Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health

ObjectiveWe aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. DesignSecondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). SettingA total of 359 participating facilities in 29 countries. PopulationA total of 308 392 singleton deliveries. MethodsWe reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). Main outcome measuresFresh and macerated LFDs (defined as stillbirths1000g and/or 28weeks of gestation) and ENDs. ResultsThe LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day3 of life. Maternal complications were present in 85.6, 86.5, and 88.6% of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia. ConclusionsPreventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes.