Trends in Miscarriages and Stillbirths in Panama From 2002 to 2024

Pregnancy loss, including miscarriage and stillbirth, remains a significant public health concern, particularly in low- and middle-income countries. Reliable national-level data are essential to monitor trends and guide interventions. This study aims to describe temporal trends in pregnancy losses in Panama over the past 2 decades, using national vital statistics.

We conducted a population-based, retrospective analysis of pregnancy outcomes in the Republic of Panama between 2002 and 2024. Data were obtained from the Panama National Institute of Statistics and Census, which compiles vital statistics from health facilities nationwide. The dataset included all registered pregnancies resulting in live birth, miscarriage, or stillbirths. Causes for miscarriage and stillbirth were classified using ICD-10 coding categories. All analyses were conducted using IBM SPSS Statistics Version 29 and Joinpoint Regression Program version 6.0.

This study registered 190,764 miscarriages, 15,904 stillbirths, and 1,582,352 live births, which represented an average raw pregnancy loss rate of 115.6 (95% CI 110.7-120.4) per 1000 total registered pregnancies in Panama from 2002 to 2024. While the average miscarriage rate was 106.6 (95% CI 101.9-111.4) per 1000 total registered pregnancies, the average stillbirth rate was 10.0 (95% CI 9.6-10.4) per 1000 total births. In general, 11.6% of all registered pregnancies in Panama ended in pregnancy loss. Rates of pregnancy loss were highest among women aged ≥ 40 years and single women. Joinpoint regression analysis identified significant declines in miscarriage rates (2008-2021) and stillbirth rates (2002-2017), but neither was sustained through 2024. All miscarriage cases were coded exclusively as P01, reflecting a complete absence of diagnostic diversity. Among stillbirths, P95 (unspecified fetal death; 53.4%), P02 (placenta, cord, and membranes; 21%), and P20 (intrauterine hypoxia; 7.4%) together accounted for over 80% of cases.

Pregnancy loss rates in Panama have remained stagnant over the past 2 decades, despite the establishment of national surveillance policies and reporting mechanisms. Miscarriage and stillbirth trends showed limited and unsustainable improvements. The overwhelming reliance on a narrow set of ICD-10 codes highlights systemic weaknesses in perinatal cause of death classification that limits opportunities for prevention. Strengthening perinatal pathology capacity, coder training and equitable care access must be strengthened.