A glance over the surveillance of fetal deaths of Jaboatão dos Guararapes in the Brazilian state of Pernambuco, Brazil, in 2014

Maria, Lidian Franci Batalha Santa; Araújo, Thália Velho Barreto de

doi:10.1590/1413-812320172210.17572017

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ARTICLE • Ciênc. saúde colet. 22 (10) • Oct 2017 • https://doi.org/10.1590/1413-812320172210.17572017 linkcopy

A glance over the surveillance of fetal deaths of Jaboatão dos Guararapes in the Brazilian state of Pernambuco, Brazil, in 2014

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to achieve a complete evaluation of the records of investigation, and the principal indicators of fetal death surveillance of Jaboatão dos Guararapes, Pernambuco State, and their contributions Mortality Information System (Sistema de Informações sobre Mortalidade – SIM). The population of the study comprised all fetal deaths taking place in the year 2014, of people resident in the town. The data were obtained from death investigation records and the databank of the SIM. The completeness of the report forms of 68 fetal deaths, and 13 variables in the death certificates, before and after the investigation, was analyzed. In 2014 the rate of fetal mortality was 10.3‰. Of the 102 deaths, 86.3% (88) were investigated, and 67% (59) were investigated within a period of 120 days. Only nine (10.2% of the deaths investigated) were the subject of a final discussion to complete investigation. The Hospital Form was the most frequently filled in, and the Summary Form was the form most completely filled in. The Outpatient Form was the least well filled-in. In the death certificates, there were rectifications made in the 13 variables studied. The results showed deficiencies and operational difficulties in Fetal Death Surveillance in Jaboatão dos Guararapes. Conversely, the study revealed the contribution of the investigation process in qualifying of the SIM.

Fetal deaths; Epidemiology Surveillance; Health evaluation; Health information systems

Blocks / Variables	Forms (n=11)

	%	Completeness level*
Identification
Number of the death certificate	100.00	Excellent
Mother’s name	100.00	Excellent
Date of death	90.91	Good
Number of mother’s SUS card	0.00	Very bad
Gender	90.91	Good
Weight at birth	72.73	Bad
Length of pregnancy	63.64	Bad
Health/administrative district	0.00	Very bad
Coverage	36.36	Very bad
SUBTOTAL (09)	61.62	Bad
Prenatal care
Location of prenatal care	100.00	Excellent
Establishment CNES code	0.00	Very bad
Type of provider in the prenatal care	81.82	Regular
Length of pregnancy at first consultation	90.91	Good
Number of prenatal consultations	90.91	Good
Number of pregnancies	100.00	Excellent
Number of abortions	100.00	Excellent
Number of normal births	100.00	Excellent
Number of caesarean births	100.00	Excellent
High risk pregnancy	90.91	Good
Whether did high risk prenatal care	72.73	Bad
Location of HRPNC	72.73	Bad
Fetus age at start of HRPNC	72.73	Bad
Did PNC in basic care unit with HRPNC	63.64	Bad
Hospitalized during pregnancy	54.55	Bad
Number of hospitalizations	54.55	Bad
Reason(s) for admission	54.55	Bad
Hospitalization IG	54.55	Bad
Hospitalization location	54.55	Bad
Risk factors	63.64	Bad
Medication	63.64	Bad
Tetanus vaccination	27.27	Very bad
Prenatal care description	81.82	Regular
Home visit by the Health Team	9.09	Very bad
Reason for visit	9.09	Very bad
Examinations situation	81.82	Regular
Causes in patient’s medical record	36.36	Very bad
General remarks	0.00	Very bad
Remarks of interviewer	0.00	Very bad
SUBTOTAL (29)	61.44	Bad
TOTAL (38)	61.48	Bad

Blocks / Variables	Forms (n=65)

	%	Completeness level*
Identification
Number of death certificate	100.00	Excellent
Mother’s name	100.00	Excellent
Date of death	100.00	Excellent
Gender	98.46	Good
Weight at birth	100.00	Excellent
Period of pregnancy	98.46	Excellent
Mother’s SUS card number	10.77	Very bad
SUBTOTAL (07)	86.81	Regular
Healthcare at birth
Date of birth	100.00	Excellent
Time of birth	95.38	Excellent
Location of birth	100.00	Excellent
Type of birth	98.46	Excellent
Professional assisting birth	100.00	Excellent
Time of breaking of membrane	64.62	Bad
Aspect of amniotic liquid	53.85	Bad
Maternal complications during labor	73.85	Bad
Health establishment where birth took place	100.00	Excellent
Establishment CNES code	33.85	Very bad
Type of hospital/maternity institution	100.00	Excellent
Number of pregnancies	98.46	Excellent
Number of abortions	96.92	Excellent
Number of children born alive	89.23	Regular
Number of stillbirths	92.31	Good
Number of normal births	90.77	Good
Number of caesarean births	89.23	Regular
Date of last prior birth	38.46	Very bad
Risk factors	72.31	Bad
Medication during pregnancy	40.00	Very bad
Date of hospitalization	100.00	Excellent
Time of hospitalization	83.08	Regular
Condition on hospitalization	90.77	Good
Mother examined before going to delivery room	100.00	Excellent
Presentation of the birth	67.69	Bad
Blood tests on admission	96.92	Excellent
Birth chart	93.85	Good
Number of maternal evaluations	84.62	Regular
Number of fetal evaluations	83.08	Regular
Longest interval without maternal evaluation	80.00	Regular
Longest interval without fetal evaluation	78.46	Bad
Medication used	78.46	Bad
Indication for caesarean section	96.92	Excellent
Anesthesia	83.08	Regular
Type of anesthesia	81.54	Regular
Other methods for relief of pain	58.46	Bad
SUBTOTAL (36)	82.91	Regular
Annotations on the stillborn child
Professional assisted child in delivery room	84.62	Regular
Reanimation attempt	93.85	Good
Conditions of birth	95.38	Excellent
Problems of fetus	55.38	Bad
Maternal problems affecting the fetus	70.77	Bad
Body sent to autopsy	92.31	Good
Causes in patient’s medical record	67.69	Bad
General observations	16.92	Very bad
Interviewer’s remarks	41.54	Very bad
SUBTOTAL (09)	68.72	Bad
TOTAL (52)	80.98	Regular

