Delivering health - perinatal mortality in Matlab, Bangladesh

Mortality rates among children under 5 years old have decreased substantially over the past 20 years in developing countries. Why has perinatal mortality not followed the same pattern? What proportion of infant deaths are due to complications during childbirth? Will current attempts to reduce maternal mortality through improved care during labour and delivery also reduce perinatal mortality?

Researchers from the London School of Hygiene and Tropical Medicine assessed the proportion of perinatal deaths attributable to complications during childbirth among women living in Matlab, a rural area of Bangladesh.

Part of the area, with a population of approximately 100,000, has been covered by a maternal and child health and family planning (MCH-FP) programme since October 1977. A community-based maternity care component was added to the MCH-FP programme in 1987 and expanded to the entire area in 1990. This included a maternity clinic in Matlab town, a network of professional midwives in villages, and transport for emergency cases. Midwives visited the women at home, providing antenatal and postnatal care and delivery assistance.

The study found that between 1987 and 1993, 61.6 percent of pregnant women living in the area covered by the maternity care programme had been in contact with a midwife in the antenatal period, during labour or both. Within this group the perinatal infant mortality rate was 71.4 per 1000 births for women who had received both antenatal and delivery care.

By examining the prevalence of childbirth complications and perinatal mortality rates, the study found that:

• Complications during labour and delivery, such as prolonged or obstructed labour and hypertensive diseases of pregnancy, increase the risk of perinatal mortality fivefold and account for 30 percent of infant deaths around the time of birth.
• Premature labour occurs in a fifth of pregnancies and accounts for 27 percent of perinatal mortality. This equates to a fourfold increase in the risk of perinatal death.
• Eclampsia and multiple pregnancy are associated with mortality rates of 323 and 215 per 1000 births respectively.
• Young maternal age, a bad obstetric history, an upper arm circumference of 250mm or greater, and thinness of the mother are also significantly associated with perinatal mortality.
• Antenatal signs significantly associated with perinatal death are pre-eclampsia and jaundice.

To combat the effects of childbirth complications and premature delivery on perinatal death rates the study recommends:

• training midwives in labour management and neonatal care techniques such as thermal protection and resuscitation
• encouraging pregnant women to attend for antenatal care
• screening for high blood pressure and twin pregnancies when women seek care late in the pregnancy
• introducing the partograph for use by midwives in the community for early recognition of prolonged or obstructed labour
• improving referral mechanisms.

Source(s):
'Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh' by T. Kusiako, C. Ronsmans and L. van der Paal, Bulletin of the World Health Organisation 78 (2000)

Funded by: UK Department for International Development

id21 Research Highlight: 25 October 2002

Further Information:
Carine Ronsmans
Maternal and Child Epidemiology Unit
London School of Hygiene and Tropical Medicine
49-51 Bedford Square
LONDON
WC1B 3DP
UK

Tel: +44 (0)20 79272190
Fax: +44 (0)20 7299 4720
Contact the contributor: carine.ronsmans@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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