Stillbirth and Neonatal Death - Types and Causes

Introduction

Numerous infants pass away shortly after delivery; most of these deaths occur in the first four weeks of life, known as neonatal deaths. A stillbirth occurs when a baby dies or is lost before, during, or after birth. Although both terms for pregnancy loss - miscarriage and stillbirth - differ depending on when the loss happens, stillbirth is defined in the United States as the loss of a child at or after the 20th week of pregnancy. In contrast, a miscarriage is typically described as the loss of a child before the 20th week of pregnancy. Neonatal deaths and stillbirths have different causes and contributing factors than post neonatal and child deaths.

What Are Stillbirth and Neonatal Death?

Regardless of the length of pregnancy, stillbirth or fetal death occurs before the fetus is fully expelled or extracted from the mother. This type of death is indicated by the fact that the fetus does not breathe or display any other signs of life after this separation, such as the heartbeat, the pulsing of the umbilical cord, or the definite movement of the voluntary muscles. The neonatal period begins with birth and ends 28 complete days after birth. A neonatal death (also called a newborn death) is when a baby dies during the first 28 days of life. Most neonatal deaths happen in the first week after birth.

What Are the Types of Stillbirth and Neonatal Death?

Based on the duration, the different types of stillbirth and neonatal death are

• Early Neonatal Death - When a death occurs during the first week of life.

• Late Neonatal Death - Death occurring after seven days but before the 28th day of life.

• Early Stillbirth - Fetal death occurs between 20 and 27 weeks of completed pregnancy.

• Late Stillbirth - Death occurring between 28 and 36 weeks of completed pregnancy.

• Term Stillbirth - Death occurring between 36 and more weeks of completed pregnancy.

What Are the Risk Factors of Stillbirth?

Families of all racial, ethnic, and socioeconomic backgrounds and women of all ages, experience stillbirth. However, some populations are more likely to experience a stillbirth, including women who:

• are of the black race.

• are 35 years of age or older.

• are of low socioeconomic status.

• smoke cigarettes during pregnancy.

• have certain medical conditions, such as high blood pressure, diabetes, and obesity.

• have multiple pregnancies, such as triplets or quadruplets.

• have had a previous pregnancy loss.

This does not imply that every one of black ethnicity or older is more likely to experience a stillbirth. The discrepancies in mothers' preconception health, socioeconomic position, access to high-quality medical treatment, and stress are a few factors that may be responsible for these stillbirth differences. More investigation is required to ascertain the underlying cause of some of these factors associated with stillbirths. Numerous elements have also been linked to other unfavorable pregnancy outcomes, such as preterm birth.

What Are the Causes of Stillbirth and Neonatal Death?

The common causes of stillbirth and neonatal death are

• Poor maternal health.

• Mother’s nutritional status at the time of pregnancy.

• Early childbearing.

• Pregnancy and child-related complications.

• Prolonged pregnancy.

• Maternal infections like malaria, syphilis, and HIV.

• Maternal conditions like hypertension and diabetes.

• Fetal growth restriction - When an unborn child is smaller than it should be because it cannot reach its growth potential.

• Neonatal tetanus.

• Prolonged labor or prolonged rupture of membranes causes infections in both mothers and babies.

• Poor hygiene during delivery.

• Improper management of complications during delivery.

• Birth asphyxia and trauma.

• Preterm birth and malformations.

What Is Perinatal Mortality?

There are numerous common causes and causes of neonatal deaths and stillbirths. The phrase "perinatal mortality" has been used to refer to deaths that could be connected to obstetric occurrences, such as stillbirths and neonatal deaths within the first week of life. The perinatal mortality index is crucial in giving the knowledge required to enhance the health of expectant mothers, new moms, and infants. Decision-makers can use this data to pinpoint issues, analyze discrepancies and trends over time and space, and evaluate adjustments to public health policy and practice. The quality of obstetric and pediatric care that is accessible is also reflected in perinatal mortality, which is a significant indicator of maternal care, maternal health, and nutrition. Birth results are influenced mainly by social variables, although quality medical treatment becomes more important as societies develop.

What Are the Sources of Neonatal and Perinatal Mortality Data?

Vital registration, sample registration, or community studies can be used to get information on live births and infant mortality rates. In contrast, mortality statistics or community studies can provide information on stillbirths. Unfortunately, each of these sources is prone to underreporting. Following are some observations of familiar data sources' qualities, inherent restrictions, and the impact of underreporting.

• Vital and Mortality Statistics - Reporting vital occurrences refer to the results of live births, such as the delivery and death of a baby or the death later in life. Despite being widely acknowledged, many nations do not rely on birth registration on WHO standards. Countries may have different legal definitions from those advised by the WHO for some events, such as live birth, stillbirth, or infant death. Additionally, the requirements for registering births differ by country and by event, as does the deadline for registering an event.

