Stillborn in Brazil: could neonatal mortality be just the tip of the iceberg? / Natimortos no Brasil: a mortalidade neonatal pode ser apenas a ponta do iceberg?

Cássia Lorena Dantas Rodrigues, Ricardo Queiroz Gurgel, Débora Cristina Fontes Leite

Abstract


INTRODUCTION: Stillbirth has an estimation of more than 2.5 million cases across the world. A great percentage of the cause of stillbirths is reported as unknown or unexplained. The aim of this study was the identification of the causes, incidence and profile of the fetal and also the mothers in a maternity hospital in the State of Sergipe. METHODS: This was an observational and cross-sectional study in which all stillbirths of the maternal hospital in the State of Sergipe from June 2020 to May 2021 were included. Fetal death investigation forms were analyzed and some women were interviewed through telephone calls. The interview was based on the SAMPLE VA questionnaire 1 from the WHO Verbal autopsy instrument and an additional list to assess the maternal, pregnancy and labor history, and also history of signs and symptoms of COVID-19 infection. RESULTS: A total of 10375 births were delivered at the hospital and the months with highest births were May and March of 2021. We found 64 cases of stillbirth. Forty-two cases of neonatal deaths were also registered. Only 11 women with cases of stillbirth were interviewed in our study. The major participants were married or living with a partner (60%) and finished secondary education (63.63%). There were 5 cases of women with gestational age at 37 weeks or greater. Antenatal care was completed by 90.9%(n=10) of women. The majority (54.5%) had Unknown or unexplained causes of death. The remaining categories also showed relevant results. CONCLUSION: Fetal deaths were responsible for approximately 60% of perinatal deaths, in which the most reported cause in our interview were unexplained or unknown. The total number of deaths when neonatal deaths were added almost duplicated the percentage of the mortality rate at the maternity hospital. All women went into labor with less than 42 weeks of gestational age and greater or equal to 22 and most were healthy and had no diagnosed diseases.


Keywords


cause of death, neonatal death, stillbirth .

Full Text:

PDF

References


Aminu, M., Bar-Zeev, S., White, S. et al. Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa. BMC Pregnancy Childbirth 19, 470 (2019). https://doi.org/10.1186/s12884-019-2626-7.

Basu M, Johnsen I, Wehberg S, Sørensen R, Barington T, Nørgård B. Causes of death among full term stillbirths and early neonatal deaths in the Region of Southern Denmark: Journal of Perinatal Medicine. 2018;46(2): 197-202. https://doi.org/10.1515/jpm-2017-0171).

Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, Hogan D, Shiekh S, Qureshi ZU, You D, Lawn JE; Lancet Stillbirth Epidemiology Investigator Group. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016 Feb;4(2):e98-e108. doi: 10.1016/S2214-109X(15)00275-2. Epub 2016 Jan 19. Erratum in: Lancet Glob Health. 2016 Mar;4(3):e164. PMID: 26795602.)

BRASIL. Ministério da Saúde. Banco de dados do Sistema único de Saúde -DATASUS: Sistema de informações sobre mortalidade. 2019. Available at http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/fet10br.def.

BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Manual de vigilância do óbito infantil e fetal e do Comitê de Prevenção do Óbito Infantil e Fetal / Ministério da Saúde, Secretaria de Vigilância em Saúde, Secretaria de Atenção à Saúde. – 2. ed. – Brasília: Ministério da Saúde, 2009).

Carvalho TS, Pellanda LC, Doyle P. Stillbirth prevalence in Brazil: an exploration of regional differences. Jornal de Pediatria. 2018 mar; 94(2):200–6.

Cassidy PR. Care quality following intrauterine death in Spanish hospitals: results from an online survey. BMC Pregnancy Childbirth. 2018 Jan 10;18(1):22. doi: 10.1186/s12884-017-1630-z. PMID: 29321000; PMCID: PMC5763533.

Christiansen-Lindquist, Lauren et al. “Improving surveillance for the hidden half of fetal-infant mortality: a pilot study of the expansion of the Pregnancy Risk Assessment Monitoring System to include stillbirth.” Annals of epidemiology vol. 26,6 (2016): 401-4. doi:10.1016/j.annepidem.2016.03.012).

Grzybowski S, Stoll K, Kornelsen J. Distance matters: a population based study examining access to maternity services for rural women. BMC Health Serv Res. 2011 Jun 10;11:147.

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Frøen JF, Qureshi ZU, Calderwood C, Shiekh S, Jassir FB, You D, McClure EM, Mathai M, Cousens S; Lancet Ending Preventable Stillbirths Series study group; Lancet Stillbirth Epidemiology investigator group. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016 Feb 6;387(10018):587-603. doi: 10.1016/S0140-6736(15)00837-5. Epub 2016 Jan 19. PMID: 26794078.

Lisonkova S, Sheps SB, Janssen PA, Lee SK, Dahlgren L, Macnab YC. Birth outcomes among older mothers in rural versus urban areas: a residence-based approach. J Rural Health. 2011;27(2):211-219.

