Brasilian List of Avidable Causes of Death that can be avoided by National Health System interventions, and its applicability for analysis of perinatal deaths in municipalities in the states of Rio de Janeiro and São Paulo, Brazil, 2011

Vieira, Fernanda Morena dos Santos Barbeiro; Kale, Pauline Lorena; Fonseca, Sandra Costa

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Epidemiologia e Serviços de Saúde

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Original article • Epidemiol. Serv. Saúde 29 (2) • 2020 • https://doi.org/10.5123/S1679-49742020000200019 copy

Brasilian List of Avidable Causes of Death that can be avoided by National Health System interventions, and its applicability for analysis of perinatal deaths in municipalities in the states of Rio de Janeiro and São Paulo, Brazil, 2011^* * This study received funding from the following institutions: São Paulo State Research Support Foundation (FAPESP) (Call for Proposals PPSUS 2009); Ministry of Health, via its Work Management and Health Education Secretariat (SGTES) and its Health Surveillance Secretariat (Health Work Education Program [PET-Saúde/SVS]); National Scientific and Technological Development Council / Ministry of Science, Technology, Innovation and Communications (CNPq/MCTIC); and the Rio de Janeiro State Carlos Chagas Filho Research Support Foundation (FAPERJ). This article is derived from the thesis written by Fernanda Morena dos Santos Barbeiro Vieira, entitled ‘Perinatal mortality and neonatal near miss: analysis of hospital-based and population-based birth cohorts with emphasis on the avoidability of causes of death and birth in life-threatening situations in Southeast Brazilian cities’, defended at the Federal University of Rio de Janeiro Institute of Public Health Studies Postgraduate Public Health Program, in August 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to assess the applicability of the Brazilian List of Avoidable Causes of Death (BAL) to perinatal mortality in public maternity hospitals in the states of Rio de Janeiro (RJ) and São Paulo (SP) in 2011.

Methods

this was a descriptive case series study of perinatal deaths using primary data from the Mortality Information System; the BAL was applied, with adaptations (codes P20.9 and P70-74) and, in addition in Rio de Janeiro the Extended Wigglesworth (EW) Classification was also used.

Results

according to the BAL, 61.2% of the 98 perinatal deaths were avoidable, mainly by providing adequate attention to women in pregnancy; ‘Ill-defined causes of death’ accounted for 26.6% of cases, mainly fetal deaths; use of EW in RJ indicated that the ‘Antepartum Fetal Death’ category was predominant and was related to inadequate prenatal care; this was in line with the BAL.

Conclusions

after reallocating some codes, the BAL can improve fetal death evaluation, whereby studies with a larger number of participants are needed.

Perinatal Mortality; Fetal Death; Early Neonatal Death; Cause of Death; International Classification of Diseases

Cause groups/categories and ICD-10 codes^a	RJ Center (36 deaths: 25 F and 11 EN)				SP Center (62 deaths: 40 F and 22 EN)			Total (98 deaths: 65 F and 33 EN)

	Fetal	Early neonatal	Total		Fetal	Early neonatal	Total	Fetal	Early neonatal	Total
	n	n	n		n	n	n	n	n	n (%)
1. Causes of avoidable deaths	13	9	22	21		17	38	34	26	60 (61.2)

1.2.1. Deaths reducible by adequate care of women during pregnancy	10	9	19	13		6	19	23	15	38

Early congenital syphilis (A50.0)	5	–	5	–		–	–	5	–	5
Fetus and newborn affected by maternal hypertensive disorders (P00.0)	4	2	6	3		3	6	7	5	12
Fetus and newborn affected maternal infectious diseases (P00.2)	–	–	–	2		–	2	2	–	2
Fetus and newborn affected by other maternal circulatory and respiratory diseases (P00.3)	–	–	–	1		–	1	1	–	1
Fetus and newborn affected by other maternal conditions (P00.8)	–	1	1	–		–	–	–	1	1
Fetus and newborn affected by premature rupture of membranes (P01.1)	–	1	1	1		2	3	1	3	4
Fetus and newborn affected by chorioamnionitis (P02.7)	–	1	1	2		–	2	2	1	3
Extremely low birth weight newborn (P07.0)	–	3	3	–		–	–	–	3	3
Unspecified pulmonary hemorrhage (P26.9)	–	–	–	–		1	1	–	1	1
Other low birth weight newborn (P07.1)	–	1	1	–		–	–	–	1	1
Syndrome of infant of diabetic mother (P70.1)	1	–	1	4		–	4	5	–	5

1.2.2. Deaths reducible by adequate care of women at childbirth	3	–	3	8		7	15	11	7	18

Fetus and newborn affected by placenta previa (P02.0)	-	–	–	1		–	1	1	–	1
Fetus and newborn affected by placental separation (P02.1)	3	–	3	5		3	8	8	3	11
Late newborn (P08.2)	–	–	–	1		–	1	1	–	1
Birth injury, unspecified (P15.9)	–	–	–	–		1	1	–	1	1
Intrauterine hypoxia during labor and delivery (P20.1)	–	–	–	1		–	1	1	–	1
Birth asphyxia (P21.9)	–	–	–	–		1	1	–	1	1
Meconium aspiration syndrome (P24.0)	–	–	–	–		1	1	–	1	1
Neonatal aspiration syndrome, unspecified (P24.9)	–	–	–	–		1	1	–	1	1

1.2.3. Deaths reducible by adequate care of fetus and newborn	–	–	–	–		3	3	–	3	3

Respiratory failure of newborn (P28.5)	–	–	–	–		1	1	–	1	1
Bacterial sepsis of newborn, unspecified (P36.9)	–	–	–	–		1	1	–	1	1
Other specified perinatal digestive system disorders (P78.8)	–	–	–	–		1	1	–	1	1

1.4. Deaths reducible by adequate health promotion actions, linked to adequate health care actions	–	–	–	–		1	1	–	1	1

Other slipping, tripping and stumbling and falls (W18)	–	–	–	–		1	1	–	1	1

2. Ill-defined causes of death	10	–	10	16		–	16	26	–	26 (26.6)

Fetal death of unspecified cause (P95)	10	–	10	16		–	16	26	–	26

3. Other causes (not clearly avoidable)	2	2	4	3		5	8	5	7	12 (12.2)

Anencephaly and similar malformations (Q00)	1	1	2	–		2	2	1	3	4
Congenital hydrocephalus (Q03)	–	–	–	–		1	1	–	1	1
Other congenital malformations of heart (Q24)	–	1	1	1		–	1	1	1	2
Congenital malformations of lung (Q33)	–	–	–	–		1	1	–	1	1
Renal agenesis, bilateral (Q60.1)	–	–	–	–		1	1	–	1	1
Other congenital malformations (Q80-Q89)	1	–	1	2		–	2	3	–	3

Categories	Fetal	Early neonatal	TOTAL

	n	n	n
Group 1 – Malformation	2	2	4
Group 2 – Antepartum fetal death	16	–	16
Group 3 – Intrapartum death	2	1	3
Group 4 – Prematurity	–	8	8
Group 5 – Perinatal/maternal infection	5	–	5

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Fernanda Morena dos Santos Barbeiro Vieira – Rua Antônio Silva, n^o 34, apto. 502, Fonseca, Niterói, RJ, Brazil. Postcode: 24130-175 E-mail: nurse_fe@hotmail.com