three rates for 21,360 normally formed infants weighing above 1000 gm would be statistically significantly lower (perinatal mortality rate 30·7, stillbirth rate 18·4 and early neonatal rate 12·5 (p<·01). An erratum to this article is available at .     

Perinatal Mortality in Jamaica 1986-1987

ABSTRACT. A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51 % of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70 % to the rest of the time period when the post-mortem rate was only 40 %. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 % of deaths overall and 59 % of deaths in infants of more than 2 500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20 % of deaths. Sixty percent of the infants in this group weighed less than 2 500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focusses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.     

Perinatal Mortality in a Saudi Maternity Hospital

ABSTRACT. Perinatal mortality was analyzed in infants to mothers who delivered at the main Maternity hospital in Riyadh and who represented a large proportion of the obstetric population in the city. The crude perinatal mortality rate was 39.8 per 1000 births. The hirth weight-specific mortality rates were compared with the corresponding Swedish rates. The ratio between the birth weight-specific mortality rates in Riyad and Sweden increased from the lightest to the heaviest hirth weight category. Thus the perinatal mortality rate was 2.3 times higher in infants less than 1500 g, and 8.8 times higher in infants with birth weights of 3500 g and more. Similarly, the ratio between the gestational age-specific mortality rates in Riyadh and Sweden increased with advancing gestational age. The perinatal mortality rate of infants less than 28 weeks was 1.6 times higher, and that of term infants 4.8 times higher than in Sweden. The findings indicated shortcomings in the obstetric services. The perinatal mortality rate of teenage mothers, who comprised 17 percent of the material, was 9.1 times the Swedish rate. Other risk groups were para 0 mothers and mothers with a previous infant loss.     

Mortality from birth to adult life: a longitudinal study of twins

We have examined mortality from birth through adult life in a cohort of 2562 twins born in Birmingham, UK, between 1950 and 1954. Their birthweights and obstetric details had been recorded as part of a longitudinal study of births in Birmingham. There were a total of 151 perinatal deaths (perinatal mortality rate = 116 per 1000 births) and 227 infant deaths (infant mortality rate = 94 per 1000 live births). 70 deaths occurred after the age of one year. In comparison with national mortality rates in the UK, overall mortality in the twins was high (standard mortality rate, SMR = 259, 95% CI 221-300). Mortality was highest in the first year of life and, although it then declined progressively, it remained significantly higher that that of the general population until age 5 years. The excess mortality was largely due to conditions originating in the perinatal period but there were excess rates of congenital abnormalities, diseases of the respiratory system, digestive system and nervous and sensory organs. A Cox proportional Hazards analysis showed that the risk of death was related to low birthweight, prematurity and male sex. Death of the co-twin was highly predictive of mortality throughout the period of follow up. These studies not only underline the excess mortality associated with twin birth but show for the first time that this excess mortality extends into childhood.     

PERINATAL MORTALITY

From November, 1967, to the end of December, 1969, perinatal deaths among 7 190 consecutive single births in the University Hospital of Uppsala, Sweden, were analysed in a study using multiple regression analysis and a program for selecting optimal combinations of explanatory variables. The overall perinatal mortality rate, expressed as stillbirths and early infant deaths per 1 000 births, was found to be 15.2; the coefficient of determination was 0.2245. A significantly higher perinatal mortality rate was found for the children of the youngest and the oldest mothers, of mothers with immunizations, breech deliveries, toxaemias, short gesta-tional periods, and for low-weight and congenitally malformed children. Babies of primi-parae with breech deliveries and of smoking mothers showed lower perinatal mortality rates than children of corresponding contrasted mothers, a finding which may at first seem surprising but which can probably be given a natural explanation. The selection of optimal combinations of explanatory variables gave predictor trees which can be utilized for determination of favourable and unfavourable combinations of factors associated with perinatal death. Some individual cases of foetal deaths were analysed in detail. The study ends in a discussion of possible preventive measures to be taken in order to prevent perinatal deaths in the future.     

Perinatal and infant mortality in urban slums under I.C.D.S. scheme

Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.     

