PERINATALMORTALITY EditedbyOliverC.Ezechi andKarenOdberg‐Petterson Perinatal Mortality Edited by Oliver C. Ezechi and Karen Odberg-Petterson Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romina Skomersic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published June, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Perinatal Mortality, Edited by Oliver C. Ezechi and Karen Odberg-Petterson p. cm. ISBN 978-953-51-0659-3 Contents Preface VII Chapter 1 Overview of Global Perinatal Mortality 1 Oliver C. Ezechi and Agatha N. David Chapter 2 The Effect of Intrauterine Development and Nutritional Status on Perinatal, Intrauterine and Neonatal Mortality: The MDN System 11 Péter Berkő and Kálmán Joubert Chapter 3 Current Trends in Perinatal Mortality in Developing Countries: Nigeria as a Case Study 27 Uchenna Onwudiegwu and Ibraheem Awowole Chapter 4 Neonatal Mortality: Incidence, Correlates and Improvement Strategies 37 Sajjad ur Rahman and Walid El Ansari Chapter 5 Perinatal Mortality in Multiple Pregnancy 73 Patricia Steenhaut and Corinne Hubinont Chapter 6 Helicopter Transportation for Perinatal and Maternal Emergency Care in Japan 101 Ryuzo Higuchi and Sawako Minami Chapter 7 The Contribution of Severe Pre-Eclampsia and Eclampsia to Perinatal Mortality in a Nigerian Teaching Hospital 111 Olufemiwa Niyi Makinde Chapter 8 A Survey of Late Fetal Deaths in a Japanese Prefecture 121 Ryuzo Higuchi and Sawako Minami Chapter 9 Super Eyes and Hands for Future Fetal Intervention 131 Hiromasa Yamashita, Takashi Kakimoto, Wenji Yuan and Toshio Chiba Preface It gives us great pleasure to present the book “Perinatal Mortality”. We have taken greatpaintoensurequalityandthatcurrentarticles onthesubjectofperinatologyare included. A variety of subjects ranging from global overview of perinatal mortality, trends in low income countries, effect of some medical disorders on perinatal morbidity and mortality, strategies for its prevention and control, and future trends werecoveredbyexpertsinthefield. The information presented in the book will, hopefully, benefit not only professionals intheperinatalmedicine,butalsootherclinicians,scientistsandstudentswhowould like to improve and expand their understanding of perinatal mortality and the best strategiestoitsreduction,bothinlowandhighincomecountries. I thank all the contributing authors who have generously given their expertise and time to make this book a reality. They kept the deadline despite their very busy and tight schedules. This show of scholarship is greatly appreciated. To colleagues who assisted with peer‐review of the chapters, we cannot thank you enough. We have to respect your wish of remaining unanimous, otherwise we would have preferred to documentyournamesinthisbookforposterity. TechnicalassistanceprovidedbyInTech EditorialOfficeduring theproductionofthe bookisgratefullyacknowledged. OliverC.Ezechi ChiefResearchFellow&ConsultantObstetricianandGynaecologist, DivisionofClinicalSciences,NigerianInstituteofMedicalResearch(NIMR), Lagos, Nigeria KarenOdberg‐Pettersson FacultyofMedicine,LundUniversity, Sweden 1 Overview of Global Perinatal Mortality Oliver C. Ezechi and Agatha N. David Division of Clinical Sciences, Maternal, Reproductive and Child Health Research Programme, Nigerian Institute of Medical Research, Lagos 1. Introduction Perinatal mortality refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. The perinatal period is the most vulnerable period in the life of an individual and the rate of death during this period is higher than at any other period of life. Deaths during this short period equal the rate of death over the next forty year period. Social, cultural, environmental and genetic factors all play vital roles in determining the outcome of this period of life. Perinatal mortality is at an unacceptably high level in low income countries, especially those in sub-Saharan Africa and south central Asia [1]. Recent estimates show that the perinatal mortality rate in high income countries of the world is about 10 per 1000 live births compared with 50 per 1000 live births in low income countries [2]. These figures are particularly troubling because the perinatal mortality rate is a key indicator of the health status of a community. Specifically, it reflects the quality of prenatal, delivery and early infant care practices available in any setting. It is also a major contributor to overall under- five mortality [1]. Reducing the 1990 childhood mortality levels by two-thirds by the year 2015 is one of the Millennium Development Goals (MDG-4) set by the United Nations. Recent evidence shows that perinatal mortality accounts for about 40% of infant mortality globally (Figure 1). In addition 75% of all neonatal deaths occur during the perinatal period. It is therefore obvious that MDG-4 cannot be achieved without substantially reducing these perinatal deaths most especially in the high burden countries of south central Asia and sub Saharan Africa. [3, 4]. While substantial gains have been made in the reduction of infant and under5 mortality rates (IMR and U5MR), same cannot be said for perinatal and neonatal mortality rates. As a result of this disparity, neonatal mortality now accounts for a greater proportion of IMR. Neonatal mortality was responsible for 27% of IMR globally in 1970 but accounted for 41% of IMR in 2010 [5]. In countries with low IMR and U5MR, the NMR accounts for an even higher proportion of IMR [1-5]. Perinatal Mortality 2 Fig. 1. Child mortality and stillbirth rates in 2000 – adapted from WHO 2005 1 While perinatal mortality rate is a useful indicator of the quality of antenatal and perinatal care, its wholesale application in international comparisons can be misleading if a number of factors and important determinants that need to be assessed separately before reaching conclusions about quality-of-care issues are not taken into consideration [6]. This chapter provides a general overview of perinatal mortality. It will address the burden of perinatal mortality and its contribution to global childhood deaths. The relationship between quality of antenatal and perinatal care and risk factors for perinatal mortality, and how these lead to the perinatal mortality rate will be discussed. Finally evidence based strategies for reduction and prevention of perinatal mortality and future thrust will be highlighted. 