Intrapartum and very early neonatal death rate

 

The proportion of births weighing ≥ 2.5 kg during a specified time period that result in an intrapartum death (fresh stillbirth) or very early neonatal death within the first 24 hours during a specified time period (WHO et al., 2010).

Intrapartum or fresh stillbirths include infants born dead after 28 weeks of gestation without skin deterioration or maceration. The death is assumed to have occurred less than 12 hours before delivery and excludes infants with severe, lethal congenital abnormalities.  Early neonatal deaths include neonates born at term who could not be resuscitated, for whom resuscitation was not available, or who had a specific birth trauma, where death occurred within 24 hours of delivery. Given the fact that low birthweight infants have high fatality rates, it is recommended that newborns with weights under the international standard of 2.5 kg be excluded from the numerator and denominator whenever the data allow.  However, some countries prefer to use 2.0 kg as their threshold. For further details on this indicator, see WHO et al. (2010).

This indicator is calculated as:

(Number of births weighing ≥ 2.5 kg resulting in intrapartum deaths and very early neonatal deaths within first 24 hours / Total number of women giving birth to infants weighing ≥ 2.5 kg during specified time frame) x 100

The Research Triangle Institute in collaboration with international health partners is developing a prospective intrapartum stillbirth and early neonatal death indicator, designed to monitor improvements in the quality of obstetric and newborn care provided at birth by skilled attendants in health facilities (EngenderHealth, 2011).


Reviews of records and registers from all facilities providing labor and delivery care can be used to calculate the indicator. Alternative types of information include prospective data from facilities and retrospective data from surveys with detailed pregnancy histories. Data may be disaggregated by type of facility (e.g., by basic versus emergency obstetric care, and/or by public, private, non-governmental organization) in addition to other factors such as urban/rural location and districts.


Facility records; birth and death registers; prospective studies; surveys with detailed pregnancy histories.


This indicator reflects the quality of intrapartum care for fetuses and newborns delivered at facilities. Worldwide, nearly two million infants die each year around the time of delivery. A major cause of intrapartum or early very neonatal death is asphyxia which can result from poorly managed obstetric complications and from the absence of neonatal resuscitation. Good quality intrapartum care is crucial for both mothers and their infants, and where appropriate and timely care is provided, most maternal and neonatal deaths can be prevented (WHO et al., 2010).  Quality intrapartum care is directly related to Millennium Development Goals #4. reduce child mortality and #5. improve maternal health.  This indicator focuses on the intrapartum and very early neonatal deaths that could have been averted by the health system’s ability to provide quality obstetric care and neonatal resuscitation.  Trends over time can be followed in the aggregate, as well as, disaggregated by facility types, locations, and individual facilities. A maximum acceptable level for the indicator can be explored and set where appropriate. In facilities with high rates for this indicator, it may be useful to conduct perinatal death audits to gain information for improving the quality of care.


Few countries have sufficiently developed vital registration systems that can provide valid and reliable information on all births and deaths in the community. Health information systems can only provide information on births and deaths in facilities and, in most settings, are not well developed. Most community-based programs do not have the capacity to measure infant and child mortality. For newborn health, prospective studies would provide the most reliable mortality rates, but are costly for regular reporting purposes. Large-scale surveys that rely on the retrospective reporting of deaths in early infancy can provide estimates of neonatal mortality, but estimates of perinatal mortality (which includes intrapartum and very early neonatal deaths) require very detailed pregnancy histories (Gage at al., 2005). In addition, retrospective data are subject to recall error, which is likely to increase with the length of the recall period.


newborn (NB), quality, safe motherhood (SM)

 

Engenderhealth, July 2011, Maternal Health Task Force Updates, New York: The Maternal Health Task Force at EngenderHealth. https://www.engenderhealth.org/media/2010/2010-07-22-maternal-health-task-force.php 

Gage A, Ali D, Suzuki C, 2005, A Guide for Measuring and Evaluating Child Health Programs, Chapel Hill, NC: MEASURE Evaluation. https://www.cpc.unc.edu/measure/publications/ms-05-15

WHO, UNFPA, UNICEF, AMDD, 2010, Monitoring Emergency Obstetric Care: A handbook, Geneva: WHO. http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf

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