Overview of the problems of the small birth weight baby in Singapore

Some of the possible reasons why Singapore's perinatal mortality rate (PMR) is lower than that of many Western countries are examined. The PMR is lower despite the fact that Singapore's economic status is lower than that in most Western countries and the perinatal facilities are not superior. Also considered are the problems associated with perinatal health of the infants in Singapore. In Singapore in 1984 the PMR was 10.6 stillbirths and deaths within the 1st week of life per 1000 stillbirths and livebirths. This is one of the lowest PMR rates in the world. Legalized abortions comprise 50% of livebirths in Singapore. The mothers who choose legalized abortions often are young and members of the lower socioeconomic group, suggesting that if their pregnancies had come to term, many of these babies may have added to the perinatal or infant mortality rate. An assessment of the role of abortions in lowering the PMR of a country might provide some interesting data. Of the 3 major ethnic groups in Singapore -- Chinese, Malay, and Indian, the Indians have the highest proportion of low birth weight (LBW) babies. The Chinese have the least LBW babies with the Malays in between. These differences continued to be evident in 1982. In 1984, the perinatal mortality rates of the Malay and Indian children were higher than that of the Chinese, but there was no difference between that of the Indian and the Malay. In LBW babies (2500 g and less), females predominate in every birth weight category except for 1000g-1499g. After 3000g, males predominate in every birth weight category, so that males predominate as a whole. This male preponderant sex ratio changes postnatally due to a higher death rate in males right up to age 75. As the mortality rate in LBW infants is high, males also will die in greater numbers in this LBW category. An improvement in perinatal care, particularly in the intensive care area, has served to lower mortality rates among both normal birthweight and LBW babies. LBW is the major determinant of neonatal mortality, and in the Singapore context, it is necessary to study survivors with LBW and very low birth weight and to follow them to school and beyond. It is not sufficient to be satisfied with low perinatal mortality rates, as the perinatal mortality rate suggests only the tip to the iceberg, which hides considerable morbidity.     

HIV-1 infection and perinatal mortality in Zimbabwe.

As part of a survey of the causes of perinatal mortality at Mpilo Maternity Hospital, 220 neonatal deaths and the mothers of 221 stillbirths were tested for HIV-1 antibodies. The HIV positive rate in neonatal deaths was 23.6% (95% confidence interval (CI) 18.0 to 29.2%), significantly higher than 15.4% (95% CI 10.6 to 20.1%) in stillbirths. Perinatal deaths from congenital malformations, birth asphyxia, pregnancy induced hypertension, placental abruption, and oFther non-infectious causes had similar low HIV positive rates averaging 8.1% (95% CI 3.9 to 12.3%). Deaths from septicaemia had a significantly greater rate of 39.3% (95% CI 27.0 to 51.6%) and the highest rate of 72.2% (95% CI 51.5 to 92.9%) was found in deaths from congenital infection other than syphilis, indicating that maternal HIV infection predisposes to neonatal septicaemia and congenital infection. Unexplained stillbirths also had a significantly greater rate of 22.4% (95% CI 10.7 to 34.1%), presumably because some died from unrecognised infection. The rate in deaths from congenital syphilis was 17.4% (95% CI 9.6 to 25.2%), indicating a significant but weak association between these two sexually transmitted diseases in Bulawayo. The rate in deaths from hyaline membrane disease was not significantly greater at 15.0% (95% CI 6.0 to 24.0%). By predisposing to infection, maternal HIV infection was estimated to increase the stillbirth rate by 1.6 times and the neonatal mortality rate by 2.7 times. It predisposed equally to early and late onset neonatal septicaemia, but more to infection from streptococci and staphylococci than from Gram negative enterobacteria. HIV positive deaths from congenital infection had respiratory distress and usually intrauterine growth retardation, hepatosplenomegaly, and congenital pneumonia on lung histology.     

Mortality patterns among very preterm babies: a comparative analysis of two European regions in France and England

OBJECTIVE: To explore the differences in outcome of very preterm pregnancies between two geographically defined populations in Europe with similar socioeconomic characteristics and healthcare provision but different organisational arrangements for perinatal care. DESIGN: Prospective cohort study. SETTING: Nord Pas-de-Calais (NPC), France, and Trent, UK. PARTICIPANTS: All pregnancy outcomes 22(+0) to 32(+6) weeks' gestational age for resident mothers. OUTCOME MEASURES: Mortality patterns (antepartum death, intrapartum death, labour ward death and neonatal unit death) among very preterm babies were analysed by region. Multinomial logistic regression was used to model regional differences for a variety of pregnancy outcomes and to adjust for regional differences in the organisation of perinatal care. RESULTS: Delivery of very preterm infants was significantly higher in Trent compared with NPC (1.9% v 1.5% of all births, respectively (p<0.001)). Stillbirth rate was significantly higher in NPC than in Trent (23.0%, 95% CI 20.0% to 26.5% v 14.4%, 95% CI 12.3% to 16.6%, respectively (p<0.001)) and survival to discharge was higher in Trent than in NPC (74.6%, 95% CI 71.9% to 77.1% v 66.7%, 95% CI 63.3% to 69.9%, respectively (p<0.001)). Probability of intrapartum and labour ward death in NPC was more than five times higher than Trent (relative risk 5.3, 95% CI 2.2 to 13.1 (p<0.001)). CONCLUSION: The high rate of very preterm deliveries and the larger proportion of these infants recorded as live born in Trent appear to be the cause of the excess neonatal mortality seen in the routine statistics. Information about very preterm babies (not usually included in routine statistics) is vital to avoid inappropriate interpretation of international perinatal and infant data. This study highlights the importance of including deaths before transfer to neonatal care and emphasises the need to include the outcome of all pregnancies in a population in any comparative analysis.