Characteristics Overview of Mother with Perinatal Death at Dr. Soetomo Hospital in 2015

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

Perinatal mortality in the Netherlands. Backgrounds of a worsening international ranking

Perinatal mortality rates have dropped sharply in the past few decades, in the Netherlands as well as in all other European countries. However, as the decrease has generally slowed down since the 1980s, the Netherlands has lost its prominent position in the international ranking of countries with favourable perinatal mortality rates. This lower ranking is not only the result of the dialectics of progress, but also the consequence of a relatively restrained use of antenatal diagnostics. In addition, the Netherlands is among the European countries scoring highest on a number of important risk factors. This article examines the effect on perinatal mortality rates of known risk factors, in particular the presence of non-western foreigners, multiple births and older mothers. With respect to the latter factor, it is concluded that children of older mothers run a significantly higher risk of foetal mortality, whereas babies of young mothers (including women in their early twenties) run a higher risk of infant mortality. For babies of non-western mothers, infant mortality rates are higher, although there are substantial differences between ethnic backgrounds. First week mortality is most unfavourable for Surinamese and Antillean/Aruban children, and post-neonatal mortality is highest among Turkish and Moroccan babies. The fact that relatively many non-western foreigners from countries with relatively high risks of perinatal mortality have settled in the Netherlands, is one of the reasons for the fall in the international ranking. Lastly, the increase in the number of multiple births has been stronger in the Netherlands than in most other countries. The higher incidence of assisted reproduction explains most of this increase.ethnicity, foetal mortality, infant and child mortality, mortality, multiple births, neonatal mortality, perinatal mortality, Peristat, risk factors

Did the Celtic Tiger Decrease Socio-Economic Differentials in Perinatal Mortality in Ireland?

Irish perinatal mortality rates have been falling steadily for a number of decades but evidence from the 1980s showed pronounced differentials in mortality rates across socio-economic groups. Between 1995 and 2006 Irish gross national product increased from 60 per cent of the EU average to 110 per cent. Real incomes increased across the income distribution during this period but income inequality between the top and bottom income deciles increased marginally. This paper examines whether socio-economic differentials in Irish perinatal mortality rates changed between the 1980s and 2000s. This task is complicated by demographic change in Ireland since the 1980s and its interaction with the birth registration process. Overall perinatal mortality rates have fallen from 14 per 1,000 in 1984 to 7 per 1,000 in 2006. Without adjusting for demographic change, differentials between professional and unskilled/unemployed groups have decreased from 1.99 to 1.79. Adjusted estimates suggest the real differential has decreased to 1.88.

Non-immune fetal hydrops: etiology and outcome according to gestational age at diagnosis.

OBJECTIVE: Fetal hydrops is associated with increased perinatal morbidity and mortality. The etiology and outcome of fetal hydrops may differ according to the gestational age at diagnosis. The aim of this study was to evaluate the cause, evolution and outcome of non-immune fetal hydrops (NIFH), according to the gestational age at diagnosis. METHODS: This was a retrospective cohort study of all singleton pregnancies complicated by NIFH, at the Fetal Medicine Unit at St George's University Hospital, London, UK, between 2000 and 2018. All fetuses had detailed anomaly and cardiac ultrasound scans, karyotyping and infection screening. Prenatal diagnostic and therapeutic intervention, gestational age at diagnosis and delivery, as well as pregnancy outcome, were recorded. Regression analysis was used to test for potential association between possible risk factors and perinatal mortality. RESULTS: We included 273 fetuses with NIFH. The etiology of the condition varied significantly in the three trimesters. Excluding 30 women who declined invasive testing, the cause of NIFH was defined as unknown in 62 of the remaining 243 cases (25.5%). Chromosomal aneuploidy was the most common cause of NIFH in the first trimester. It continued to be a significant etiologic factor in the second trimester, along with congenital infection. In the third trimester, the most common etiology was cardiovascular abnormality. Among the 152 (55.7%) women continuing the pregnancy, 48 (31.6%) underwent fetal intervention, including the insertion of pleuroamniotic shunts, fetal blood transfusion and thoracentesis. Fetal intervention was associated significantly with lower perinatal mortality (odds ratio (OR), 0.30 (95% CI, 0.14-0.61); P  0.05). CONCLUSIONS: An earlier gestational age at diagnosis of NIFH was associated with an increased risk of aneuploidy and worse pregnancy outcome, including a higher risk of perinatal loss. Fetal therapy was associated significantly with lower perinatal mortality. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology

