OBJECTIVE:To assess risk factors for early neonatal mortality. METHODS:A population-based case-control study was carried out with 146 early neonatal deaths and a sample of 313 controls obtained among survivals of the neonate period in the south region of the city of São Paulo, in the period of 8/1/2000 to 1/31/2001. Information was obtained through home interviews and hospital charts. Hierarchical assessment was performed in fi ve groups with the following characteristics 1) socioeconomic conditions of mothers and families, 2) maternal psychosocial conditions, 3) obstetrical history and biological characteristics of mothers, 4) delivery conditions, 5) conditions of newborns. RESULTS:Risk factors for early neonate mortality were: Group 1: poor education of household head (OR=1.6; 95% CI: 1.1;2.6), household located in a slum area (OR=2.0; 95% CI: 1.2;3.5) with up to one room (OR=2.2; 95% CI: 1.1;4.2); Group 2: mothers in recent union (OR=2.0; 95% CI: 1.0;4.2), unmarried mothers (OR=1.8; 95% CI: 1.1;3.0), and presence of domestic violence (OR=2.7; 95% CI: 1;6.5); Group 3: presence of complications in pregnancy (OR=8.2; 95% CI: 5.0;13.5), previous low birth weight (OR=2.4; 95% CI: 1.2;4.5), absence of pre-natal care (OR=16.1; 95% CI: 4.7;55.4), and inadequate pre-natal care (block 3) (OR=2.1; 95% CI: 2.0;3.5); Group 4: presence of clinical problems during delivery (OR=2.9; 95% CI: 1.4;5.1), mothers who went to hospital in ambulances (OR=3.8; 95% CI: 1.4;10.7); Group 5: low birth weight (OR=17.3; 95% CI: 8.4;35.6) and preterm live births (OR=8.8; 95% CI: 4.3;17.8). CONCLUSIONS:Additionally to proximal factors (low birth weight, preterm gestations, labor complications and unfavorable clinical conditions in gestation), the variables expressing social exclusion and presence of psychosocial factors were also identifi ed. This context may affect the development of gestation and hinder the access of women to health services. Adequate prenatal care could minimize the effect of these variables.

OBJECTIVE:To assess risk factors for antepartum fetal deaths. METHODS:A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS:Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS:Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors -mother's low education and marital status -are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality. KEYWORDS

OBJECTIVE:To evaluate the quality of information registered on fetal death certifi cates. METHODS:Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the fi rst semester of 2008. Completeness was analyzed for variables on fetal death certifi cates issued by hospitals and autopsy service. The death certifi cates from a sub-sample of 212 fetal deaths in hospitals of the National Unifi ed Health System (public) were compared to medical records and to the records from Coroner's Offi ce. RESULTS:Among death certifi cates, 75% were issues by Coroner's Offi ce, with Coroner's greater frequency in public hospitals (78%). Completeness of variables on death certifi cates issued by hospitals was higher among nonpublic hospitals. There was greater completeness, agreement and sensitivity in death certifi cates issued by hospitals. There was low agreement and high specifi city for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certifi cates issued by Coroner's Offi ce. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identifi ed as unspecifi ed fetal death as 24.3% as intrauterine hypoxia, while death certifi cates by hospitals reported 18.1% as unspecifi ed and 41.7% as intrauterine hypoxia. CONCLUSIONS:Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.