Decline in Perinatal Mortality in the United States, 2017–2019

This report presents trends in perinatal mortality, as well as its components, late fetal and early neonatal mortality, for 2017 through 2019. Also shown are perinatal mortality trends by mother’s age, race and Hispanic origin, and state for 2017–2019.

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.

Association between a single measurement of progesterone and cortisol blood concentrations at two to one week before parturition, and number of fetuses in the Teramana goat

The Teramana goat is an at-risk breed, needing population protection and programs to increase their numbers. The first step for a population increase is the best management of reproduction, leading to an as high as possible number of healthy and viable kids born. To this purpose, beside the optimization of mating, the best possible management of pregnancy and parturition is mandatory. The goat is a prolific farm animal in which single, double, or triple ovulations can occur, leading to singleton, twin or triple pregnancies, and the birth of multiple kids. Twins and triplets are associated to increased risk for perinatal mortality and need a special surveillance and possible assistance at birth. Knowledge of the number of fetuses that have to be delivered from each goat could be a practical tool for a better management of parturition. Among the methods to define the number of fetuses in the goat, the measurement of blood progesterone (P4) concentrations have provided inconsistent results. Therefore, the present study was aimed to assess the possible association between the maternal concentrations of plasma P4 and cortisol (C), two hormones possibly associated to the number of fetuses, measured only once at about two to one week before parturition in Teramana goats, and the number of fetuses. The results, obtained from 23 does, showed that both plasma P4 and C are higher in does bearing multiple fetuses than does with singleton pregnancies. However, the single measurement of plasma C, but not P4, two to one week before the expected parturition in the Teramana goat is useful to distinguish between does bearing singleton and triplet pregnancies for a better surveillance and assistance at delivery. Therefore, it could represent a tool for the best management of reproduction in a breed population at risk for extinction.

Setting Up the Stillbirth Registration System and Investigating the Related Causes in Iran in Selected Hospitals: Observational Cohort Study

Background One of the major causes of perinatal mortality is stillbirth. In many cases, the cause of stillbirth is difficult to identify, and the cause of many cases remain unexplained. Because of the lack of registration stillbirth system in our country we developed protocol and instructions for stillbirth and setting up a stillbirth registration system in selected hospitals around country. Methods Iranian Maternal and Neonatal Network (IMaN) registers information about almost all births (live & dead) around the country, but this network does not collect data about stillbirth causes. In this study, we developed the stillbirth evaluation protocol with experts' cooperation, and we designed forms for the stillbirth registration system electronically. Then we trained related individuals in 14 selected hospital from 12 provinces (14 cities) of Iran. After a year, we extracted, analyzed, and, based on the Relevant Condition of Death Classification (ReCoDe), interpreted the collected data. Results A total of 105,562 births and 762 stillbirths registered. In 742 registered stillbirth cases in 14 selected hospitals, the relevant causes were identified in 65.4% of cases, while 34.6% of cases remained unclassified. The most frequent relevant conditions were fetal (33.2%), maternal (9.1%), amniotic fluid (8.8%), placenta (7.7%), and umbilical cord (6.2%). Conclusions Our registration decreased the percentage of stillbirth with an unexplained cause from about 70–34.6%.

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

DYNAMICS OF PERINATAL LOSSES IN ALMATY

Динамика и уровень перинатальной смертности за последние десятилетие свидетельствовали о том, что в г. Алматы имеет устойчивую тенденцию к снижению до 8,8‰ к 2019 году. В структуре перинатальной смертности большая часть приходится на антенатальную (5,5-6,5‰); около трети - на раннюю неонатальную смертность (3,2 до 2,3‰). В структуре причин неонатальных потерь наблюдалось устойчивое снижение дыхательных и сердечно-сосудистых нарушений в 2,3-3,8 раза - с 5 до 1,3‰, врожденных аномалий с 4,4 до 0,9‰, неонатальные потери от инфекционных болезней остаются стабильными. Сохраняющие риски инфекционной патологии, особенно в беспрецедентной ситуации в период пандемии диктуют необходимость пересмотра подходов к оказанию перинатальной помощи населению и разработкой новой концепции перинатальной помощи с существенными изменениями в подходах инфекционного контроля, развития превентивной перинатологии с более эффективной антенатальной охраной здоровья плода. The dynamics and level of perinatal mortality over the past decade testified to the fact that in Almaty it has a steady downward trend to 8.8 ‰ by 2019. In the structure of perinatal mortality, most of it falls on antenatal (5.5-6.5 ‰); about a third - for early neonatal mortality (3.2 to 2.3 ‰). In the structure of the causes of neonatal losses, there was a steady decrease in respiratory and cardiovascular disorders by 2.3-3.8 times - from 5 to 1.3 ‰, congenital anomalies from 4.4 to 0.9 ‰, neonatal losses from infectious diseases remain stable. The persisting risks of infectious pathology, especially in an unprecedented situation during a pandemic, dictate the need to revise approaches to providing perinatal care to the population and develop a new concept of perinatal care with significant changes in approaches to infection control, thedevelopment of preventive perinatology with more effective antenatal fetal health care.