Perinatal deaths preventable by intervention of the Unified Health System of Brazil

Rêgo, Midiã Gomes da Silva; Vilela, Mirella Bezerra Rodrigues; Oliveira, Conceição Maria de; Bonfim, Cristine Vieira do

doi:10.1590/1983-1447.2018.2017-0084

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Sumário

Original Article • Rev. Gaúcha Enferm. 39 • 2018 • https://doi.org/10.1590/1983-1447.2018.2017-0084 linkcopy

Perinatal deaths preventable by intervention of the Unified Health System of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE To describe the epidemiological characteristics of perinatal deaths through the actions of the Unified Health System.

METHODS This is a descriptive study of temporal analysis with a population of perinatal deaths of mothers residing in Recife, Brazil, from 2010 to 2014. A list was used to classify the preventable diseases and the variables were analysed using Epi lnfo^™ version 7

RESULTS The perinatal deaths totalled 1,756 (1,019 foetal and 737 neonatal premature) with a reduction of neonatal deaths (-15.8%) and an increase of foetal deaths (12.1%) in the study period. The main causes of death were foetus and newborn affected by the mother´s condition and asphyxia/hypoxia at birth.

CONCLUSIONS Most deaths were avoidable, especially in the group of appropriate care to mothers during pregnancy. Faults in the care provided to women at birth explain the percentage of deaths caused by asphyxia/hypoxia. The reduction of preventable perinatal mortality is associated with the increased access and quality of care, which ensures health promotion, disease prevention, treatment and specific and timely care.

Keywords:
Perinatal mortality; Vital statistics; Obstetric nursing; Neonatal nursing; Public health

Indicators	2010			2011			2012			2013			2014			Δ%
Indicators	n	%	MC	N	%	MC	n	%	MC	n	%	MC	n	%	MC
Total births	21,787			22,253			22,642			23,186			23,520
Foetal deaths	175	53.2	8.0	214	59.8	9.5	199	57.7	8.7	219	58.9	9.4	212	60.2	8.9	12.1
Early neonatal deaths	154	46.8	7.1	144	40.2	6.5	146	42.3	6.4	153	41.1	6.6	140	39.8	6.0	-15.8
Perinatal deaths	329	100	15.0	358	100	15.9	345	100	15.1	372	100	15.9	352	100	14.8	-1.0

Variables	Foetal death (n= 1,019)		Early neonatal Death (n = 737)		Perinatal death (n = 1,756)		p-value
	(n)	(%)	(n)	(%)	(n)	(%)
Age group (years)	955 (5)		732 (3)				0.009 (1)
< 20	165	17.3	165	23	330	19.6
20 to 34	624	65.3	466	63	1090	64.6
≥ 35	166	17.4	101	14	267	15.8
Schooling (years)	873 ^(c)		731 (3)				< 0.001 (1)
< 8	416	47.7	219	30	635	39.6
8 or more	457	52.3	512	70	969	60.4
Location	1,011 (3)		737 (3)				(2)
Hospital	991	98	730	99	1721	98.5
Residence	9	0.9	3	0.4	12	0.7
Other establishments	4	0.4	3	0.4	7	0.4
Public roads	7	0.7	1	0.1	8	0.4
Type of delivery	985 (5)		731 (3)				<0.001 (1)
Vaginal	701	71.2	456	62	1157	67.4
Caesarean section	284	28.8	275	38	559	32.6
Premature birth	924 (5)		722 (4)				0.082
Yes	711	77	582	81	1293	78.6
No	213	23	140	19	353	21.4
Sex	979 (5)		772 (4)				0.54
Girl	463	47.3	330	46	793	46.6
Boy	516	52.7	392	54	908	53.4

Preventability	Foetal deaths			Early neonatal deaths			Perinatal deaths
Preventability	(n)	(%)	(MC)	(n)	(%)	(MC)	(n)	(%)	(MC)
Preventable causes	843	82.7	7.4	583	79.1	5.1	1,426	81.2	12.5
Amenable by providing appropriate care to the women during pregnancy	499	49.0	4.4	427	57.9	3.8	926	52.7	8.1.
Amenable by providing appropriate care to the women during delivery	299	29.3	2.6	94	12.8	0.8	393	22.4	3.4
Amenable by providing appropriate care to the newborn child	45	4.4	0.4	57	7.7	0.5	102	5.8%	0.9
Amenable through appropriate diagnosis and treatment	-	-	-	2	0.3	-	2	0.1	0.0
Amenable through health promotion	-	-	-	3	0.4	-	2	0.1	0.0
Ill-defined causes	109	10.7	1.0	3	0.4	-	112	6.4	1.0
Other causes (not clearly preventable)	67	6.6	0.6	151	20.5	1.3	218	12.4	1.9
Total	1,019	100.0	8.9	737	100.0	6.5	1,756	100.0	15.3

