Epidemiological investigation of perinatal deaths in Recife-Pernambuco: a quality assessment

Heráclio, Isabela de Lucena; Silva, Maysa Almeida da; Vilela, Mirella Bezerra Rodrigues; Oliveira, Conceição Maria de; Frias, Paulo Germano de; Bonfim, Cristine Vieira do

doi:10.1590/0034-7167-2017-0916

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 71 (5) • Sep-Oct 2018 • https://doi.org/10.1590/0034-7167-2017-0916 copy

Epidemiological investigation of perinatal deaths in Recife-Pernambuco: a quality assessment

Evaluación de la calidad de la investigación epidemiológica de las muertes perinatales, Recife-Pernambuco

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to evaluate the completeness of perinatal death investigation sheets, stratified by age components.

Method:

descriptive study carried out in Recife, PE, in 2014. Among 308 perinatal deaths, 46 were excluded from this study due to association with congenital malformations, and 7 due to missing investigation sheets. Analysis included 255 deaths (160 fetal deaths, and 95 preterm neonatal deaths). The degree of completeness of 98 variables was calculated. They were aggregated into six blocks: identification, prenatal care, birth care, family characteristics, occurrence of death and conclusions and recommendations.

Results:

the median rate of completeness for perinatal death investigation sheets was 85.7% (82.8% for records of fetal deaths and 89.5% for records of preterm neonatal deaths). The best-filled information block was “identification” (96.1%), as well as its components: fetal (94.7%) and preterm neonatal (97.9%). The worst was “prenatal care” (69.8%), along with its components: fetal (73.8%) and preterm neonatal (67.4%).

Conclusion:

investigation sheets had good completeness; there were differences between variables and components of perinatal death.

Descriptors:
Perinatal Mortality; Epidemiological Surveillance; Vital Statistics; Health Information Systems; Public Health

Variable block					Age components
	Perinatal				Fetal				Preterm neonatal
	Mean ± SD	Median	Min.	Max.	Mean ± SD	Median	Min.	Max.	Mean ± SD	Median	Min.	Max.
Identification	82.5 ± 18.05	96.1	40	100	84.4 ± 18.96	94.7	44.4	100	92.2 ± 19.83	97.9	32.6	100
Prenatal care	67.6 ± 25,9	69.8	26.7	98.4	67.6 ± 25.7	73.8	26.3	98.1	67.6 ± 26.5	67.4	24.2	100
Birth care	74.1 ± 31.6	87.1	10.6	100	66.2 ± 37	81.9	7.5	100	76 ± 30	89.5	13.7	100
Family characteristics	79.2 ± 6	82.4	62.4	83.5	77.4 ± 5	79.4	63.1	81.3	82.4 ± 7.8	86.3	61.1	87.4
Occurrence of death	69.7 ± 32.9	80	15.3	99.6	73.2 ± 29.2	82.8	30	7.4	70.5 ± 35.8	82.1	7.4	100
Conclusions and recommendations	78.6 ± 22.9	85.7	12.2	100	80.9 ± 19.8	85	10.6	100	86.1 ± 17.1	91.6	14.7	100

Variables				Age components
	Perinatal			Fetal			Preterm neonatal
	n	%	Cl^* * classification; FHS = Family Health Strategy; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable	n	%	Cl^* * classification; FHS = Family Health Strategy; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable	n	%	Cl^* * classification; FHS = Family Health Strategy; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable
Moment of death	255	100.0	E	160	100.0	E	95	100.0	E
Sex	255	100.0	E	160	100.0	E	95	100.0	E
Age	94	98.9	E	NA			94	98.9	E
Race/color	200	78.4	P	110	68.8	P	90	94.7	G
Mother's age	253	99.2	E	158	98.8	E	95	100.0	E
Mother's race/color	200	78.4	P	110	68.8	P	90	94.7	G
Mother's level of education	244	95.7	E	151	94.4	B	93	97.9	E
Mother's occupation	245	96.1	E	152	95.0	B	93	97.9	E
Marital status	215	84.3	RE	122	76.3	P	93	97.9	E
Partner occupation	102	40.0	VP	71	44.4	VP	31	32.6	VP
Area covered by the FHS	250	98.0	E	156	97.5	E	94	98.9	E
Block average	82.5			84.4			92.2

