Understanding Perinatal Death: A Systematic Analysis of New York City Fetal and Neonatal Death Vital Record Data and Implications for Improvement, 2007–2011

Abstract

We aimed to compare demographic, medical, and cause-of-death information reported for third-trimester fetal and neonatal death vital records collected in New York City (NYC) before and after implementation of the revised fetal death certificate to identify: (1) the limitations of combining fetal and neonatal death records for the purpose of perinatal death prevention; and (2) improvement opportunities for fetal death vital records registration. Using Chi squared tests, we compared data completeness and cause-of-death information between third-trimester NYC fetal (n = 1,930) and neonatal deaths (n = 735) from 2007 to 2011. We also compared fetal death data before and after the 2011 implementation of the 2003 United States (US) Standard Report of Fetal Death and an electronic reporting system. Compared with neonatal deaths, fetal death data were generally less complete (P < 0.0001). Fetal death data much more frequently reported an ill-defined cause of death (67 vs. 5 %). Most ill-defined reported causes of fetal death (73 %) were attributed to stillbirth synonyms (e.g., "fetal demise"). Ill-defined causes of fetal death decreased from 68 to 61 % (P < 0.01) after 2011. Both data completeness and ill-defined causes of death varied widely by hospital. In NYC, fetal deaths lack demographic, medical, and cause-of-death information compared with neonatal deaths, with implications for research that uses combined perinatal mortality data sets. Electronic implementation of the US Standard Report of Fetal Death minimally improved cause-of-death information. Substantial variability by hospital suggests opportunities for improvement exist.

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

“…Late foetuses that eventually die during delivery suffer from intrauterine hypoxia and account for a third of foetal deaths in developing countries (6) . According to a study, essential obstetric care in emergency rooms can reduce foetal deaths during delivery by 40% in comparison with non-specialised care (15) . Comprehensive obstetric care may decrease late foetal deaths by up to 85% late with essential obstetric care, which includes the use of antibiotics, oxytocin, and parenteral anticonvulsant drugs, vaginal birth, manual removal of placenta, and removal of retained placenta (15) .…”

“…According to a study, essential obstetric care in emergency rooms can reduce foetal deaths during delivery by 40% in comparison with non-specialised care (15) . Comprehensive obstetric care may decrease late foetal deaths by up to 85% late with essential obstetric care, which includes the use of antibiotics, oxytocin, and parenteral anticonvulsant drugs, vaginal birth, manual removal of placenta, and removal of retained placenta (15) . Comprehensive obstetric support is standard obstetric care including Caesarean section and blood transfusion (15) .…”

“…Comprehensive obstetric care may decrease late foetal deaths by up to 85% late with essential obstetric care, which includes the use of antibiotics, oxytocin, and parenteral anticonvulsant drugs, vaginal birth, manual removal of placenta, and removal of retained placenta (15) . Comprehensive obstetric support is standard obstetric care including Caesarean section and blood transfusion (15) . Death surveillance can identify theses factor during the investigation by discussing the case with a multidisciplinary team and recommending prevention measures.…”

Trends in Stillbirth by Gestational Age in the United States, 2006–2012

“…Although reporting requirements for fetal deaths vary somewhat by state, fetal mortality rates from the National Vital Statistics System are generally shown for fetal deaths at 20 weeks of gestation or more (otherwise known as stillbirths) (4, 12). Variables included in this study are considered to be reasonably well reported in both birth and fetal death data sets (14, 15). Since the study was based on de-identified, aggregated data from US government public-use data sets, the study was exempt from requiring IRB approval.…”

Epidemiological investigation of perinatal deaths in Recife-Pernambuco: a quality assessment

“…Although the World Health Organization (WHO) launched in 2014 a plan of action to significantly reduce preventable deaths and fetal deaths by 2035 (5) , the organization's Sustainable Development Goals did not prioritize the monitoring of perinatal mortality rate, keeping it out of the public's attention (6) . However, countries that have vital statistics information systems with good coverage and reliable data can acquire knowledge on their perinatal epidemiological situation, planning interventions in favor of maternal and newborn health (7) .…”