title: The importance of quality of care in perinatal mortality: a case-control study in Chiapas, Mexico.
abstract: BACKGROUND
  This study was undertaken in order to ascertain the relative importance of different risk factors for perinatal mortality (PM) in a community of Chiapas, Mexico stressing the importance of antenatal and neonatal medical care.
  
  
  METHODS
  Cases were stillbirth and early neonatal death (END). Two children born in the same hospital and/or day as the case were randomly selected as controls, in Tapachula, Chiapas, Mexico. Socioeconomic, cultural, maternal, pregnancy, delivery, product and medical care factors were recorded. Two analyses were performed using multiple logistic regression: one for stillbirths, the other for END.
  
  
  RESULTS
  PM rate was 46.7/1000; 142 cases and 284 controls were studied. Fifteen cases were excluded due to congenital malformations; 62 stillbirth and 65 END were analyzed. For stillbirth, pregnancy-delivery and maternal medical care factors resulted in the most strongly associated risk factors for PM (OR=27.5 95% CI 6.4-116.8), and within this index insufficient prenatal care had the strongest impact on PM (%population attributable risk (%PAR)=24%). For END, fetal conditions and the newborn medical care index had the strongest association with PM (OR=9.5 95% CI 1.5-60.3), and within the index inappropriate medical care of the newborn (%PAR=27%) was the most important variable.
  
  
  CONCLUSIONS
  Our results support the fact that insufficient prenatal care and failure to comply with the standards of care for labor, delivery and for the care of the newborn are strong predictors of PM.
authors.affiliation: Hospital General de Zona #1, Instituto Mexicano del Seguro Social (IMSS), Tapachula, Chiapas, Mexico.
authors.forename: Veronica
authors.initials: V
authors.lastname: Cruz-Anguiano
authors.forename: Juan O
authors.initials: JO
authors.lastname: Talavera
authors.forename: Laura
authors.initials: L
authors.lastname: Vázquez
authors.forename: Abdiel
authors.initials: A
authors.lastname: Antonio
authors.forename: Antonio
authors.initials: A
authors.lastname: Castellanos
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Lezana
authors.forename: Niels H
authors.initials: NH
authors.lastname: Wacher
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012307:Risk Factors; D012959:Socioeconomic Factors