Variables				Age components
	Perinatal			Fetal			Preterm neonatal
	n	%	Cl^* * classification; NB = Newborn; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable	n	%	Cl^* * classification; NB = Newborn; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable	n	%	Cl^* * classification; NB = Newborn; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable
Prenatal care
Prenatal	251	98.4	E	156	97.5	E	95	100.0	E
Prenatal unit type	204	80.0	R	135	84.4	RE	69	72.6	R
Starting month of prenatal period	199	78.0	R	123	76.9	R	76	80.0	R
Number of medical consultations	205	80.4	RE	129	80.6	RE	76	80.0	R
Familial antecedents	149	58.4	R	94	58.8	R	55	57.9	R
Personal antecedents	116	45.5	MR	69	43.1	MR	47	49.5	MR
Complementary examinations	161	63.1	R	104	65.0	R	57	60.0	R
Procedures	178	69.8	R	118	73.8	R	60	63.2	R
Risk factors	120	47.1	MR	74	46.3	MR	46	48.4	MR
Complications	170	66.7	R	106	66.3	R	64	67.4	R
Treatment	84	32.9	MR	52	32.5	MR	32	33.7	MR
Number of previous pregnancies	251	98.4	E	157	98.1	E	94	98.9	E
Number of vaginal deliveries	233	91.4	B	142	88.8	RE	91	95.8	E
Number of cesarean deliveries	232	91.0	B	141	88.1	RE	91	95.8	E
Number of live births	250	98.0	E	156	97.5	E	94	98.9	E
Number of fetal losses/abortions	251	98.4	E	157	98.1	E	94	98.9	E
Interval between the last two pregnancies	79	31.0	MR	56	35.0	MR	23	24.2	MR
Pre-gestational weight	74	29.0	MR	43	26.9	MR	31	32.6	MR
Maternal height	68	26.7	MR	42	26.3	MR	26	27.4	MR
Birth care
Place of birth	255	100.0	E	160	100.0	E	95	100.0	E
Birth unit type	252	98.8	E	158	98.8	E	94	98.9	E
Partogram	49	51.6	R	NA			49	51.6	R
Induction of childbirth	211	82.7	RE	134	83.8	RE	77	81.1	RE
Rapid syphilis test	222	87.1	RE	137	85.6	RE	85	89.5	RE
HIV rapid test	198	77.6	R	126	78.8	R	72	75.8	R
Gestational age	253	99.2	E	158	98.8	E	95	100.0	E
Type of pregnancy	255	100.0	E	160	100.0	E	95	100.0	E
Type of birth	255	100.0	E	160	100.0	E	95	100.0	E
Caesarean section indication	53	20.8	MR	40	25.0	MR	13	13.7	MR
Pre-delivery intervention	36	14.1	MR	15	9.4	MR	21	22.1	MR
Sac rupture time	76	29.8	MR	34	21.3	MR	42	44.2	MR
Amniotic fluid odor	27	10.6	MR	12	7.5	MR	15	15.8	MR
Appearance of amniotic fluid	111	43.5	MR	60	37.5	MR	51	53.7	R
Birth weight	255	100.0	E	160	100.0	E	95	100.0	E
Assisted birth	219	85.9	RE	128	80.0	R	91	95.8	E
Apgar score 1-min	91	95.8	E	NA			91	95.8	E
Apgar score 5-min	92	96.8	E	NA			92	96.8	E
NB with issues	84	88.4	RE	NA			84	88.4	RE
NB length of stay in maternity ward	94	98.9	E	NA			94	98.9	E
Reason for permanence	70	73.7	R	NA			70	73.7	R

