A multi‐country study of the “intrapartum stillbirth and early neonatal death indicator” in hospitals in low‐resource settings

Abstract

Objective To determine the feasibility of introducing a simple indicator of quality of obstetric and neonatal care and to determine the proportion of potentially avoidable perinatal deaths in hospitals in low-income countries. Methods Between September 1, 2011, and February 29, 2012, data were collected from women who had a term pregnancy and were admitted to the labor ward of 1 of 6 hospitals in 4 low-income countries. Fetal heart tones on admission were monitored, and demographic and birth data were recorded. Results Data were obtained for 3555 women and 3593 neonates (including twins). The doptone was used on 97% of women admitted. The overall perinatal mortality rate was 34 deaths per 1000 deliveries. Of the perinatal deaths, 40%–45% occurred in the hospital and were potentially preventable by better hospital care. Conclusion The results demonstrated that it is possible to accurately determine fetal viability on admission via a doptone. Implementation of doptone use, coupled with a concise data record, might form the basis of a low-cost and sustainable program to monitor and evaluate efforts to improve quality of care and ultimately might to help to reduce the in-hospital component of perinatal mortality in low-income countries.

A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries

“…34,35 Since then, others have described the possible connection between maternal and perinatal outcomes in greater detail. 4,36,37 Our study confirms that the mother's death has important implications for the risk that her fetus or neonate will also die. Since most deaths occurred near to delivery and because most obstetric complications are not recognized in advance, the intervention most likely, by far, to reduce mortality is the provision of high-quality emergency obstetric and neonatal care in hospitals capable of carrying out deliveries by caesarean section, blood transfusion and neonatal resuscitation in addition to other key elements of obstetric care, such as uterine evacuation of the retained products of conception, manual removal of the placenta, assisted vaginal delivery by forceps or vacuum and the administration of oxytocin, anticonvulsants and antibiotics.…”

Stillbirths

“…Because signs of maceration begin to appear about 12 hours after fetal death, whether the fetus showed signs of maceration is often used to distinguish an antepartum from an intrapartum demise. 44 Stillbirths are also classified by cause of death, by birth weight, by gestational age, and by whether an anomaly was present. These characteristics often help determine whether the stillbirth was likely due to asphyxia or some other cause.…”

“…Intrapartum stillbirths, which represent between 50% and 70% of all stillbirths in LMICs, are nearly always caused by asphyxia and can be substantially reduced by monitoring the fetus during labor and providing a cesarean section when distress is discovered. 44 Other intrapartum interventions that contribute to a reduction in intrapartum stillbirths include not overstimulating contractions during induction or augmentation of labor, preventing seizures in women with preeclampsia, and maintaining maternal blood pressure in cases of dehydration or hemorrhage. [45][46][47][48] Because labor is generally of short duration, vigilance during this time may not require extensive resources.…”

“…[45][46][47][48] Because labor is generally of short duration, vigilance during this time may not require extensive resources. In a study done in 5 LMIC hospitals, with fetal viability on 44 Of the in-hospital stillbirths, most occurred in term nonanomalous fetuses. The cause of death was likely asphyxia.…”

Measuring maternal, foetal and neonatal mortality: Challenges and solutions

“…It can be calculated at a facility level as: (intrapartum stillbirths + neonatal deaths within the first 24 hours of life (≥2,500g))/(livebirths+ fetal deaths (≥2,500 grams)). (25,26) Another, less frequently used, measure is the 'prospective fetal mortality rate': (number of fetal deaths at a gestational age per 1,000 fetal deaths at that gestational age or greater, plus livebirths). This is a more accurate denominator for those at risk, and provides an estimate of the risk of fetal death at a given gestational age.…”