title: Antepartum complications and perinatal mortality in rural Bangladesh.
abstract: Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates of perinatal deaths, which include stillbirths and early neonatal deaths, but the extent is not well studied. This study examines patterns of antepartum complications and the risk of perinatal deaths associated with such complications in rural Bangladesh.
  
  
  
  We used data on self-reported antepartum complications during the last pregnancy and corresponding pregnancy outcomes from a household survey (N = 6,285 women) conducted in Sylhet district, Bangladesh in 2006. We created three binary outcome variables (stillbirths, early neonatal deaths, and perinatal deaths) and three binary exposure variables indicating antepartum complications, which were antepartum hemorrhage (APH), probable infection (PI), and probable pregnancy-induced hypertension (PIH). We then examined patterns of antepartum complications and calculated incidence rate ratios (IRR) to estimate the associated risks of perinatal mortality using Poisson regression analyses. We calculated population attributable fraction (PAF) for the three antepartum complications to estimate potential risk reductions of perinatal mortality associated them.
  
  
  
  We identified 356 perinatal deaths (195 stillbirths and 161 early neonatal deaths). The highest risk of perinatal death was associated with APH (IRR = 3.5, 95% CI: 2.4-4.9 for perinatal deaths; IRR = 3.7, 95% CI 2.3-5.9 for stillbirths; IRR = 3.5, 95% CI 2.0-6.1 for early neonatal deaths). Pregnancy-induced hypertension was a significant risk factor for stillbirths (IRR = 1.8, 95% CI 1.3-2.5), while PI was a significant risk factor for early neonatal deaths (IRR = 1.5, 95% CI 1.1-2.2). Population attributable fraction of APH and PIH were 6.8% and 10.4% for perinatal mortality and 7.5% and 14.7% for stillbirths respectively. Population attributable fraction of early neonatal mortality due to APH was 6.2% and for PI was 7.8%.
  
  
  
  Identifying antepartum complications and ensuring access to adequate care for those complications are one of the key strategies in reducing perinatal mortality in settings where most deliveries occur at home.
authors.affiliation: International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E8153, 615 North Wolfe Street, Baltimore, MD, 21205, USA.|International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.
authors.forename: Rasheda
authors.initials: R
authors.lastname: Khanam
authors.affiliation: Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E8153, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Andreea A
authors.initials: AA
authors.lastname: Creanga
authors.affiliation: International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E8153, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Nazma
authors.initials: N
authors.lastname: Begum
authors.affiliation: International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E8153, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Alain K
authors.initials: AK
authors.lastname: Koffi
authors.affiliation: International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E8153, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Arif
authors.initials: A
authors.lastname: Mahmud
authors.affiliation: , Washington DC, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Rosen
authors.affiliation: International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room - E8153, 615 North Wolfe Street, Baltimore, MD, 21205, USA. abaqui@jhu.edu.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality*; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000401:mortality*; D054238:Perinatal Mortality; D006473:Postpartum Hemorrhage / Q000401:mortality*; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
keywords: Antepartum complications; Antepartum hemorrhage; Early neonatal deaths; Perinatal deaths; Pregnancy induced hypertension; Probable infection; Stillbirths