Maternal condition as an underlying cause of perinatal mortality: Prospective cohort study

To compare the distribution of various causes of perinatal mortality in a public hospital in low-middle-income country setting.

A prospective cohort study was conducted from January 2016 to December 2018 at a large public hospital, Services Institute of Medical Sciences, Services Hospital, in Lahore, Pakistan. We applied the World Health Organization's perinatal mortality coding in the International Classification of Diseases. All stillbirths after 28 weeks' gestation weighing more than 1 kg were identified and followed up till delivery. All live births were followed up till discharge or early neonatal death. A multidisciplinary group of obstetricians, pediatricians, midwife and related healthcare professionals was established to assess each case of fatality. The associated maternal conditions were identified for each of the antepartum, intrapartum and neonatal deaths.

Of 11 850 births, there were 690 perinatal deaths, with 240 stillbirths (antepartum 167, intrapartum 73) and 450 early neonatal deaths (perinatal mortality rate 58.2/1000 births). Among antepartum deaths, hypoxia accounted for 70 (42%) cases. Among intrapartum deaths, an acute event was responsible for 50 (68%) cases. Among neonatal deaths (450, 65% of total), low birthweight and prematurity contributed to 152 (34%) cases. A maternal condition was found in 183 (76%) of stillbirths and 355 (79%) patients with neonatal death.

In our study, the most important causes of perinatal deaths were maternal in origin. There was an excess in the distribution of neonatal causes of perinatal deaths. These data should inform policy and practice.