title: Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health.
abstract: OBJECTIVE
  We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications.
  
  
  METHODS
  Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS).
  
  
  METHODS
  A total of 359 participating facilities in 29 countries.
  
  
  METHODS
  A total of 308 392 singleton deliveries.
  
  
  METHODS
  We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions).
  
  
  METHODS
  Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs.
  
  
  RESULTS
  The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia.
  
  
  CONCLUSIONS
  Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes.
authors.affiliation: School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia; Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: J P
authors.initials: JP
authors.lastname: Vogel
authors.forename: J P
authors.initials: JP
authors.lastname: Souza
authors.forename: R
authors.initials: R
authors.lastname: Mori
authors.forename: N
authors.initials: N
authors.lastname: Morisaki
authors.forename: P
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: M
authors.initials: M
authors.lastname: Laopaiboon
authors.forename: E
authors.initials: E
authors.lastname: Ortiz-Panozo
authors.forename: B
authors.initials: B
authors.lastname: Hernandez
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Cuevas
authors.forename: M
authors.initials: M
authors.lastname: Roy
authors.forename: S
authors.initials: S
authors.lastname: Mittal
authors.forename: J G
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Ö
authors.initials: Ö
authors.lastname: Tunçalp
authors.forename: A M
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004461:Eclampsia / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D008428:Maternal Mortality / Q000639:trends*; D008429:Maternal Welfare; D008430:Maternal-Child Health Centers / Q000458:organization & administration / Q000592:standards; D008877:Middle East / Q000453:epidemiology; D054238:Perinatal Mortality / Q000639:trends*; D011225:Pre-Eclampsia / Q000401:mortality* / Q000517:prevention & control; D011247:Pregnancy; D015995:Prevalence; D014944:World Health Organization; D055815:Young Adult
keywords: Early neonatal death; fetal death; maternal complications; perinatal mortality