Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade.

BACKGROUND: Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. OBJECTIVE: To describe information on stillbirths in Brazil during the past decade. SEARCH STRATEGY: A literature search was performed from January 2010 to December 2020. SELECTION CRITERIA: Original observational studies and clinical trials. DATA COLLECTION AND ANALYSIS: Data were manually extracted to a spreadsheet and descriptive analysis was performed. RESULTS: A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). CONCLUSION: Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.

Fetal deaths in Brazil: What changed in the last decade and what can we learn from the current situation?

OBJECTIVE: To determine fetal death rates (FDRs) according to maternal characteristics in Brazil. METHODS: A serial cross-sectional analysis was conducted based on vital statistics of the Brazilian population from 2007 to 2019. FDRs were estimated according to maternal and pregnancy characteristics. Annual percent change (APC) of FDR was assessed by joinpoint regression model. Causes of death were compared between the ante-/intrapartum periods. RESULTS: A significant reduction in FDR occurred in Brazil during 2007-2019 (11.1 and 10.43 in 2007 and 2019, respectively; APC -0.44). Only the northern region showed an increase in FDR. In 2019, the northeast and southeast had the highest and lowest FDRs, respectively (11.4 and 7.8/1000 live births). In adolescents, FDR increased from 2007 to 2016 (APC 1.75). In 2019, missing information was significantly high for maternal skin color (99.7%), schooling (17.0%), and age (7.0%) in fetal death registries. The most common causes of fetal death in the ante-/intrapartum periods were fetus and newborn affected by maternal conditions. CONCLUSION: A reduction in FDR has been achieved in Brazil over the last decade. However, there is an unmet need for decreasing social and regional disparities. A better system to attribute causes of death is needed to identifying priorities in maternal-fetal health care.