Fetal mortality and the challenges for women’s health care in Brazil

Abstract

OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country’s fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.

Spatial analysis of inequalities in fetal and infant mortality due to avoidable causes

“…The avoidable fetal mortality rate calculated in this study rose from 7.4 to 8.0 per 1,000 births over the five-year period, which is an increase of 8.1%. In a study, was analyzed the time series of fetal mortality in Brazil in the period from 1996 to 2015, and from 2000, was found a stationary picture for the country and its regions (25) . For the Northeast Region, the fetal mortality rate was around 11 per 1,000 births in 2015 (25) .…”

“…In a study, was analyzed the time series of fetal mortality in Brazil in the period from 1996 to 2015, and from 2000, was found a stationary picture for the country and its regions (25) . For the Northeast Region, the fetal mortality rate was around 11 per 1,000 births in 2015 (25) . In the 10 th Health Region of the state of Ceará, the fetal mortality rate was 14.5 per 1,000 births in the year 2013, and in the state of Ceará, it was 12 per 1,000 births (26) .…”

“…Moreover, issues regarding educational level, family income, access to healthcare services, basic sanitation and living conditions also influence outcomes (17,34) . These determinant factors reflect the greater vulnerability of these mothers to situations of risk and influence fetus and infant survival (17,25,34) . In Nigeria, the results of a study analyzing socioeconomic inequalities in infant mortality among groups defined by wealth, maternal educational level and maternal age clearly showed that a significant proportion of infant deaths could have been avoided if socioeconomic inequalities in rates of infant mortality had been eliminated/reduced by appropriate policies (35) .…”

Ações e impactos na redução de óbitos fetais: Percepção de integrantes do comitê de mortalidade

“…A Taxa de Mortalidade Fetal (TMF) é considerada um dos indicadores mais apropriados para analisar a qualidade da assistência prestada à gestante e ao parto, pois reflete o estado de saúde da mulher, a qualidade, e as condições de acessibilidade e de utilização dos serviços de saúde disponibilizados (Brasil, 2009;Barros, Aquino & Souza, 2019). Para calcular a TMF são considerados os óbitos fetais ocorridos a partir da 22ª semana completa de gestação ou 154 dias, com fetos com peso igual ou superior a 500 g ou estatura a partir de 25 cm por mil nascimentos totais na população, residente em um determinado espaço geográfico e ano (Brasil, 2009).…”

“…A evitabilidade dos óbitos fetais é reconhecida como indicador da efetividade da assistência à saúde, podendo direcionar a disponibilidade de recursos necessários para o planejamento de ações, objetivando a melhoria da assistência prénatal e ao parto (Barros, Aquino & Souza, 2019). Algumas ações básicas possibilitam promover uma resposta mais positiva sobre a sobrevida e redução da TMF, tais como: qualificação do cuidado; a ampliação do acesso aos serviços, desde o pré-natal à assistência hospitalar ao parto e ao nascimento; pronto reconhecimento de situações de risco; e a provisão do cuidado apropriado e resolutivo à gestante (Brasil, 2009).…”