Academic journal article Bulletin of the World Health Organization

Perinatal Mortality Attributable to Complications of Childbirth in Matlab, Bangladesh

Academic journal article Bulletin of the World Health Organization

Perinatal Mortality Attributable to Complications of Childbirth in Matlab, Bangladesh

Article excerpt

Voir page 626 le resume en francais. En la pagina 626 figura un resumen en espanol.

Introduction

Mortality rates among under-5-year-old children have decreased substantially over the past 20 years in developing countries, but perinatal mortality has not followed the same pattern and continues to present a huge burden. In 1995, WHO estimated the number of perinatal deaths worldwide to be greater than 7.6 million, with 98% of these deaths occurring in developing countries (1). In Africa, perinatal mortality rates as high as 75 per 1000 births have been reported; estimates for Asia are in the range 36-74 per 1000 births (1).

Studies carried out in both developed and developing countries have identified several risk factors for perinatal mortality. Perinatal deaths are largely the result of poor maternal health, adverse social conditions, and inadequate care during pregnancy, delivery, and the immediate postpartum period (2). Strategies to improve perinatal health include prevention and treatment of pregnancy complications such as infections (particularly syphilis) and hypertension, adequate nutrition during pregnancy, improved care at delivery, and better care of neonates (2-5). Ensuring that all deliveries are supervised by a trained attendant has now become the cornerstone of safe motherhood programmes (6).

Complications during childbirth have long been known to increase the risk of perinatal death. During the 1960s in Norway, for example, perinatal mortality rates after uterine rupture and placenta praevia were, respectively, as high as 216 and 99 per 1000 (7). In a hospital-based case-control study in Saudi Arabia, complications during labour increased the risk of perinatal death fivefold (8). Although perinatal deaths associated with dystocia are now relatively rare in industrialized countries, they are still substantial in many developing countries. In Guatemala, up to 87% of babies have been reported to have died during deliveries complicated by abnormal fetal position (9). In India, breech delivery accounted for 19% and 12% of stillbirths and neonatal deaths, respectively, and birth asphyxia led to 41% of early neonatal deaths (10). WHO has estimated that birth asphyxia and birth injuries may account for up to one-third of neonatal deaths, but the epidemiological evidence to support this claim is scant (2).

Very few of the population-based studies of perinatal mortality in developing countries have considered intrapartum risk factors (9-11). Most workers have examined the place or type of delivery rather than the complications per se (3, 4, 12). In view of the current emphasis on improving the care given during labour and delivery to reduce maternal mortality, it is important to assess the extent to which this approach may also contribute to the reduction of perinatal mortality.

The present study assessed the proportion of perinatal deaths that are attributable to complications during childbirth in Matlab, Bangladesh. Since deliveries complicated by maternal pathology may be partly associated with preterm labour and with complications during pregnancy, we have separated the effects of complications during childbirth from those associated with premature labour and with those detectable antenatally.

Methods

The study was conducted in Matlab, a rural area in Bangladesh that has been under continuous demographic surveillance since 1966 (13). Major demographic events such as births, deaths and marriages are recorded during monthly home visits by community health workers and the completeness of reporting is high (13). Since October 1977, part of the area -- with a population of approximately 100 000 -- has been covered by a maternal and child health and family planning (MCH-FP) programme. A community-based maternity care programme was introduced in part of the MCH-FP area in 1987 and expanded to the entire area in 1990 (14, 15). A maternity clinic was established in Matlab town, professional midwives were posted in the villages, and transport for emergency cases was provided. …

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