• Survey Data - The accuracy with which births and deaths are reported determines the validity of mortality estimates derived from prospective and retrospective birth or pregnancy histories gathered in community studies. Infant deaths that happen extremely early in infancy tend to be more underreported, including age at death, recollection accuracy, and completeness, which may decline over time. Women are questioned about the results of their pregnancies in the 60 months before the survey, which is the primary data source for developing nations. The proposed WHO standards are challenging to follow because menstrual cycles are unpredictable, newborns are frequently not weighed at delivery, and women may not have records to rely on.

• Hospital Data - Unless all babies are born in a medical facility, hospital studies are an inappropriate data source for determining mortality incidence.

• Underreporting - Underreporting is still an issue, particularly concerning stillbirths and premature deaths. Statistics on stillbirths are more likely to be underreported since they are less commonly available than data on fatalities after birth. Stillbirth data are less reliable and available in fewer countries than early neonatal and death data. Births and deaths must be accurately reported and recorded for data to be considered reliable. Both the mother and the recording device can be at blame for underreporting and misclassification, which are frequent occurrences. Underreporting might be done to avoid a laborious registration process, especially in the case of early death, or it might be done because the person is unaware of the requirements. It might also have to do with obstacles, such as paying a registration fee or just a lack of evident advantages. Misclassification of live births and deaths is another possibility; this can happen when the terms "live birth" and "fetal death" aren't understood or when the "reporting purpose" isn't understood.

What Are the Different Methods Used to Estimate the Perinatal Mortality Rate?

The following steps were used to determine rates by nation and to determine regional and worldwide estimates:

1. Establishing the Estimation Dataset of Available Data - The Centers for Disease Control (CDC), the Pan Arab Project for Child Development (PAPChild), the Gulf Child Health Surveys (GCHS), and other national surveys - many of which relied on an adaption of the Macro Demographic and Health Surveys questionnaire - were used to collect reliable data. In partnership with country partners, these organizations conduct and assist demographic and health surveys in underdeveloped countries, giving comparable mortality statistics; definitions for some other health indicators, such as the presence of a skilled attendant during delivery, may vary. However, surveys frequently overlooked stillbirth data and did not always provide age-at-death rates.

2. Estimating Missing Neonatal, Early Neonatal, and Stillbirth Mortality Rates - When one or more rates were unavailable, the missing rate was calculated using the regressions and ratios described below.

   1. Estimating the neonatal mortality rate of countries with no data.

   2. Estimating the early neonatal mortality rate of countries with no data.

   3. Estimating the stillbirth rate of countries with no data.

3. Adjusting Mortality Rates to Who Under-Five (5q0) Mortality Estimates for the Year 2000 - Neonatal and earlier mortality rates were adjusted to the under-five mortality rate as estimated by WHO for the year 2000 to project year-specific mortality estimates and to keep early mortality within the under-five mortality for that year. The under-five mortality rate of each country's estimation dataset was compared to the under-five mortality rate estimated by the WHO for the year 2000. The stillbirth, newborn, and early neonatal mortality rates of surveys or civil registration were then adjusted using this information. This proportional adjustment made the observed age-at-death distribution remain within the WHO-predicted under-five mortality envelope. The rates for the year 2000 were predicted using this method, nation by country, based on the most recent data on newborn death and the two leading causes of perinatal mortality: stillbirths and early neonatal mortality.

4. Calculating Rates and Numbers by Country, Region, and Globally - Neonatal, early neonatal, and stillbirth rates were reported for 187 of the 192 nations and regions with a population of more than 300 000 people using the estimation methods stated above. Early neonatal fatalities and stillbirths are combined with the matching number of deaths by the nation to determine numbers and rates of perinatal deaths. It could not estimate the rates for five remote locations that account for 0.1% of births.

How Can Perinatal Mortality Be Intervened?

Interventions in public health, including vaccination, better nutrition, water, and sanitation, as well as treatment for diarrhea, respiratory infections, malaria, and malnutrition, have helped increase child survival. However, additional therapies and strategies are needed for maternal, perinatal, and neonatal survival. The best way to deliver the right technologies for the majority of life-threatening medical issues and complications is through a program that guarantees a woman's and baby's continuity of care throughout pregnancy, delivery, and the postpartum period, at the primary care level for all pregnant women, and at higher levels of care for women and babies with complications. In addition, other crucial measures for the best pregnancy outcomes can be incorporated into maternity services based on disease patterns.

Conclusion

Family planning to prevent unintended pregnancies, good health and nutrition before and throughout pregnancy, and quality and respectful prenatal and delivery care with appropriately qualified health staff, especially midwives, can all help prevent stillbirths.