Man J, Hutchinson JC, Heazell AE, Ashworth M, Jeffrey I, Sebire NJ. Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death. Ultrasound Obstet Gynecol. 2016 Nov;48(5):579-584. doi: 10.1002/uog.16019. Epub 2016 Oct 25. PMID: 27781319.

McClure EM, Saleem S, Goudar SS, Garces A, Whitworth R, Esamai F, Patel AB, Tikmani SS, Mwenechanya M, Chomba E, Lokangaka A, Bose CL, Bucher S, Liechty EA, Krebs NF, Yogesh Kumar S, Derman RJ, Hibberd PL, Carlo WA, Moore JL, Nolen TL, Koso-Thomas M, Goldenberg RL. Stillbirth 2010-2018: a prospective, population-based, multi-country study from the Global Network. Reprod Health. 2020 Nov 30;17(Suppl 2):146. doi: 10.1186/s12978-020-00991-y. PMID: 33256783; PMCID: PMC7706249.

McNamara, K., O’Donoghue, K. & Greene, R.A. Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 – 2014; a descriptive study. BMC Pregnancy Childbirth 18, 9 (2018). https://doi.org/10.1186/s12884-017-1636-6.

Nijkamp JW, Sebire NJ, Bouman K, Korteweg FJ, Erwich JJHM, Gordijn SJ. Perinatal death investigations: What is current practice? Semin Fetal Neonatal Med. 2017 Jun;22(3):167-175. doi: 10.1016/j.siny.2017.02.005. Epub 2017 Mar 18. PMID: 28325580; PMCID: PMC7118457.

Okonofua FE, Ntoimo LFC, Ogu R, Galadanci H, Mohammed G, Adetoye D, Abe E, Okike O, Agholor K, Abdus-Salam R, Randawa A. Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study. BMC Pregnancy Childbirth. 2019 Dec 30;19(1):533. doi: 10.1186/s12884-019-2682-z. PMID: 31888536; PMCID: PMC6937841.

Page JM, Bardsley T, Thorsten V, Allshouse AA, Varner MW, Debbink MP, Dudley DJ, Saade GR, Goldenberg RL, Stoll B, Hogue CJ, Bukowski R, Conway D, Reddy UM, Silver RM. Stillbirth Associated With Infection in a Diverse U.S. Cohort. Obstet Gynecol. 2019 Dec;134(6):1187-1196. doi: 10.1097/AOG.0000000000003515. PMID: 31764728.

Patterson JK, Aziz A, Bauserman MS, McClure EM, Goldenberg RL, Bose CL. Challenges in classification and assignment of causes of stillbirths in low- and lower middle-income countries. Semin Perinatol. 2019 Aug;43(5):308-314. doi: 10.1053/j.semperi.2019.03.021. Epub 2019 Mar 16. PMID: 30981473; PMCID: PMC7894980.

Ravelli AC, Jager KJ, de Groot MH, et al. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG. 2011;118(4):457-465.

Reinebrant H, Leisher S, Coory M, Henry S, Wojcieszek A, Gardener G, et al. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG: Int J Obstet Gy. janeiro de 2018;125(2):212–24.

Serina P, Riley I, Hernandez B, Flaxman AD, Praveen D, Tallo V, Joshi R, Sanvictores D, Stewart A, Mooney MD, Murray CJ, Lopez AD. What is the optimal recall period for verbal autopsies? Validation study based on repeat interviews in three populations. Popul Health Metr. 2016 Oct 18;14:40. doi: 10.1186/s12963-016-0105-1. PMID: 27833459; PMCID: PMC5101705.) Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490796/.

Singh A, Kumar M. An Analysis of Cause of Stillbirth in a Tertiary Care Hospital of Delhi: A Contribution to the WHO SEARO Project. J Obstet Gynecol India. abril de 2019;69(2):155–60.

Sistema de Informação sobre Mortalidade [Internet]. Brasília: Ministério da Saúde. 2008. Available at http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10br.def

Wagle RR, Sabroe S, Nielsen BB. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth. 2004 May 22;4(1):8.

WHO. Verbal autopsy standards: the 2016 WHO verbal autopsy instrument. Geneva: World Health Organization; 2016. Available from: http://www.who.int/healthinfo/statistics/verbalautopsystandards.

Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJH, Flenady V. Interventions for investigating and identifying the causes of stillbirth. Cochrane Database Syst Rev. 2018 Apr 30;4(4):CD012504. doi: 10.1002/14651858.CD012504.pub2. PMID: 29709055; PMCID: PMC6494629.

World Health Organization (2010). Fetal death, cause not specified. In: ICD-10 International classification of diseases for mortality and morbidity statistics. 10th revision. Geneva: World Health Organization.

World Health Organization (2016). Making every baby count: Audit and review of stillbirths and neonatal deaths. World Health Organization.

Wu D, Fang D, Wang R, Deng D, Liao S. Management of Pregnancy during the COVID-19 Pandemic. Glob Chall. 2020 Oct 22;5(2):2000052. Doi: 10.1002/gch2.202000052. Epub ahead of print. PMID: 33173591; PMCID: PMC7645978.




DOI: https://doi.org/10.34119/bjhrv5n3-013

Refbacks

  • There are currently no refbacks.