Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health

Authors

  • JP Vogel,

    Corresponding author
    1. School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia
    2. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
    • Correspondence: JP Vogel, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland. Email vogeljo@who.int

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  • JP Souza,

    1. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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  • R Mori,

    1. Department of Health Policy, National Centre for Child Health and Development, Tokyo, Japan
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  • N Morisaki,

    1. Department of Health Policy, National Centre for Child Health and Development, Tokyo, Japan
    2. Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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  • P Lumbiganon,

    1. Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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  • M Laopaiboon,

    1. Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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  • E Ortiz-Panozo,

    1. Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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  • B Hernandez,

    1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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  • R Pérez-Cuevas,

    1. Social Protection and Health Division, Inter-American Development Bank, Mexico City, Mexico
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  • M Roy,

    1. Indian Council of Medical Research, New Delhi, India
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  • S Mittal,

    1. Fortis Memorial Research Institute, Gurgaon, India
    2. All India Institute of Medical Sciences, New Delhi, India
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  • JG Cecatti,

    1. University of Campinas, Campinas, Sao Paulo, Brazil
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  • Ö Tunçalp,

    1. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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  • AM Gülmezoglu,

    1. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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  • on behalf of the WHO Multicountry Survey on Maternal and Newborn Health Research Network

Errata

This article is corrected by:

  1. Errata: Corrigendum Volume 122, Issue 3, 451, Article first published online: 27 January 2015

Abstract

Objective

We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications.

Design

Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS).

Setting

A total of 359 participating facilities in 29 countries.

Population

A total of 308 392 singleton deliveries.

Methods

We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions).

Main outcome measures

Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs.

Results

The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 85.6, 86.5, and 88.6% of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia.

Conclusions

Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes.

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