Antepartum complications and perinatal mortality in rural Bangladesh

for the Projahnmo Study Group in Bangladesh, Rasheda Khanam, Saifuddin Ahmed, Andreea A. Creanga, Nazma Begum, Alain K. Koffi, Arif Mahmud, Heather Rosen, Abdullah H. Baqui

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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%. Conclusions: 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.

LanguageEnglish (US)
Article number81
JournalBMC Pregnancy and Childbirth
Volume17
Issue number1
DOIs
StatePublished - Mar 7 2017

Fingerprint

Bangladesh
Perinatal Mortality
Stillbirth
Pregnancy Induced Hypertension
Incidence
Hemorrhage
Perinatal Death
Infection
Population
Infant Mortality
Risk Reduction Behavior
Pregnancy Outcome
Regression Analysis
Mothers

Keywords

  • Antepartum complications
  • Antepartum hemorrhage
  • Early neonatal deaths
  • Perinatal deaths
  • Pregnancy induced hypertension
  • Probable infection
  • Stillbirths

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Antepartum complications and perinatal mortality in rural Bangladesh. / for the Projahnmo Study Group in Bangladesh.

In: BMC Pregnancy and Childbirth, Vol. 17, No. 1, 81, 07.03.2017.

Research output: Contribution to journalArticle

for the Projahnmo Study Group in Bangladesh. Antepartum complications and perinatal mortality in rural Bangladesh. BMC Pregnancy and Childbirth. 2017 Mar 7;17(1). 81. Available from, DOI: 10.1186/s12884-017-1264-1
for the Projahnmo Study Group in Bangladesh. / Antepartum complications and perinatal mortality in rural Bangladesh. In: BMC Pregnancy and Childbirth. 2017 ; Vol. 17, No. 1.
@article{39847bb2ddee459f842e2c426d1347f8,
title = "Antepartum complications and perinatal mortality in rural Bangladesh",
abstract = "Background: 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. Methods: 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. Results: 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{\%}. Conclusions: 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.",
keywords = "Antepartum complications, Antepartum hemorrhage, Early neonatal deaths, Perinatal deaths, Pregnancy induced hypertension, Probable infection, Stillbirths",
author = "{for the Projahnmo Study Group in Bangladesh} and Rasheda Khanam and Saifuddin Ahmed and Creanga, {Andreea A.} and Nazma Begum and Koffi, {Alain K.} and Arif Mahmud and Heather Rosen and Baqui, {Abdullah H.}",
year = "2017",
month = "3",
day = "7",
doi = "10.1186/s12884-017-1264-1",
language = "English (US)",
volume = "17",
journal = "BMC Pregnancy and Childbirth",
issn = "1471-2393",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Antepartum complications and perinatal mortality in rural Bangladesh

AU - for the Projahnmo Study Group in Bangladesh

AU - Khanam,Rasheda

AU - Ahmed,Saifuddin

AU - Creanga,Andreea A.

AU - Begum,Nazma

AU - Koffi,Alain K.

AU - Mahmud,Arif

AU - Rosen,Heather

AU - Baqui,Abdullah H.

PY - 2017/3/7

Y1 - 2017/3/7

N2 - Background: 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. Methods: 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. Results: 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%. Conclusions: 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.

AB - Background: 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. Methods: 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. Results: 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%. Conclusions: 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.

KW - Antepartum complications

KW - Antepartum hemorrhage

KW - Early neonatal deaths

KW - Perinatal deaths

KW - Pregnancy induced hypertension

KW - Probable infection

KW - Stillbirths

UR - http://www.scopus.com/inward/record.url?scp=85014688286&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014688286&partnerID=8YFLogxK

U2 - 10.1186/s12884-017-1264-1

DO - 10.1186/s12884-017-1264-1

M3 - Article

VL - 17

JO - BMC Pregnancy and Childbirth

T2 - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

SN - 1471-2393

IS - 1

M1 - 81

ER -