Abstract:
BACKGROUND: Reviews of perinatal deaths are mostly facility based. Given the number of women who, globally,
deliver outside of facilities, this data may be biased against total population data. We aimed to analyse population
based perinatal mortality data from a LMIC setting (Mpumalanga, South Africa) to determine the causes of perinatal
death and the rate of maternal complications in the setting of a perinatal death.
METHODS : A secondary analysis of the South African Perinatal Problems Identification Program (PPIP) database for
the Province of Mpumalanga was undertaken for the period October 2013 to January 2014, inclusive. Data on each
individual late perinatal death was reviewed. We examined the frequencies of maternal and fetal or neonatal
characteristics in late fetal deaths and analysed the relationships between maternal condition and fetal and/or
neonatal outcomes. IBM SPSS Statistics 22.0 was used for data analysis.
RESULTS : There were 23503 births and 687 late perinatal deaths (stillbirths of ≥ 1000gr or ≥ 28 weeks gestation and
early neonatal deaths up to day 7 of neonatal life) in the study period. The rate of maternal complication in
macerated stillbirths, fresh stillbirths and early neonatal deaths was 50.4%, 50.7% and 25.8% respectively. Mothers in
the other late perinatal deaths were healthy. Maternal hypertension and obstetric haemorrhage were more likely in
stillbirths (p = <0.01 for both conditions), whereas ENNDs were more likely to have a healthy mother (p < 0.01). The
main causes of neonatal death were related to immaturity (48.7%) and hypoxia (40.6%). 173 (25.2%) of all late perinatal
deaths had a birth weight less than the 10th centile for gestational age.
CONCLUSION : A significant proportion of women have no recognisable obstetric or medical condition at the time of a
late perinatal death; we may be limited in our ability to predict poor perinatal outcome if emphasis is put on detecting
maternal complications prior to a perinatal death. Intrapartum care and hypertensive disease remain high priority areas
for addressing perinatal mortality. Consideration needs to be given to novel ways of detecting growth restriction in a
LMIC setting.
