High risk pregnancy associated perinatal morbidity and mortality: a second birth population-based survey in Huai’an in 2015

Abstract

Background The objective of this survey was to explore the association between pregnancy complications and perinatal outcome from regionally total birth population. Methods In this prospectively collected data of complete birth registries from all level I-III hospitals in Huai’an in 2015, perinatal morbidity and mortality in relation to pregnancy complications and perinatal outcome were analyzed using international definitions. The results were compared with that of 2010 survey in the same region. Results Of 59,424 total births in the hospitals of level I ( n = 85), II (16) and III (6), delivery rate was 30.4, 40.1 and 29.5%, and rates of pregnancy complications were 12.9, 9.8 and 21.1% (average 14.1%), with antenatal corticosteroids rate in < 37 gestational weeks being 17.3, 31.0 and 39.9% (mean 36.6%), respectively. The preterm birth rate was 0.6, 2.7 and 9.5% (mean 4.06%), and the composite rate of fetal death, stillbirth, and death immediately after delivery was 0.1, 0.4 and 0.6%, respectively. By multivariable logistic regression analysis, congenital anomalies, low Apgar scores, multi-pregnancy and amniotic fluid contamination were risk factors of adverse perinatal outcomes. Despite a higher rate of pregnancy complications than in 2010 survey, perinatal and neonatal mortality continued to fall, in particular in very preterm births. The high cesarean delivery rate in non-medically indicated cases remained a challenge. Conclusions Our regional birth-population data in 2015 revealed a robust and persistent improvement in the perinatal care and management of high risk pregnancies and deliveries, which should enable more studies using similar concept and protocol for vital statistics to verify the reliability and feasibility. Electronic supplementary material The online version of this article (10.1186/s12884-019-2323-6) contains supplementary material, which is available to authorized users.

Preterm Morbidity and Mortality by Gestational Age. A Birth Population-Based Study

“…By comparison, the 50% survival rate was reported in 23-25 weeks of gestation from the nation-wide registry or perinatal network data in developed countries [1][2][3][4][5][7][8][9]. Our previous data demonstrated substantial and persistent improvement in Huai'an perinatalneonatal care between 2010 and 2015, probably due to the establishment of centralized prenatal care and deliveries at level II and III hospitals [10,11,20]. This enabled us to take facility-speci c conditions and regional infrastructure into consideration, when investigating the impact of integrated antenatal, peripartum and postnatal interventions in this region.…”

“…The concept and protocol of investigation, de nition of diagnosis of preterm morbidity and mortality as well as speci c disease severity and level of care were adopted from the references cited in the manuscript, during the data collection, analysis and preparation of manuscript in 2018-2020. This study followed the whole regional birth population survey in 2015, in which a complete birth data was prospectively collected from totally 107 level I-III hospitals providing obstetric care (6 municipal, 16 county and 85 township), and 8 level II and 4 level III hospitals equipped with neonatal wards and/or intensive care units (NICU) [11,20]. Non-medical abortions (especially unplanned pregnancy) were excluded.…”

“…1). The study protocol was approved by the ethic committee of Children's Hospital of Fudan University, and accepted by HWCH as well as all participating hospitals in Huai'an [11,20]. As no speci c intervention was applied, informed consent from parents/guardians was waived.…”

“…The diagnostic criteria of pregnancy, perinatal and neonatal co-morbidities and complications are presented in additional le 1 [23][24][25][26][27][28][29][30][31][32][33][34]. De nitions regarding vital statistics are based on the original survey [11,20], and the 10 th revision of the international classi cation of diseases [35]. Brie y, GA was mainly determined by the date of last menstrual period and/or fetal sonography in early pregnancy, or postnatal assessment by new Ballard score when prenatal records were missing or incomplete [36].…”

“…Small for GA was de ned as a BW < 10th percentile for gender and GA [37]. Birth defects (BD) were identi ed prenatally or within the rst seven postnatal days (PND) [11,20]. Severity of neonatal underlying diseases were characterized as requiring intensive or critical care based on the treatment strength during hospitalization, such as degree of the disease severity, in need of noninvasive/ mechanical ventilation (NIV/MV), surfactant, vasopressor, or surgery, etc (also see additional le 1) [7,28,38].…”