Stillbirths: the vision for 2020

Goldenberg, Robert L.; McClure, Elizabeth M; Bhutta, Zulfiqar Ahmed; Belizán, José M.; Reddy, Uma M.; Rubens, Craig E.; Mabeya, Hillary; Flenady, Vicki

doi:10.1016/s0140-6736(10)62235-0

Cited by 161 publications

(146 citation statements)

References 37 publications

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“…The occurrence of foetal deaths has also affected developed countries, which recorded around 1 stillborn for every 300 births (10) . In recent decades, efforts to reduce these deaths focused on neonatal diseases, while the prevention of stillbirths received less attention and investments because they were not specifically addressed in the Millennium Development Goals (11) .…”

Section: Discussionmentioning

confidence: 99%

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil

Rêgo¹,

Vilela

Oliveira

et al. 2018

Rev. Gaúcha Enferm.

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Objective:To describe the epidemiological characteristics of perinatal deaths by actions of the Public Health System. Methods: Descriptive study of temporal analysis, population composed of perinatal deaths of mothers residing in Recife, 2010Recife, -2014 Used List of causes of preventable deaths to classify avoidance and, EpiInfo version 7 for analysis of variables. Results: There were 1,756 perinatal deaths (1,019 fetal, 737 neonatal premature), reduction of early neonatal deaths (-15.8%), and fetal increase (12.1%). Main causes: fetus and newborn affected by maternal condition and asphyxia/hypoxia at birth. Conclusions: Most deaths were avoidable, concentrating on the adequate grouping of attention given to the woman during pregnancy. Failures in the care given to the woman at birth explain the percentage of asphyxia/ hypoxia. Reduction of preventable perinatal mortality is associated with increased access and quality of care to ensure promotion, prevention, treatment, and specific and timely care. Keywords: Perinatal mortality. Vital statistics. Obstetric nursing. Neonatal nursing. Public health. RESUMOObjetivo: Descrever características epidemiológicas dos óbitos perinatais por ações do Sistema Público de Saúde. Métodos: Estudo descritivo de análise temporal, população composta por óbitos perinatais de mães residentes no Recife, 2010-2014. Utilizado Lista de causas de mortes evitáveis para classificar a evitabilidade e EpiInfo versão 7 para análise das variáveis. Resultados: Ocorreram 1.756 óbitos perinatais (1.019 fetais e 737 neonatais precoce), observou-se redução dos óbitos neonatais precoces (-15,8%) e aumento dos fetais (12,1%). Apresentou como principais causas: feto e recém-nascido afetado por afecção materna e asfixia/hipóxia ao nascer. Conclusões: A maior parte dos óbitos foi evitável, concentrando-se no grupamento de assistência adequada dispensada à mulher na gestação. Lacunas na assistência dispensada à mulher no parto, explicam o percentual de asfixia/hipóxia. Redução da mortalidade perinatal evitável associa-se à ampliação do acesso e qualidade da assistência para garantir promoção, prevenção, tratamento, cuidados específicos e oportunos. Palavras-chave: Mortalidade perinatal. Estatísticas vitais. Enfermagem obstétrica. Enfermagem neonatal. Saúde pública. RESUMEN Objetivo:Describir las características epidemiológicas de las muertes perinatales por acciones del Sistema de Salud Pública. Métodos: Estudio descriptivo del análisis temporal, población compuesta por muertes perinatales de madres residentes en Recife, 2010-2014. Lista de causas de muertes evitables para clasificar la evitación y, EpiInfo versión 7 para el análisis de variables. Resultados: Hubo 1.756 muertes perinatales (1.019 fetales, 737 prematuros neonatos), reducción de muertes neonatales tempranas (-15,8%) y aumento fetal (12,1%). Principales causas: feto y recién-nacido afectados por afección materna y asfixia / hipoxia al nacer. Conclusiones: La mayoría de las muertes fueron evitables, concentrándose en la agrupació...

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Section: Discussionmentioning

confidence: 99%

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil

Rêgo¹,

Vilela

Oliveira

et al. 2018

Rev. Gaúcha Enferm.

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“…Although there have been considerable improvements in health care in developed countries, stillbirth remains a common adverse pregnancy outcome, 23 and in the UK rates have been particularly high. 24 This issue appears to be intractable and, in contrast to the improvements seen in neonatal mortality, there has been little or no reduction in rates of stillbirth over time.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, stillbirth is a major public health burden that is frequently overlooked, since stillbirths are often excluded from international comparisons of maternal and infant health. 25,23 This burden has not affected all groups alike. Socioeconomic inequalities in stillbirth rates have been found in the UK and internationally, 24,26,27 with women in deprived areas at higher risk of stillbirth.…”

Section: Introductionmentioning

confidence: 99%

Towards reducing variations in infant mortality and morbidity: a population-based approach

Field

Boyle

Draper

et al. 2016

Programme Grants Appl Res

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BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Many obstacles exist for improving our understanding of the causes of stillbirth, for example, there is no consensus definition of stillbirth, nor is there a standard protocol for stillbirth examination that is universally accepted. 3 In this article we will define stillbirth as any fetus delivered without ''signs of life,'' that is, at least 28 weeks of gestation and/or with a body weight of 2000 g or more. This definition was chosen because the survival rate of such an infant, if liveborn, is likely nearly 100% 4,5 (with minimal clinical intervention); therefore, if these deaths could be avoided, the result would likely be viable infants.…”

mentioning

confidence: 99%

Perinatal Pathology: Practice Suggestions for Limited–Resource Settings

Roberts

2013

Archives of Pathology &Amp; Laboratory Medicine

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The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements (''ramping up'') over time.

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Stillbirths: the vision for 2020

Cited by 161 publications

References 37 publications

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil

Towards reducing variations in infant mortality and morbidity: a population-based approach

Perinatal Pathology: Practice Suggestions for Limited–Resource Settings

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