Determinants of intrapartum fetal death in a remote and indigent population in China.
OBJECTIVE
To explore the reasons for the high rate of intrapartum fetal death observed in a remote and indigent population in China.


METHODS
We conducted an epidemiologic analysis of determinants of intrapartum fetal death in a sample of 20,891 births in 18 hospitals participating in the Qingyuan Perinatal Surveillance System from January 1, 1997 to June 30, 1998. The main determinant examined was cesarean delivery; other determinants included mother's insurance status, residence, maternal age, infant's gender, parity, gestational age, birth weight, and obstetric complications. Rates of intrapartum fetal death within categories of various maternal and infant factors were first calculated and compared; adjusted odds ratios for intrapartum fetal death were then estimated by multiple logistic regression analysis.


RESULTS
The intrapartum fetal death rate in this population was 5 per 1000 total births, which accounted for about one-third of all fetal deaths. Compared with vaginal delivery, elective cesarean delivery was associated with a 100% (i.e., no intrapartum fetal death among 1572 elective cesarean deliveries) and emergency cesarean delivery with a 88% reduction, in intrapartum fetal death. Other significant determinants were related to access to obstetric care (i.e., insurance status and residence).


CONCLUSIONS
Lack of access to quality obstetric care is the major determinant of intrapartum fetal death in this population.
Wen
Shi Wu
SW
Department of Obstetrics and Gynecology and Clinical Epidemiology Program, University of Ottawa Faculty of Medicine, Ontario, Canada.
Lei
Huizhong
H
Kramer
Michael S
MS
Sauve
Reg
R
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services; D016017:Odds Ratio; D011203:Poverty; D011247:Pregnancy; D012307:Risk Factors; D019035:Rural Health Services; D012424:Rural Population