Child death in high-income countries

Although high income countries have made substantial progress towards reducing child mortality over recent decades, rates vary markedly between and within countries, and modifiable factors continue to be identified in many deaths. A series of three articles in The Lancet has described the epidemiology of child mortality and a standardised approach to child death reviews in high income countries. Patterns of child mortality at different ages are delineated into five broad categories: perinatal, congenital, acquired natural, external, and unexplained; while contributory factors are described across four broad domains: factors intrinsic to the child, the physical environment, the social environment, and service delivery. This commentary attempts to draw on the conclusions of these three articles and make practical recommendations on strategies in three key areas with perhaps the greatest potential to further reduce child mortality in high income countries: perinatal conditions, particularly preterm birth; acquired natural conditions, such as sepsis or acute respiratory problems; and external causes, including road traffic fatalities

Health Services, Maternal Intrinsic and Socio-Cultural Factors and Perinatal Mortality

This study question was how significant the determination of health services, maternal intrinsic risk factors and socio-cultural factors on perinatal mortality. Its objective was to construct a model of perinatal mortality pattern by case-control design. The case population was all mothers with perinatal mortality. The sample-size was 35 by simple random sampling with case-control ratio of 1:1 (35:35). The data analysis applied Bivariate using Chi Square Test and Multivariate using Logistic Regression Test. The Bivariate Analysis Results found the risk-variables on Perinatal Mortality were Birth Attendant (OR=2.1; 1.63-2.7; 95%CI), Health Financing (OR=7.1; 1.82-27.8; 95% CI), Maternal Disease History (OR=8; 2.05-31.16; 95%CI), Perinatal History (OR=6.47; 2.26-18.55; 95%CI) and Custom (OR=2.17; 1.67-2.82; 95%CI). Multivariat Analysis found three consistent risk variables on Perinatal Mortality i.e.: Health Financing (p=0.016; OR=6.8; 95% CI), Maternal Disease History (p=0.006; OR=8.41; 95%CI) and Perinatal History (p=0.021; OR=4.3; 95%CI). It concluded that the most significant determinant on Perinatal Mortality was Maternal Disease History

Folic Acid, Dietary Patterns and Perinatal Health: The Generation R Study

The perinatal mortality rate in The Netherlands is among the highest in the European Union, with one in 100 babies dying during pregnancy, at birth or shortly thereafter. Low birth weight, preterm birth, congenital anomalies, perinatal asphyxia, and pre-eclampsia are major contributors to perinatal mortality. Moreover, pre-eclampsia is not only a major driver for perinatal mortality but plays a significant role in maternal mortality as well

Perinatal deaths in Australia 1993–2012

Summary The loss of a baby who was either stillborn or died in the first weeks of life is a tragic event that affects around 3,000 families every year in Australia. Perinatal mortality is widely recognised as an important indicator of population health. While Australia is one of the safest places in the world to give birth, almost 1 in 100 pregnancies will end in a perinatal death. Perinatal deaths in Australia 1993–2012 represents the first comprehensive national report on perinatal mortality in Australia and includes a detailed analysis of data relating to stillbirths and neonatal deaths for the period 2011-2012 and an analysis of trends for 1993–2012. The aim of this report is to gain a better understanding of the causes of perinatal deaths at a population level and identify changes in perinatal mortality over time. Data used for this report come from information recorded in jurisdictional perinatal data collections and information collated by state and territory perinatal mortality review committees. For the 2 years 2011 and 2012, just over 6,000 babies died during the perinatal period: a rate of 9.9 deaths per 1,000 births. Approximately three-quarters of those deaths were stillbirths (4,485) with the remaining 1,580 deaths being neonatal deaths. The rate of perinatal mortality varied by the state or territory in which babies were born, with the highest perinatal mortality rate recorded in Victoria (12.2 deaths per 1,000 births) and the lowest in New South Wales (8.3 deaths per 1,000 births). The rates also varied considerably between different subgroups including those based on mothers\u27 level of remoteness, socioeconomic status, age, smoking status, body mass index (BMI) and Indigenous status. The perinatal mortality rate of babies born to mothers who identified as Aboriginal or Torres Strait Islander was almost double that of babies of non-Indigenous mothers (17.1 versus 9.6 deaths per 1,000 births). Similarly, the perinatal mortality rate was almost 50% higher among babies whose mothers smoked compared with those who did not smoke (13.3 versus 8.9 deaths per 1,000 births). The stillbirth rate for babies of teenage mothers and mothers older than 45 was more than double that for mothers aged 30–34 (13.9 and 17.1 versus 6.4 deaths per 1,000 births). Over the 20-year period 1993–2012, the overall perinatal mortality rate was stable at around 10 deaths per 1,000 live births. There was a decrease in the rate of neonatal death (3.2 to 2.4 deaths per 1,000 live births) and an increase in the stillbirth rate (6.4 to 7.2 deaths per 1,000 births). Although remaining high, the report shows a decrease of 20% in the perinatal mortality rate among babies of Aboriginal and Torres Strait Islander mothers. During 2011 and 2012, congenital abnormality was the leading condition in the fetus classified by the PSANZ Perinatal Death Classification as the cause of stillbirths (26.3% of stillbirths) and neonatal deaths (33.1%). An additional PSANZ Neonatal Death Classification of extreme prematurity was the leading condition contributing to deaths in the neonatal period (33.5%). When examined by Indigenous status, however, the leading cause of perinatal death among babies of Aboriginal and Torres Strait Islander mothers was spontaneous pre-term birth (26.8% of stillbirths and 48.0% of neonatal deaths). This report provides insight into the trends in perinatal mortality in Australia, and highlights variations in some of Australia\u27s most vulnerable and disadvantaged population subgroups. This indicates areas that warrant further investigation and attention by clinicians, researchers and health policy makers

