Temporal trend in fetal mortality according to two death avoidability classifications

Area of Science:

• Public Health
• Epidemiology
• Maternal and Child Health

Background:

• Fetal mortality remains a significant public health concern globally.
• Accurate classification of causes of fetal death is crucial for targeted interventions.
• Assessing avoidability of fetal deaths helps identify areas for healthcare quality improvement.

Purpose of the Study:

• To analyze temporal trends of fetal mortality and its components in Recife, Brazil, from 2010 to 2021.
• To evaluate fetal mortality trends using two distinct avoidability classifications: the Brazilian List of Avoidable Causes of Death for fetal deaths (LBE-OF) and the Brazilian List of Avoidable Causes of Death for children under five years of age (LBE < 5).
• To assess trends in fetal deaths attributed to avoidable and ill-defined causes.

Main Methods:

• Ecological study design analyzing temporal trends of fetal mortality.
• Application of Joinpoint regression models to identify significant trends.
• Utilized two Brazilian avoidability classification lists (LBE-OF and LBE < 5) for cause-specific analysis.

Main Results:

• Overall fetal mortality trends in Recife were stationary between 2010 and 2021.
• Avoidable causes of fetal death showed higher mortality rates, with an increasing trend according to LBE-OF (APC: 2.1%, p=0.018) and a stationary trend by LBE < 5.
• Mortality from ill-defined causes showed a decreasing trend solely under the LBE-OF classification (APC: -12.3%, p<0.001).

Conclusions:

• Fetal mortality trends in Recife have stagnated, indicating a need for enhanced public health strategies.
• A significant proportion of fetal deaths are avoidable, highlighting opportunities for improved perinatal care.
• The LBE-OF classification demonstrates utility in monitoring the quality of information and avoidability of fetal deaths.