Blocks / Variables	Forms (n=23)

	%	Completeness level*
Identification
Number of death certificate	100.00	Excellent
Mother’s name	100.00	Excellent
Date of death	100.00	Excellent
Gender	100.00	Excellent
Weight at birth	95.65	Excellent
Period of pregnancy	86.96	Regular
Mother’s SUS card number	17.39	Very bad
Coverage	52.17	Bad
Health/administrative district	8.70	Very bad
District	82.61	Regular
SUBTOTAL (10)	74.35	Bad
Characteristics of the mother and the family
Name of interviewee	73.91	Bad
Relationship to the child	95.65	Excellent
Number of persons in the home	100.00	Excellent
Number of bedrooms in the home	100.00	Excellent
Number of water points	100.00	Excellent
Smokers in the home	91.30	Good
Number of smokers	82.61	Regular
Mother’s age	100.00	Excellent
Remunerated work	78.26	Bad
Mother’s level of schooling	100.00	Excellent
Conjugal situation	100.00	Excellent
Mother's race/color	100.00	Excellent
Number of prior pregnancies	100.00	Excellent
Number of abortions	100.00	Excellent
Number of children born alive	95.65	Excellent
Number of children still born	95.65	Excellent
Number of normal births	95.65	Excellent
Number of caesarean births	91.30	Good
Date of last prior birth	30.43	Very bad
Did anyone of children born alive die	86.96	Regular
Age of sibling who died	86.96	Regular
Cause of death of sibling who died	86.96	Regular
Person who cared for sibling who died	86.96	Regular
SUBTOTAL (23)	90.36	Good
Pregnancy and prenatal care
Planned pregnancy	95.65	Excellent
Information on contraceptive methods	86.96	Regular
Mother did PNC	100.00	Excellent
Reason why did not do PNC	100.00	Excellent
Month when PNC started	100.00	Excellent
Reason for not starting PNC in first three months	95.65	Excellent
Number of PN consultations	100.00	Excellent
Took anti-tetanus vaccine	95.65	Excellent
Number of doses	91.30	Good
Location of PNC	95.65	Excellent
Type of provider of PNC	91.30	Good
Difficulties consultation Health Center	60.87	Bad
Health center. Which?	60.87	Bad
Difficulties in HRPNC	65.22	Bad
HRPNC. Which?	65.22	Bad
Difficulties in examinations	65.22	Bad
Examinations. Which?	60.87	Bad
Difficulties ultrasound	65.22	Bad
Ultrasound. Which?	56.52	Bad
Difficulties drugs	56.52	Bad
Drugs. Which?	56.52	Bad
Was there referral of maternity unit	95.65	Excellent
Maternity unit referred	95.65	Excellent
How evaluates PNC care	95.65	Excellent
PNC card complete	95.65	Excellent
PNC situation	78.26	Bad
Risk factors	91.30	Good
Was there treatment	95.65	Excellent
In which month of pregnancy	95.65	Excellent
Use of cigarettes	91.30	Good
Use of drugs	91.30	Good
Use of alcoholic beverages	91.30	Good
SUBTOTAL (32)	83.83	Regular
Care at the birth
Reason for seeking care	95.65	Excellent
If baby stopped moving, how long before the birth?	91.30	Good
Time between start of signs and seeking of care	69.57	Bad
Time membrane broke	73.91	Bad
Aspect of liquid	52.17	Bad
Length of pregnancy at birth	91.30	Good
Location of birth	100.00	Excellent
Reason not having happened in hospital	100.00	Excellent
Birth took place at maternity unit indicated in PNC	100.00	Excellent
Reason it did not happen in the maternity unit indicated	78.26	Bad
Birth took place at first maternity unit sought	100.00	Excellent
Number of establishments sought	100.00	Excellent
Means of transport used at time of birth	100.00	Excellent
Waiting time for care	95.65	Excellent
Accompanying person in delivery room	95.65	Excellent
Mother examined before going to delivery room	91.30	Good
Presence of fetal heartbeats	95.65	Excellent
Who carried out the birth	86.96	Regular
How assesses care in the maternity unit	100.00	Excellent
Reason for assessment	95.65	Excellent
SUBTOTAL (20)	90.65	Good
Information on the stillborn child
Sign of life at birth	91.30	Good
Period of time of signs of life	91.30	Good
Reanimation attempted	86.96	Regular
Professional who attempted reanimation	78.26	Bad
Death in relation to the birth	78.26	Bad
Weight at birth	86.96	Regular
Premature	60.87	Bad
Family’s remarks	100.00	Excellent
Family’s prior events	86.96	Regular
Interviewer’s remarks	65.22	Bad
Repercussions in the family	34.78	Very bad
SUBTOTAL (11)	78.26	Bad
TOTAL (96)	85.19	Regular

