PERINATAL & NEONATAL

MORTALITY
Mark Khan
MBBS 2K17
Obstetrics & Gynecology
October 2016

Objectives
Definition
Calculation
Epidemiology
Causes
Risk Factors
Prevention

Introduction
Annually, 130 million babies are born; almost
8 million will die before their first birthday
and
more than 10 million will die before their fifth
(Neonatal and Perinatal Mortality:
Country, Regional and Global Estimates.
WHO 2006)

DEFINITIONS
Perinatal Mortality: stillbirths and
deaths up to the first week of life (22
weeks GA- 7 days postpartum)
Neonatal Mortality: deaths occurring
during the first four weeks after birth
(birth 28 days).
-Early: 0-7 days
-Late: 8-28 days

UNITED NATIONS (U.N) MILLENNIUM

DEVELOPMENT GOAL 4
REDUCE CHILD MORTALITY
Target 4.A:

Reduce by two thirds, between 1990

and 2015, the under-five mortality
rate
[UNITED NATIONS]

Stillbirths
Stillbirth refers to a fetus that is dead at

birth
Antepartum (pregnancy complications,

maternal diseases, often unknown)

Intrapartum (complications arising during

birth)

PMR Perinatal Mortality Rate

Number of perinatal deaths per 1000 total
births
# of perinatal deaths x 1000
total # of births (still births + live births)

NMR Neonatal Mortality Rate

Number of neonatal deaths per 1000 live
births
# of neonatal deaths x 1000
total # of live births

Incidence
25.0
22.3

21.6

21.0

20.0

20.3

19.7

19.2

15.0
11.5
10.8
10.0

11.4
10.7

11.3
10.5

11.1
10.2

10.7
9.7

10.4
9.3

5.0

0.0

2010.5 2011.5 2012.5 2013.5 2014.5 2015.5

Caribbean
Jamaica
World

Antigua 6
Bahamas 8
Barbados 10
Belize
9
Dominica 9
Grenada
7
Guyana 19
Jamaica 11
St Lucia 10
St Kitts 7
St Vincent 15
Trinidad 15
Cuba 3
Haiti 25

UHWI
PMR

NMR

ENMR

LNMR

2005

33.9

20.7

15.8

4.9

2006

35.3

21.4

19

2.4

2007

30

19.6

15.8

3.8

2008

38.8

23.3

17.6

5.7

2009

32.2

16.8

14.2

2.7

2010

33.1

25.8

20.1

5.7

2011

35.3

21.4

19

2.4

Importance of Perinatal Mortality

Reflection of the standard of health care

provided to the mother and baby &

maternal nutrition and health
Indicator of socioeconomic status of a
community, region or country
Provides necessary information to make
decisions in improving the health status of
pregnant women, new mothers and
newborns and to guide policies

Importance of Neonatal Mortality

Rate
Directly reflects prenatal, intrapartum, and

neonatal care
Early neonatal deaths are more closely
associated with pregnancy-related factors
and maternal health
Late neonatal deaths are associated more
with factors in the newborns environment

Causes of stillbirth
Classifications
Extended Wigglesworth
Tulip
Aberdeen
CODAC

Extended Wigglesworth
Category 1 Congenital Defect/Malformation
Category 2 Unexplained antepartum foetal death
Category 3 Death from intrapartum asphyxia,

anoxia or trauma
Category 4 Immaturity
Category 5 Infection
Category 6 Other specific causes
Category 7 Accident or non-intrapartum trauma
Category 8 Sudden infant death, cause unknown
Category 9 Unclassifiable

Tulip

Tulip

Tulip

Aberdeen
Category 1 Congenital Anomaly
Category 2 Asphyxia before birth
Category 3 Hyaline Membrane Disease
Category 4 Intracranial Haemorrhage
Category 5 Infection
Category 6 Unclassifiable or Unknown

CODAC
0 Infectious causes of death
1 Conditions, diseases and events specific to neonatal

life
2 Mechanics and events of parturition or its
complications
3 Congenital anomalies, chromosomal anomalies and
structural malformations
4 Foetal Conditions diseases and events
5 Cord conditions diseases and events
6 Conditions, diseases and events of the placenta
7 Maternal conditions, diseases and events
8 Unknown, unexplained, unclassifiable
9 Terminations of pregnancy

Extended Wigglesworth Classification for cause of

death
Immaturit Infectio
y
n
200
5
200
6
200
7
200
8
200
9
201
0

Congenital
Malformations

Asphyxia

Other

36

41

11

33

43

30

40

Millennium Development Goals

Millennium Development Goal 4 (MDG4) set

targets to reduce by two-thirds the number

of deaths of children aged <5 years by
2015 compared with 1990.
Goal for 2015 9.3 per 1000
Jamaica in 2015 11.6 per 1000

Risk Factors
Fetal growth restriction
Preterm birth
Age of mother rates of neonatal death

higher <25 and >40 years.