2. Definition of terms Neonatal Period: The first 28 days of post natal life is the neonatal period. It is subdivided into the immediate (first 24hours), early (first 7 days) and late (8-28 days) neonatal periods. Perinatal Period: This is the period from the age of viability of the fetus to the first 7 days of postnatal life. Live birth: A product of conception which, after complete extraction from its mother, shows signs of life such as breathing, beating of the heart, umbilical cord pulsation or spontaneous movement of voluntary muscles regardless of gestational age and whether the cord has been cut or the placenta has been extracted or not. Stillbirth: Still birth refers to fetal mortality or death. According to WHO, stillbirth is the birth of a baby with a birth weight of 500 g or more, 22 or more completed weeks of gestation, or a body length of 25 cm or more, who died before or during labour and birth. For international comparisons, WHO recommends reporting of stillbirths with birth weight of 1000 g or more, 28 weeks’ gestation or more, or a body length of 35 cm or more [4 ]. [...]... Global Perinatal Mortality Neonatal mortality: Neonatal mortality (NM) refers to neonatal death It is the death of a new born within the first 28 days of life It can also be divided into death of a live-born baby within the first seven days of life (early neonatal mortality- ENM) and death after 7 days until 28th day of life (late neonatal mortality- LNM) NM = ENM + LNM Perinatal Mortality: Perinatal mortality. .. predisposes women to low birth weight infants and perinatal death Maternal status of high parity and extremes of age (less than 18 years and greater than 45 years) are associated with poor birth outcomes and perinatal morbidity and mortality Low socioeconomic status of the mother has been shown to be associated with higher perinatal mortality rate Effective and appropriate maternal interventions such... development and nutritional status on perinatal mortality in the groups of Hungarian premature and mature infants By comparing the perinatal mortality (PM) of Hungarian preterm and full-term neonates, using the data given in Figure 6, we can conclude the following: (1) absolutely averagely developed and nourished (AA) preterm infant mortality is 28 times as high as that of the full-term AA group, and (2)... "extended perinatal mortality" (EPM), which includes intrauterine deaths (IUM) and live-born infant Day 1-28 mortality (NM) The Effect of Intrauterine Development and Nutritional Status on Perinatal, Intrauterine and Neonatal Mortality: The MDN System 21 In view of facts described above, let us graphically represent the perinatal (PM), intrauterine (IU) and neonatal (NM, day 1-28) Hungarian mortality. .. prevention of perinatal mortality and morbidity WHO Technical Report Series No 457, Geneva Wilcox, A., Russell, JT (1983) Birthweight and perinatal mortality: II On weight-specific mortality Intern J Epidem, 12, pp 319-326 26 Perinatal Mortality Wilcox, A., Russell, I (1990) Why small black infants have a lower mortality rate than small white infants: The case for population-specific standards for birth... or etalon group on the basis of their weight and length 18 Perinatal Mortality Fig 4 Perinatal mortality rates (‰) of the entire Hungarian neonate population (gestational age 24-43 weeks) born between 1997 and 2003, as represented by the cells of the MDN matrix Relying on the birth data of neonates born between 1997 and 2003, the authors find perinatal mortality rate to be 8.9‰in Hungary in that period... reduction in perinatal mortality Overview of Global Perinatal Mortality 9 6 Conclusion Low income countries account for 97-98 percent of reported global perinatal deaths This accounts for 68-70% of annual global under five mortality It is therefore not possible to achieve the stated MDG 4 goal of reducing infant mortality rate by two thirds of 1990 rates by 2015 without addressing the causes and determinants... world health report 2005: make every mother and child count Geneva: World Health Organization, 2005 [2] WHO Neonatal and perinatal mortality: Country, Regional and Global Estimates World Health Organization 2006 [3] Zupan J, Aahman E Perinatal mortality for the year 2000: estimates developed by WHO Geneva: World Health Organization, 2005 [4] Zupan J Perinatal Mortality in Developing Countries N Engl J... development and nutritional status (Figure 7 and Table 6) It is clear to see that growth retardation and overnourishment nearly identically increase the intrauterine and Fig 7 Comparison of intrauterine and neonate mortality (‰) based on the MDN matrix Nourishment 680,947 newborns, 1997-2003 Overnourished Perinatal mortality (‰) Intrauterine mortality (‰) 8.9 Abbreviations 4.3 Day 1-28 neonatal mortality. .. with the letters (W and L) and numbers (1-8) of its weight and length zones For example, if the birth weight of a newborn is in weight zone 6, i.e., between weight percentile curves 75 and 90, and its length is in length zone 2, i.e., between percentile curves 3 and 10, then the standard positions of this baby are W6 and L2 2.2 Description of the nutritional status To characterize and decribe the nutritional . PERINATAL MORTALITY Edited by Oliver C. Ezechi and Karen Odberg‐Petterson Perinatal Mortality Edited by Oliver C. Ezechi and. Additional hard copies can be obtained from orders@intechopen.com Perinatal Mortality, Edited by Oliver C. Ezechi and Karen Odberg-Petterson p. cm. ISBN