Perinatal mortality

Question 1

Perinatal mortality

• Terms

Answer 1

Live birth: complete expulsion from the mother irrespective to the duration of pregnancy, which after
such separation shows evidence of life such as breathing, heart-beating, umbilical cord pulsation or
definite movement of voluntary muscles regardless the cut of umbilical cord or attachment of placenta
(baby born alive).

§ Stillbirth or fetal death: death before complete expulsion or extraction from the mother irrespective of
the duration of the pregnancy.

Death is indicated by fetus showing no vital signs.

§ Perinatal period: starts at 22 completed gestation weeks and ends 7 completed days after birth.

§ Neonatal period: begins with birth and ends 28 complete days after birth.

§ Neonatal death: Subdivided to early neonatal deaths (0-6 days) and late neonatal deaths (7-27 days).

Question 2

Mortality rates

Answer 2

Perinatal mortality rate (PNMR): the number of stillbirths and early neonatal deaths (those occurring
in the first week of life) per 1000 total births (live births and stillbirths). ~ 7.5/ 1000.

§ Stillbirth rate (SBR): the number of stillbirths per 1000 total births.

Estimated ~ 13.9 stillbirths per 1000
total births globally.

§ Neonatal mortality rate (NMR): the number of neonatal deaths occurring within the first 28 days of life
per 1000 live births.

Estimated ~ 17 deaths per 1000 live births in 2019 globally.

§ Incidence of perinatal mortality are region-divided to 3: more-developed, less and least developed.

§ The PNMR in developing countries are x5 times higher, and the least-developed countries are x6 times
greater both than developed countries!

§ Developed countries have steady fall in PNMR over last 30 years.

§ Global comparison shows perinatal mortality rate > neonatal mortality rate and stillbirth rate.

Question 3

Perinatal mortality rate (PNMR)

Answer 3

the number of stillbirths and early neonatal deaths (those occurring
in the first week of life) per 1000 total births (live births and stillbirths). ~ 7.5/ 1000.

Question 4

Stillbirth rate (SBR)

Answer 4

the number of stillbirths per 1000 total births. Estimated ~ 13.9 stillbirths per 1000
total births globally

Question 5

Neonatal mortality rate (NMR)

Answer 5

the number of neonatal deaths occurring within the first 28 days of life
per 1000 live births. Estimated ~ 17 deaths per 1000 live births in 2019 globally.

Question 6

Factors affecting perinatal mortality

Answer 6

Maternal age: < 20 years or > 40 years

§ Deprivation: diets poor in specific nutrients contribute to inequalities in pregnancy outcome.

§ Ethnicity: Black women has highest risk.

§ Other factors: Smoking, obesity, infections, etc

Question 7

Causes of stillbirth

Answer 7

Largest contributor to perinatal mortality.

§ Other main causes identified were intrauterine growth restriction (IUGR) 10%, antepartum or
intrapartum haemorrhage 13%, andspecific placental conditions 9%.

§ ~ 23% of stillbirths are unexplained.

§ Other causes include pre-eclampsia, mechanical and major congenital anomaly.

Question 8

Causes of neonatal deaths

Answer 8

Congenital anomalies and prematurity (early neonatal deaths), birth trauma and infections (neonatal
tetanus; late neonatal deaths) are main causes.

§ Low birth weight shows important association (<2500 g) and is an indication to maternal health
and nutrition.

§ Neonatal tetanus remains a common cause of neonatal death in settings where lack of hygiene; deaths
from neonatal tetanus occur between the 7th and 10th day of life.

§ Main causes identified are respiratory disorders 38%, major congenital anomalies 21%, neurological
disorders 14% and extreme prematurity 9%.