Foundations for enhanced maternity data collection and reporting in Australia: national maternity data development project - stage 1

Findings from a project aimed at building a more comprehensive and consistent national data collection for maternal and perinatal health are presented in this report. Summary Investment in more comprehensive and consistent national data collection for maternal and perinatal morbidity and mortality was recommended by the Report of the maternity services review-a review conducted in 2008 by the then Australian Government Department of Health and Ageing in response to concerns that maternity care was not meeting the needs of all Australian women. Its findings led to the development of the National Maternity Services Plan (NMSP). The NMSP is a strategic national framework to guide policy and program development and reflects the joint understanding and commitment of health ministers in all jurisdictions. The National Maternity Data Development Project (NMDDP) was established in response to Action 4.1.5 of the NMSP: The Australian Governmentfunds the development of nationally consistent maternal and perinatal data collection. This report presents the findings of Stage 1 of the NMDDP which was conducted between May 2011 and June 2013, under the expert guidance of a project advisory group and with extensive stakeholder consultation. Major components included: identifying national information needs for maternity data and assessing options to meet these needs through enhanced data collection and reporting conducting a range of data development activities, including developing a classification system for models of maternity care reaching agreement on the national requirements for maternal mortality reporting, including developing a standardised data collection form investigating issues with collecting and reporting national perinatal mortality data. One outcome of the project has been an agreed set of priority data items for improving national data collection and reporting. These data items fall into three main categories: improvement of maternal morbidity data items (such as diabetes and hypertension) that are currently inconsistently collected across Australia addition of data items relating to lifestyle and risk factors in the antenatal period, including obesity and maternal mental health addition of data items on indications for caesarean section and other interventions, reflecting a need for consistent and accurate information about interventions before and during labour. Another outcome is the development of the Maternity Care Classification System (MaCCS) to classify the diverse range of models of maternity care in Australia. Once implemented, this system is designed to support analysis of outcomes of maternity care provided in different ways. Stage 1 of the NMDDP also involved in-depth examination of the current collection of data on maternal mortality. While maternal deaths are rare in Australia, they are still an important indicator of the quality of maternity services and obstetric care. A national report on maternal mortality in Australia for 2006-2010 will be published in 2014. A second stage of the NMDDP has now begun and will focus on continuing the development of priority data items and of the MaCCS, extending maternal mortality reporting work, developing methods to better capture and report on national perinatal mortality, and providing greater access to maternal and perinatal data through web tools

The reliability of perinatal and neonatal mortality rates: Differential under-reporting in linked professional registers vs. Dutch civil registers

Official Dutch perinatal mortality rates are based on birth and death certificates. These civil registration data are not detailed enough for international comparisons or extensive epidemiological research. In this study, we linked and extrapolated three national incomplete, professional registers from midwives, obstetricians and paediatricians, containing detailed perinatal information. This linkage and extrapolation resulted in one detailed professional database which is representative of all Dutch births and from which gestational age-specific perinatal mortality rates could be calculated. The reliability of these calculated mortality rates was established by comparing them with the rates derived from the national civil registers. The professional database reported more perinatal deaths and fewer late neonatal deaths than the civil registers. The underreporting in the civil registers amounted to 1.2 fewer perinatal deaths per 1000 births and was most apparent in immature newborns. We concluded that under-reporting of perinatal and neonatal deaths depends on the data source used. Mortality rates for the purpose of national and international comparison should, therefore, be defined with caution. This study also demonstrated that combining different incomplete professional registers can result in a more reliable database containing detailed perinatal information. Such databases can be used as the basis for extensive perinatal epidemiological research