Preventability	Foetal deaths		Early neonatal deaths		Perinatal deaths
Preventability	(n)	(%)	(n)	(%)	(n)	(%)
1. Preventable causes	843	82.7	583	79.1	1,426	81.2
1.2.1. Amenable by providing appropriate care during pregnancy	499	49.0	427	57.9	926	52.7
Congenital syphilis	101	9.9	17	2.3	118	6.7
Foetus and newborn affected by complications of placenta membranes	41	4.0	24	3.3	65	3.7
Foetus and newborn affected by maternal conditions	291	28.6	239	32.4	530	30.2
Foetus and newborn affected by maternal complications during pregnancy	64	6.3	116	15.7	180	10.3
Retarded foetal growth and foetal malnutrition	1	0.1	2	0.3	3	0.2
Preterm pregnancy disorder and low birth weight	-	-	6	0.8	6	0.3
Respiratory distress syndrome of newborn	-	-	21	2.8	21	1.2
Pulmonary haemorrhage in the perinatal period	-	-	1	0.1	1	0.1
Necrotizing enterocolitis foetus and newborn	-	-	1	0.1	1	0.1
Other haemolytic disease of the newborn foetus due to isoimmunisation	1	0.1	-	-	1	0.1
Birth trauma	1	0.1	3	0.4	4	0.2
Intrauterine hypoxia and asphyxia at birth	168	16.5	36	4.9	204	11.6
Neonatal aspiration syndrome except regurgitated food or milk	-	-	4	0.5	4	0.2
1.2.2. Amenable by providing appropriate care during delivery	299	29.3	94	12.8	393	22.4
Newborn foetuses affected by placenta previa or placental abruption	65	6.4	32	4.3	97	5.5
Foetuses and newborns affected by umbilical cord disorders	46	4.5	6	0.8	52	3.0
Newborn foetuses affected by other complications at childbirth	19	1.9	13	1.8	32	1.8
Birth trauma	1	0.1	3	0.4	4	0.2
Intrauterine hypoxia and asphyxia at birth	168	16.5	36	4.9	204	11.6
Neonatal aspiration syndrome except regurgitated food or milk	-	-	4	0.5	4	0.2
1.2.3. Amenable by providing appropriate care to the newborn	45	4.4	57	7.7	102	5.8%
Cardiopulmonary and cardiovascular disorder specific to the neonatal period	-	-	26	3.5	26	1.5
Neonatal infections except CRS and congenital viral hepatitis	5	0.5	16	2.2	21	1.2
Neonatal haemorrhage except intracranial non-traumatic haemorrhage	-	-	1	0.1	1	0.1
Transitory endocrine metabolic disorder specific of foetus and newborn	18	1.8	4	0.5	22	1.3
Other haematological disorders of foetus and newborn	-	-	1	0.1	1	0.1
Digestive disorders of foetus and newborn except necrotizing enterocolitis	-	-	1	0.1	1	0.1
Disorders compromising the regular integument system of foetus and newborn	9	0.9	3	0.4	12	0.7
Other disorders of the perinatal period	13	1.3	5	0.7	18	1.0
1.3. Amenable through appropriate diagnosis and treatment	-	-	2	0.3	1	0.1
Down syndrome	-	-	2	0.3	2	0.1
1.4. Amenable through health promotion linked to healthcare actions	-	-	3	0.4	3	0.2
Other accidental respiratory risks	-	-	1	0.1	1	0.1
Aggression	-	-	1	0.1	1	0.1
Events (facts) with an undefined intention	-	-	1	0.1	1	0.1
2. Ill-defined causes	109	10.7	3	0.4	112	6.4
Disorders originating in the perinatal period, unspecified	92	9.0	3	0.4	95	5.4
Foetal death of unspecified cause	17	1.7	-	-	17	1.0
3. Other causes (not clearly preventable)	67	6.6	151	20.5	218	12.4
Total	1019	100.0	737	100.0	1756	100.0

	Foetal deaths (p-value < 0.001)		Neonatal deaths (p-value = 0.03)		Perinatal deaths (p-value < 0.001)
Weight	N	%	n	%	N	%
<1000g	396	61.7	246	38.3	642	37.8
1000 to 1499g	91	35.0	169	65.0	260	15.4
1500 to 2499g	109	26.0	310	74.0	419	24.7
> 2500 g	133	35.5	242	64.5	375	22.1

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[TFN12] Source: Sistema de Informações sobre Mortalidade, Secretaria de Saúde do Recife, Pernambuco, Brazil, 2016.

[TFN13] Note: Foetal and perinatal mortality coefficient per 1000 total births; early neonatal mortality coefficient per 1000 live births