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[Toward a reduction of perinatal mortality]
Insights
The current perinatal mortality calculation is outdated, failing to account for advancements in neonatology and the survival of low-birth-weight infants. A revised definition is proposed to include all fetal and neonatal deaths, improving accuracy and international comparability.
Area of Science:
- Perinatal Health
- Neonatalogy
- Obstetrics
Context:
- The existing methodology for calculating perinatal mortality, established in Ille-et-Vilaine, is outdated.
- It fails to incorporate significant advancements in obstetrics and neonatology.
- The current definition excludes early neonatal deaths of infants weighing less than 1 kilogram and does not account for therapeutic abortions due to fetal abnormalities.
Purpose:
- To highlight the deficiencies in the current perinatal mortality calculation method.
- To propose a revised definition of perinatal mortality that addresses current medical advancements and statistical needs.
- To ensure more accurate and internationally comparable perinatal mortality data.
Summary:
- The study identifies that the traditional method of calculating perinatal mortality is inadequate due to medical progress, particularly the survival of infants weighing under 1,000 grams.
- It proposes a new definition encompassing all fetal and neonatal deaths (from 500g), including late neonatal mortality, stillbirths, and deaths following therapeutic abortions for fetal malformations.
- This revised approach aims to provide a more comprehensive measure of "lost pregnancies" and facilitate international comparisons.
Impact:
- Adoption of a new definition will lead to more accurate perinatal mortality statistics.
- Improved data will better reflect the impact of modern obstetrics and neonatology.
- Enhanced international comparability of perinatal mortality rates will be achieved.
Abstract:
Having studied perinatal mortality in Ille-et-Vilaine from 1972 onwards, the authors have come to realise how out of date the present method of working out perinatal mortality is because it only takes account of late intra-uterine death and early neonatal mortality of infants weighing at least 1 kilogram. The old method does not take notice of the changes that have occurred because of the progress that has taken place in obstetrics and neonatology such as the survival of an increasing number of newborn that weigh less than 1,000 grams or of the fact that the distinction between early and late neonatal death seems to be less and less valid. It does not add up to the total of "lost pregnancies". Furthermore, it does not make it possible to compare our figures with those published in foreign countries. The authors therefore feel that a new definition of perinatal mortality should be made, and this should satisfy the four following requirements: It should include on the one hand all fetuses and newborn that weigh at least 500 grams and on the other hand it should include early and late mortality and even mortality that occurs after the neonatal period. It should take into account the problem of false still-births. It should take into account fetal malformations and abnormalities that have called for therapeutic abortions because they are among the principal causes of perinatal mortality. It should study all the statistics and publications on this subject.