title: Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000-2010: a registry based study.
abstract: BACKGROUND
  Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths.
  
  
  METHODS
  We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE).
  
  
  RESULTS
  Overall perinatal mortality was 57.7/1000 (1958 out of 33 929), of which 1219 (35.9/1000) were stillbirths and 739 (21.8/1000) were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Obstructed/prolonged labour was the leading condition (251/303, 82.8%) among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2%) among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths), perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal conditions (from 8.5 to 5.5/1000).
  
  
  CONCLUSIONS
  The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths.
authors.affiliation: Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical College, P,O Box 3010, Moshi, Tanzania. blaymt@yahoo.com
authors.forename: Blandina T
authors.initials: BT
authors.lastname: Mmbaga
authors.forename: Rolv Terje
authors.initials: RT
authors.lastname: Lie
authors.forename: Raimos
authors.initials: R
authors.lastname: Olomi
authors.forename: Michael Johnson
authors.initials: MJ
authors.lastname: Mahande
authors.forename: Oneko
authors.initials: O
authors.lastname: Olola
authors.forename: Anne Kjersti
authors.initials: AK
authors.lastname: Daltveit
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D004461:Eclampsia / Q000401:mortality; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D007744:Obstetric Labor Complications / Q000401:mortality; D054238:Perinatal Mortality; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D012042:Registries; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult