Medical conditions present during pregnancy and risk of perinatal death in Jamaica

ABSTRACT

In an attempt to identify causes of perinatal mortality and hence devise preventative strategies on the island of Jamaica, a study was made of the 1847 singleton perinatal deaths occuring over the 12 month period between 1 September 1986 and 31 August 1987. Complications of the pregnancy were elicited by questioning the mothers as well as abstracting data from the antenatal and clinical obstetric records. The deaths were classified using the Wigglesworth categorisation and the three largest groups were chosen for special study antepartum fetal deaths, deaths of live births from immaturity and deaths from intrapartum asphyxia. The medical features of the pregnancies were compared with data similarly obtained from 9919 women delivering singletons in the 2 months of September and October 1986 and who survived the first week of life. Unadjusted statistically significant associations were found with maternal syphilis, vaginal infection or discharge, bleeding in the first two trimesters, bleeding in the third trimester, lowest haemoglobin, highest diastolic and first diastolic blood pressures, highest level of proteinuria, diabetes and antenatal eclampsia. Logistic regression taking account of social, environmental and health behaviour variables showed the following significant relationships. Antepartum fetal death was associated with adjusted odds ratio (AOR) for syphilis 2.88[95 percent confidence interval (CI) 1.91, 4.32], bleeding in third trimester 3.86 [2.73, 5.44], highest diastolic blood pressure (P<0.0001), highest level of proteinuria (P<0.0001), lowest Hb (P<0.0001) and antenatal eclamptic fits AOR 4.62 [1.47, 14.50]. Deaths from immaturity were independently associated with bleeding < 28 weeks AOR 3.50 [2.39, 5.13], bleeding 28+ weeks AOR 1.93 [1.16, 3.22], highest diastolic blood pressure (P<0.01) and highest level of proteinuria (P<0.0001). Infection featured in deaths associated with intrapartum asphyxia, with syphilis AOR 2.17 [1.44, 3.26] and vaginal infection/discharge (P<0.01) independently associated; other strong associations were bleeding <28 weeks AOR 2.10 [1.57, 2.81], bleeding 28+ weeks AOR 2.32 [1.62, 3.33], highest diastolic blood pressure(P0.0001), first diastolic blood pressure (P<0.0001) and antenatal eclampsia AOR 6.70 [2.63, 17.13]. For all perinatal deaths combined, independent features were syphilis AOR 2.06 [1.49, 2.85], vaginal infection/discharge (P<0.001), bleeding < 28 weeks AOR 2.01 [1.60, 2.53], bleeding 28+ weeks AOR 2.65 [2.02, 3.48], highest diastolic blood pressure (P<0.0001), and antenatal eclampsia AOR 4.22[1.76, 10.14]. The results help identify areas for monitoring and identifying pregnancies at highest risk (Summary)