Risk Factors
Maternal health:
Obesity
Smoking
Chronic diseases - eg, diabetes, renal failure,

hypertension, haemoglobinopathy, rhesus

disease, thrombophilias, antiphospholipid
syndrome.
Infection - eg, varicella, measles.
Substance abuse, especially cocaine.
A history of mental health problems
increases risk

Risk Factors
Obstetric complications: pre eclampsia,

APH, intrapartum (malpresentation or

obstructed labour)
Multiple pregnancy higher in
monochorionic twins
Parity : nulliparity, third & subsequent
pregnancies
Congenital abnormality
Low birth weight

Risk Factors
Region of maternal residence: low income

regions (sub-Saharan Africa, south central

Asia)
Social factors: lack of employment, late
booking
Ethnicity:
African and African-Caribbean women, Indian

mothers
Sex: slightly higher in males

Causes of Perinatal Mortality

Spontaneous preterm labour
Intrapartum hypoxia
Antepartum hemorrhage
Hypertensive Disorders
Infections
Fetal abnormalities
IUGR
Birth trauma
Maternal diseases

Causes of Early Neonatal Deaths

Preterm labour
Hypertensive disorders
Antepartum hemorrhage
Intrapartum hypoxia
Infections
Fetal abnormalities
IUGR
Birth trauma
Maternal diseases
Final causes: immaturity, perinatal hypoxia,

infection, congenital anomalies

Causes of Late Neonatal Deaths

Neonatal tetanus
Infections acquired either at home or in

hospital (special neonatal care)

PREVENTION
Perinatal and neonatal mortality are often

due to preventable or treatable causes.

Strategies : 1) Reduce maternal morbidity
& mortality
2) Programmes ensuring a
continuum of care for the woman
and her baby throughout
pregnancy, childbirth and the
postpartum period

Antenatal Care & Maternal Health

Universal access to high- quality antenatal

care, obstetric care & care of the newborn

Good maternal nutrition
Prevent & manage anaemia
Early detection and management of STDs,
infections and complications during
pregnancy and delivery
Treatment of maternal diseases/
complications during pregnancy
Safe and clean delivery

Perinatal
Attend to physiological needs of newborn
Resuscitate if necessary
immediate breast-feeding
Warmth
hygiene (especially for delivery and cord

care)
prevention, early detection and management
of major diseases

Home Visits
Prevention strategy: skilled health care at home
Effective health measures at birth and in first two weeeks
Newborns
Promote and educate on early & exclusive breastfeeding;
help to keep the newborn warm (promoting skin-to-skin

contact between mother and infant)

promote hygienic umbilical cord and skin care
assess the baby for signs of serious health problems & advise
on care
encourage timely vaccination according to national schedules
identify and support newborns that need additional care (low
birth weight, sick babies) & advise on additional care
Provide home care where possible

Public Health
Public health interventions
Immunization
improved nutrition
water and sanitation

Treatment of diarrhoea, respiratory

infections, malaria and malnutrition.

Strengthen health systems: ensure adequate
facilities and skilled health care that are
easily accessible
Abolish harmful cultural practices that may
contribute to perinatal & neonatal mortality

Limitations
Lack of healthcare workers
Existing cultural practices
Access to services
Quality of Services

References
1. http://cdn.intechopen.com/pdfs-wm/37450.pdf
2. http://
3.

4.

5.

6.

www.un.org/millenniumgoals/childhealth.shtml
http://
www.unicef.org/progressforchildren/2007n6/i
ndex_41806.htm
http://
www.slideshare.net/oerafrica/saving-mothers-a
nd-babies-perinatal-mortality
http://www.who.int/maternal_child_adolescent
/epidemiology/en
/
http://
www.cpc.unc.edu/measure/prh/rh_indicators/spe

Neonatal and Perinatal Mortality:

Country, Regional and Global Estimates.

WHO 2006.
Froen et al Causes of death and associated
conditions (Codac) a utilitarian approach
to the classification of perinatal deaths
BMC Pregnancy and Childbirth 2009
9:22DOI: 10.1186/1471-2393-9-22
UNICEF Child Mortality Estimates: CountrySpecific neonatal mortality rate. Last
update: 9 September 2015