Perinatal death audit and classification of stillbirths in two provinces in Papua New Guinea: A retrospective analysis

Abstract

Objective To undertake a retrospective perinatal death audit and assessment of avoidable factors associated with stillbirths among a cohort of women in two provinces in Papua New Guinea. Methods We used data from an ongoing cluster‐randomized crossover trial in 10 sites among 4600 women in Papua New Guinea (from 2017 to date). The overarching aim is to improve birth outcomes. All stillbirths from July 2017 to January 2020 were identified. The Perinatal Problem Identification Program was used to analyze each stillbirth and review associated avoidable factors. Results There were 59 stillbirths among 2558 births (23 per 1000 births); 68% (40/59) were classified “fresh” and 32% as “macerated”. Perinatal cause of death was identified for 63% (37/59): 30% (11/37) were due to intrapartum asphyxia and traumatic breech birth and 19% (7/37) were the result of pre‐eclampsia. At least one avoidable factor was identified for 95% (56/59) of stillbirths. Patient‐associated factors included lack of response to reduced fetal movements and delay in seeking care during labor. Health personnel‐associated factors included poor intrapartum care, late diagnosis of breech presentation, and prolonged second stage with no intervention. Conclusion Factors associated with stillbirths in this setting could be avoided through a package of interventions at both the community and health‐facility levels.

From Pre-Implementation to Institutionalization: Lessons From Sustaining a Perinatal Audit Program in South Africa

“…7 The PPIP tool has also been adapted and used in other settings outside of South Africa. [68][69][70] Box 3 provides 10 lessons from this research, which may help South Africa and other countries in their efforts to introduce, expand, and sustain perinatal audit. These lessons relate to findings from other studies examining the history of implementation of MPDSR processes.…”

Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region – current situation and the way forward

“…Research from Papua New Guinea and the Solomon Islands 37 , 38 , 39 , 40 highlights factors leading to poor maternal and perinatal outcomes, including stillbirth and early neonatal death. In Papua New Guinea, stillbirth is defined as a baby born without a heartbeat after 22 weeks gestation and weighing more than 500 g. 41 A recent study conducted in two provinces in Papua New Guinea identified a stillbirth rate of 23.4 per 1000 total births 37 and an early neonatal mortality rate (NMR-death within the first seven days) of 14 per 1000 livebirths. 38 A number of avoidable factors were identified among these adverse outcomes, with the majority related to poor intrapartum care and inadequate clinical management – at least one avoidable factor was identified for 94% of stillbirths.…”

“… 62 Through our reporting of adverse events within this trial we identified a high burden of perinatal deaths among study participants with 23.4 per 1000 total births and 14 per 1000 livebirths for stillbirths and early neonatal deaths, respectively. 37 , 38 …”

Early neonatal death review from two provinces in Papua New Guinea: A retrospective analysis

“…As part of trial safety monitoring procedures, we undertook a retrospective analysis and audit of all perinatal deaths identified among study participants. Analysis of the stillbirths identified a stillbirth rate of 23 per 1000 births 11 . The aim of this paper is to use the PPIP to describe the causes and avoidable factors associated with ENND in this setting.…”