Risk factors for perinatal death in two different levels of care: a case-control study.
BACKGROUND
According to the World Health Organization, there are over 6.3 million perinatal deaths (PND) a year worldwide. Identifying the factors associated with PND is very helpful in building strategies to improve the care provided to mothers and their babies.


OBJECTIVE
To investigate the maternal, gestational and neonatal factors associated with PND at two different levels of care.


METHODS
Case-control study including 299 PND cases and 1161 infants that survived the early neonatal period (controls) between 2001-2006 in two hospitals at different care levels (secondary and tertiary) located in southeastern Brazil. Correlations between study variables and PND were evaluated by univariate analysis. PND-related variables were included in a multiple logistic regression model, and independent estimates of PND risk were obtained.


RESULTS
Although five-minute Apgar score <7, low birthweight and maternal hemorrhage were associated with PND in the secondary care center, no independent risk factors were identified at this level of care. In the tertiary hospital, PND was positively associated with primiparity, male sex, prematurity, low 5-minute Apgar score, and pregnancy complicated by arterial hypertension or intrauterine infection.


CONCLUSIONS
Several risk factors positively associated with PND were indentified in the tertiary, but not in the secondary care level hospital. Since most of the risk factors herein identified are modifiable through effective antenatal and intrapartum care, greater attention should be given to preventive strategies.
Paula Maria Silveira Soares
PM
Moura
Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, Brazil. imaesta@fmb.unesp.br.
Izildinha
I
Maestá
Lígia Maria Souza Suppo
LM
Rugolo
Luís Felipe Ramos Berbel
LF
Angulski
Antônio Prates
AP
Caldeira
José Carlos
JC
Peraçoli
Marilza Vieira Cunha
MV
Rudge
D000328:Adult; D001938:Brazil; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D012307:Risk Factors