Variables	Forms (n=08)

	%	Completeness level*
Moment of fetal death	87.50	Regular
Mother’s name	100.00	Excellent
Number of death certificate	100.00	Excellent
Date of death	100.00	Excellent
Gender	100.00	Excellent
Weight at birth	100.00	Excellent
Length of pregnancy	87.50	Regular
Age range at death	100.00	Excellent
Mother’s age	100.00	Excellent
Mother’s level of schooling	75.00	Bad
Municipality of residence	100.00	Excellent
Municipality of occurrence	100.00	Excellent
Summary of the case	87.50	Regular
Sources of information	100.00	Excellent
Health establishment where did PNC	100.00	Excellent
Type of establishment of PNC	100.00	Excellent
Length of pregnancy at first consultation	100.00	Excellent
Location of birth	100.00	Excellent
Establishment where birth occurred	100.00	Excellent
Type of establishment of birth	100.00	Excellent
Use of birth charts	87.50	Regular
VDRL carried out	100.00	Excellent
Investigation altered/corrected cause of death	100.00	Excellent
Causes of death after the investigation	87.50	Regular
Basic cause after investigation	87.50	Regular
Alteration/correction of other field of the death certificate	100.00	Excellent
Problems identified after the investigation	100.00	Excellent
Family planning – failing in access/care	100.00	Excellent
Prenatal care – failing in access/care	100.00	Excellent
Care at birth – failing in access/care	100.00	Excellent
Family’s difficulties	100.00	Excellent
External causes	100.00	Excellent
Problems in primary healthcare coverage	100.00	Excellent
Problems in referral and counter-referral	100.00	Excellent
Problems in HRPNC	100.00	Excellent
ICU bed availability – high risk mother	100.00	Excellent
ICU bed availability – neonatal	100.00	Excellent
Problems at regulation center	100.00	Excellent
Transport problems pre- and inter-hospital	100.00	Excellent
Blood bank problems	100.00	Excellent
Avoidable death	100.00	Excellent
Expanded Wigglesworth classification	0.00	Very bad
SEADE Foundation classification	0.00	Very bad
Brazilian List classification	100.00	Excellent
Family planning recommendations	100.00	Excellent
PNC recommendations	100.00	Excellent
Birth care recommendations	100.00	Excellent
Recommendations of care for newborn in maternity unit	100.00	Excellent
Recommendations on organization of health system/service	100.00	Excellent
Date of conclusion	100.00	Excellent
TOTAL (50)	94.00	Good

Variables – death certificate (n=102)	Before investigation		After investigation		Changes made after fetal death oversight n (%)

	%	Completeness level*	%	Completeness level*
Gender	99.02	Excellent	100.00	Excellent	1 (1.0)
Weight at birth	92.16	Good	99.02	Excellent	7 (6.9)
Length of pregnancy	80.39	Regular	92.16	Good	15 (14.7)
Mother’s age	86.27	Regular	91.18	Good	7 (6.9)
Mother’s level of schooling	79.41	Bad	85.29	Regular	14 (13.7)
District of residence	98.04	Excellent	99.02	Excellent	3 (2.9)
Location of occurrence	100.00	Excellent	100.00	Excellent	5 (4.9)
Establishment where birth took place	98.04	Excellent	99.02	Excellent	5 (4.9)
Number of children born alive	86.27	Regular	93.14	Good	10 (9.8)
Number of children born dead	85.29	Regular	93.14	Good	49 (48.0)
Type of birth	94.12	Good	98.04	Excellent	4 (3.9)
Death in relation to the birth	94.12	Good	97.06	Excellent	10 (9.8)
Sent to autopsy	62.75	Bad	86.27	Regular	25 (24.5)
TOTAL (13)	88.91	Regular	94.87	Good

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[TFN1001] CNES = National Registry of Health Establishment; PNC = prenatal care; HRPNC = high risk prenatal care.

[TFN2001] *Completeness scale: 95.00% = excellent; 95-90 = good; 9.99-80% = regular; 79.99-50% = bad; < 50 = very bad.