Perinatal deaths according to the international classification of diseases for perinatal mortality (ICD-PM) at Muhimbili National Hospital.

Abstract

ABSTRACT Background: The International Classification of Diseases for Perinatal Mortality (ICD PM) classifies perinatal deaths according to the timing, underlying cause, and contributing maternal conditions. This allows quantification, proper assignment of causes, and monitoring of perinatal deaths within and between facilities, as well as monitoring the quality of pregnancy and intrapartum care. Objective: To classify perinatal deaths according to ICD-PM and factors associated with the timing of perinatal deaths at Muhimbili National Hospital (MNH). Materials and Methods: Cross-sectional study conducted at MNH. All perinatal deaths that occurred between October 2023 and January 2024 were identified. A structured questionnaire was used to extract data. Two independent teams with knowledge of perinatal death audits reviewed the abstracted information. Data was entered and analyzed by using SPSS version 24. Results: Neonatal deaths were the most prevalent timing of perinatal deaths (62%), mostly due to prematurity and low birth weight, and mostly occurred in mothers without underlying medical conditions. Antepartum deaths were the second most prevalent timing (29.4%), mostly due to antepartum hypoxia, from mothers with hypertensive disorders of pregnancy (HDP), Intrapartum deaths were the least prevalent timing (8.6%) mainly due to acute intrapartum events from mothers with HDP. Hypertensive disorders of pregnancy (aOR=5.03, 95% CI 2.60 – 10.01), Multiple pregnancy (aOR=0.33, 95% CI 0.12-0.82), gestational age at delivery (aOR=5.97, 95% CI 2.14 -17.7) and mode of delivery (aOR=0.41, 95% CI 0.20 -0.81 were significantly associated with the timing of perinatal deaths. Conclusion: Six out of ten perinatal deaths occurred during the early neonatal period. Targeted interventions to screen, detect, and provide early management of maternal medical conditions, mainly HDP, and preterm birth, as well as to improve antepartum,intrapartum, and neonatal care, have the potential to reduce the burden of perinatal deaths.