Birth - Stillbirth and Perinatal Death

The distorted world map above shows the relative distribution of early neonatal death by country. Note the over-representation of Africa and Asia compared with Europe, USA and Australia.

Introduction

The perinatal period is the early postnatal period relating to the birth, statistically it includes the period up to 7 days after birth. Neonatal period is the four weeks/month after birth. Stillbirth and perinatal death can be classified by a number of different systems, all still have "unexplained" or "other" as a potential option. in several systems contribute to many of these deaths. Neonatal deaths include a broader age range of infants who have also died after birth from various causes.

Stillbirths with a gestational age of 28 weeks or more are defined as "late fetal deaths".

There are several death classification systems used in different countries around the world, the most recent are the suggested ReCoDe (UK, 2005), the modified Whitfield (Australia/New Zealand, 2004), and the World Health Organization's International Classification of Disease (ICD-10) systems.

A common stillbirth classification is still "unexplained", with recent analysis of data showing fetal growth restriction is a common antecedent.

Some Recent Findings

Neonatal mortality rates 2009

Perinatal mortality following assisted reproductive technology treatment in Australia and New Zealand, a public health approach for international reporting of perinatal mortality. "There is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice." Assisted Reproductive Technology Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. " In 2009, an estimated 3.3 million babies died in the first month of life-compared with 4.6 million neonatal deaths in 1990-and more than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8% (19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and Democratic Republic of the Congo 4.6% (2.1%)." Effect of screening and management of diabetes during pregnancy on stillbirths "Diabetes during pregnancy is associated with significant risk of complications to the mother, fetus and newborn. We reviewed the potential impact of early detection and control of diabetes mellitus during pregnancy on stillbirths for possible inclusion in the Lives Saved Tool (LiST)." UK study - Time of birth and risk of neonatal death at term "The risk of neonatal death was 4.2 per 10 000 during the normal working week (Monday to Friday, 0900-1700) and 5.6 per 10 000 at all other times (out of hours) (unadjusted odds ratio 1.3, 95% confidence interval 1.1 to 1.6). Adjustment for maternal characteristics had no material effect. The higher rate of death out of hours was because of an increased risk of death ascribed to intrapartum anoxia (adjusted odds ratio 1.7, 1.2 to 2.3)." (See also Swedish study) Stillbirth classification - executive summary of a National Institute of Child Health and Human Development workshop. "Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22-24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death." BMC Pregnancy and Childbirth - Special Issue 2010 Global report on preterm birth and stillbirth

World High Rate Countries

Graph shows the number of infant deaths / 1,000 live births for countries above 1%.

Australian Data

Australian Perinatal Deaths
Year	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
Rate	10.1	10.4	9.8	9.8	9.9	10.6	9.2	8.8	8.4	9.0
Number	2,534	2,571	2,475	2,480	2,541	2,769	2,459	2,532	2,501	2,671

• Perinatal deaths are all fetal deaths (at least 20 weeks gestation or at least 400 grams birth weight) plus all neonatal deaths (death of a live born baby within 28 completed days of birth).
• Perinatal death rates are calculated per 1,000 all births for the calendar year.
• Source: ABS Births, Australia, 2009 (cat. no. 3301.0); ABS Perinatal Deaths, Australia, 2009 (cat. no. 3304.0).

NSW

NSW perinatal mortality rate

In New South Wales (2002) 613 perinatal deaths were reported.

• Unexplained antepartum deaths: 26.3% of perinatal deaths (or 39.2% of stillbirths)
• Spontaneous preterm labour: 20.6% (less than 37 weeks gestation)
• Congenital abnormality: 16.8%
• Antepartum haemorrhage: 8.5%
• Specific perinatal conditions: 7.3%, of which twin-twin transfusion accounted for 2.3% of deaths
• Hypertension (high blood pressure): 5.5%
• Perinatal infection: 4.4%
• Maternal disease: 4.4%
• Hypoxic peripartum death: 3.8%

Neonatal deaths (four weeks/month after birth)

• extreme prematurity was most common cause (39.6%)
• congenital abnormality (19.3%)
• neurological disease (13.4%)
• cardio-respiratory conditions (11.9%)
• infection (8.4%)

Data: Report of the New South Wales Chief Health Officer, 2004 accessed 19Oct05

USA Data

Leading causes of infant death for 2005:

1. Congenital malformations, deformations and chromosomal abnormalities
2. Disorders related to short gestation and low birthweight, not elsewhere classified
3. Sudden infant death syndrome
4. Newborn affected by maternal complications of pregnancy
5. Newborn affected by complications of placenta, cord and membranes
6. Accidents (unintentional injuries); Respiratory distress of newborn
7. Bacterial sepsis of newborn
8. Neonatal hemorrhage
9. Necrotizing enterocolitis of newborn.

Fetal Death Information

Sample form - fetal death report

• 2003 Revisions of the U.S. Standard Certificates of Live Birth and Death and the Fetal Death Report. The revision process is generally carried out every 10 to 15 years.
• Maternal, Paternal and medical and health information is collected.

CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

• INITIATING CAUSE/CONDITION
• OTHER SIGNIFICANT CAUSES OR CONDITIONS
• WEIGHT OF FETUS (grams preferred, specify unit)
• ESTIMATED TIME OF FETAL DEATH
• WAS AN AUTOPSY PERFORMED?
• WAS A HISTOLOGICAL PLACENTAL EXAMINATION PERFORMED?
• WERE AUTOPSY OR HISTOLOGICAL PLACENTAL EXAMINATION RESULTS USED IN DETERMINING THE CAUSE OF FETAL DEATH?

Links: 2003 Revisions of the U.S. Standard Certificates of Live Birth and Death and the Fetal Death Report

Conditions Associated with Stillbirth

Based upon the 2007 National Institute of Child Health and Human Development workshop.

Infection

• Severe maternal illness
• Placental infection leading to hypoxemia
• Fetal infection leading to congenital deformity
• Fetal infection leading damage of a vital organ
• Precipitating preterm labor with the fetus dying in labor

Maternal medical conditions

• Hypertensive disorders
• Diabetes mellitus
• Thyroid disease
• Renal disease
• Liver disease
• Connective tissue disease (systemic lupus erythematosus)
• Cholestasis

Other

• Antiphospholipid syndrome
• Heritable thrombophilias
• Red cell alloimmunization
• Platelet alloimmunization
• Congenital anomaly and malformations
• Chromosomal abnormalities including confined placental mosaicism
• Fetomaternal hemorrhage
• Fetal growth restriction
• Placental abnormalities including vasa previa and placental abruption
• Umbilical cord pathology including velamentous insertion, prolapse, occlusion and entanglement
• Multifetal gestation including twin–twin transfusion syndrome and twin reverse arterial perfusion
• Amniotic band sequence
• Central nervous system lesions

References

Search PubMed

July 2010 "Perinatal Death" All (8144) Review (899) Free Full Text (1129)

Search Pubmed: Stillbirth | Perinatal Death

External Links

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• Stillbirth Foundation Australia

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Cite this page: Hill, M.A. (2024, April 19) Embryology Birth - Stillbirth and Perinatal Death. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Birth_-_Stillbirth_and_Perinatal_Death

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© Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G