Variables				Age components
	Perinatal			Fetal			Preterm neonatal
	n	%	Cl^* * classification; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable	n	%	Cl^* * classification; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable	n	%	Cl^* * classification; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable
Family characteristics
Private health plan	194	76.1	P	120	75.0	P	74	77.9	P
Family income	196	76.9	P	122	76.3	P	74	77.9	P
Number of inhabitants in the residence	210	82.4	RE	127	79.4	P	83	87.4	RE
Number of ≤ 5 years old children	159	62.4	P	101	63.1	P	58	61.1	P
Number of dormitory rooms	210	82.4	RE	127	79.4	P	83	87.4	RE
Dwelling type	210	82.4	RE	128	80.0	P	82	86.3	RE
House construction material	211	82.7	RE	129	80.6	RE	82	86.3	RE
Water supply	213	83.5	RE	130	81.3	RE	83	87.4	RE
Destination of bodily waste	212	83.1	RE	129	80.6	RE	83	87.4	RE
Destination of trash	210	82.4	RE	127	79.4	P	83	87.4	RE
Access to health services	205	80.4	RE	126	78.8	P	79	83.2	RE
Availability of medical consultations	195	76.5	P	120	75.0	P	75	78.9	P
Occurrence of death
Place of occurrence	254	99.61	E	159	99.4	E	95	100.0	E
Unit type	253	99.22	E	158	98.8	E	95	100.0	E
Hospital length of stay	89	93.68	G	NA			89	93.7	G
Sector of occurrence	76	80.00	P	NA			76	80.0	P
Child/mother transferred from another unit	204	80.00	P	113	70.6	P	91	95.8	E
General condition at admission	39	15.29	VP	NA			35	36.8	VP
Diagnostic hypothesis at admission	165	64.71	P	87	54.4	P	78	82.1	RE
Final diagnosis	228	89.41	RE	152	95.0	G	76	80.0	P
Necropsy	247	96.86	E	159	99.4	E	88	92.6	G
Necropsy site	68	26.67	VP	61	38.1	VP	7	7.4	P
Necroscopic report	55	21.57	VP	48	30.0	VP	7	7.4	P

Variables				Age components
	Perinatal			Fetal			Preterm neonatal
	n	%	Cl^* * classification; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable.	n	%	Cl^* * classification; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable.	n	%	Cl^* * classification; E = excellent; G = good; RE = regular; P = poor; VP = very poor, NA = not applicable.
Investigation changed/corrected cause of death	255	100.0	E	160	100.0	E	95	100.0	E
Investigation changed another field of the death declaration	254	99.6	E	160	100.0	E	94	98.9	E
Investigation changed another field of the live birth declaration	87	96.1	E	NA			87	91.6	G
Issues identified after investigation	249	97.6	E	155	96.9	E	94	98.9	E
Access failure
To family planning	231	90.6	G	142	88.8	RE	89	93.7	G
To prenatal care	235	92.2	G	144	90.0	G	91	95.8	E
To childbirth assistance	223	87.5	RE	136	85.0	RE	87	91.6	G
To maternity ward newborn assistance	69	72.6	P	NA			69	72.6	P
Due to family difficulties	212	83.1	RE	127	79.4	P	85	89.5	RE
Care failure
Family planning	229	89.8	RE	141	88.1	RE	88	92.6	G
Prenatal care	234	91.8	G	145	90.6	G	89	93.7	G
Delivery	224	87.8	RE	135	84.4	RE	89	93.7	G
Maternity ward newborn assistance	68	71.6	P	NA			68	71.6	P
Due to family difficulties	214	83.9	RE	127	79.4	P	87	91.6	G
External causes	31	12.2	VP	17	10.6	VP	14	14.7	VP
In primary care coverage	227	89.0	RE	138	86.3	RE	89	93.7	G
In reference and counter-reference	198	77.6	P	117	73.1	P	81	85.3	RE
In high-risk prenatal care	196	76.9	P	116	72.5	P	80	84.2	RE
In a bed in the high-risk pregnancy intensive care unit	192	75.3	P	113	70.6	P	79	83.2	RE
In a bed in the neonatal intensive care unit	80	31.4	VP	NA			80	84.2	RE
In the control center	192	75.3	P	113	70.6	P	79	83.2	RE
In inter-hospital transport	191	74.9	P	113	70.6	P	78	82.1	RE
In blood banks	77	30.2	VP	NA			77	81.1	RE
Avoidability classification	255	100.0	E	160	100.0	E	95	100.0	E

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[1] CORRESPONDING AUTHOR: Cristine Vieira do Bonfim. E-mail: cristine.bonfim@uol.com.br