View source for Perinatal mortality

{{distinguish|embryo loss|abortion|infant mortality}}
{{Infobox medical condition (new)
| name            = Perinatal mortality
| synonyms        = Perinatal death
| image           = Neonatal Death.png
| caption         = Infant, neonatal, and postneonatal mortality rates: United States, 1940–2005
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'''Perinatal mortality''' ('''PNM''') is the death of a [[fetus]] or [[neonate]] and is the basis to calculate the perinatal [[mortality rate]].<ref>{{cite web|url=http://www.cpc.unc.edu/measure/prh/rh_indicators/specific/nb/perinatal-mortality-rate-pmr|title=Perinatal mortality rate (PMR) — MEASURE Evaluation|website=www.cpc.unc.edu|date=9 September 2020 }}</ref> ''Perinatal'' means "relating to the period starting a few weeks before birth and including the birth and a few weeks after birth."<ref>{{Cite book |url=https://www.worldcat.org/oclc/1142355883 |title=Concise medical dictionary |date=2020 |others=Jonathan Law, E. A. Martin |isbn=978-0-19-187376-8 |edition=10th |location=Oxford |oclc=1142355883}}</ref>

Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion or exclusion of early fetal and late neonatal fatalities. The [[WHO|World Health Organization]] defines perinatal mortality as the "number of stillbirths and deaths in the first week of life per 1,000 total births, the perinatal period commences at 22 completed weeks (154 days) of gestation,<ref>{{Cite web|url=https://www.uptodate.com/contents/perinatal-mortality/print|title = UpToDate}}</ref> and ends seven completed days after birth",<ref>{{cite web|url=https://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/|archive-url=https://web.archive.org/web/20131203064838/http://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/|url-status=dead|archive-date=December 3, 2013|title=WHO – Maternal and perinatal health|website=www.who.int}}</ref> but other definitions have been used.<ref name="pmid9431331">{{cite journal |vauthors=Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP |title=The perinatal mortality rate as an indicator of quality of care in international comparisons |journal=[[Medical Care (journal)|Medical Care]] |volume=36 |issue=1 |pages=54–66 |date=January 1998 |pmid=9431331 |doi= 10.1097/00005650-199801000-00007}}</ref>

The UK figure is about 8 per 1,000 and varies markedly by social class with the highest rates seen in Asian women. Globally, an estimated 2.6 million neonates died in 2013 before the first month of age down from 4.5 million in 1990.<ref name=GBD204>{{cite journal|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2|volume=385|issue=9963|pages=117–71|pmc=4340604}}</ref>

==Causes==
{{Further|Preterm birth#Specific risks for the preterm neonate}}
[[Preterm birth]] is the most common cause of perinatal mortality, causing almost 30 percent of neonatal deaths.<ref name=marchofdimes>[http://www.marchofdimes.org/loss/neonatal-death.aspx March of Dimes / Neonatal Death] {{Webarchive|url=https://web.archive.org/web/20141024114718/http://www.marchofdimes.org/loss/neonatal-death.aspx |date=2014-10-24 }} Retrieved on November 10, 2014</ref> [[Infant respiratory distress syndrome]], in turn, is the leading cause of death in preterm infants, affecting about 1% of newborn infants.<ref>Rodriguez RJ, Martin RJ, and Fanaroff, AA. ''Respiratory distress syndrome and its management.'' Fanaroff and Martin (eds.) Neonatal-perinatal medicine: Diseases of the fetus and infant; 7th ed. (2002):1001–1011. St. Louis: Mosby.</ref> [[Birth defect]]s cause about 21 percent of neonatal death.<ref name=marchofdimes/>

Some major '''causes of perinatal mortality''' rate is:

* Maternal diseases 
* Pelvic diseases; endometriosis, ovarian tumor 
* Anatomical defects; Uterine, Cervical anomalies 
* Endocrine imbalance 
* Blood incompatibilities 
* Malnutrition 
* Toxemias of pregnancy 
* APH 
* Congenital defects 
* Advanced maternal age

==Fetal mortality==
Fetal mortality refers to [[stillbirth]]s or fetal death.<ref>{{cite web|url=https://www.cdc.gov/nchs/nvss/fetal_death.htm|title=NVSS – Fetal Deaths|date=8 November 2017|website=www.cdc.gov}}</ref> It encompasses any death of a fetus after 20 weeks of gestation or 500 gm. In some definitions of the PNM early fetal mortality (week 20–27 gestation) is not included, and the PNM may only include late fetal death and neonatal death. Fetal death can also be divided into death prior to [[Childbirth|labor]], antenatal (antepartum) death, and death during labor, intranatal (intrapartum) death.

==Neonatal mortality==
Neonatal mortality refers to death of a live-born baby within the first 28 days of life. Early neonatal mortality refers to the death of a live-born [[baby]] within the first seven days of life, while late neonatal mortality refers to death after 7 days until before 28 days. Some definitions of the PNM include only the early neonatal mortality. Neonatal mortality is affected by the quality of in-hospital care for the [[neonate]]. Neonatal mortality and postneonatal mortality (covering the remaining 11 months of the first year of life) are reflected in the [[Infant mortality|infant mortality rate]].

==Perinatal mortality rate==
{|  class="wikitable"
! colspan=6| Top ten countries<br>with the highest perinatal mortality rates – 2012<ref>{{cite web|url=https://www.savethechildren.net/sites/default/files/libraries/ENDING-NEWBORN-DEATHS.pdf|title=Ending Newborn Deaths}}</ref><ref>{{cite web|url=http://www.iol.co.za/lifestyle/family/birth/million-babies-die-a-year-charity-1.1653041#.Uw791uNUCKU|title=Million babies die a year – charity – IOL}}</ref><ref>{{cite web|url=http://www.pmnewsnigeria.com/2014/02/25/nigeria-pakistan-india-lead-the-world-in-infant-deaths/|title=Nigeria, Pakistan, India lead the world in infant deaths – PM NEWS Nigeria|date=25 February 2014}}</ref>
|-
!Rank||Country||PNMR ||Rank||Country|| PNMR
|-
|align=center|  1|| {{PAK}} || style="text-align:right;"|  40.7||align=center|  6|| {{AFG}} || style="text-align:right;"|  29.0
|-
|align=center|  2|| {{NGA}} || style="text-align:right;"|  32.7||align=center|  7|| {{BAN}} || style="text-align:right;"|  28.9 
|-
|align=center|  3|| {{SLE}} || style="text-align:right;"|  30.8||align=center|  8|| {{COD}} || style="text-align:right;"|  28.3
|-
|align=center|  4|| {{SOM}} || style="text-align:right;"|  29.7||align=center|  9|| {{LES}} || style="text-align:right;"|  27.5
|-
|align=center|  5|| {{GBS}} || style="text-align:right;"|  29.4||align=center| 10|| {{ANG}} || style="text-align:right;"|  27.4
|-
|  align=center colspan=6| <small>As per 2014 "[[Save the Children]]" report for intrapartum stillbirths<br>and neonatal deaths on first day of birth (per 1,000 total births)</small>
|}

The PNMR refers to the number of perinatal deaths per 1,000 total births. It is usually reported on an annual basis.<ref>{{cite web|url=http://www.checkpregnancy.com/miscarriage-statistics/|title=Miscarriage Risk by Week and What Affects Your Risks of Miscarriage|date=23 August 2015}}</ref> It is a major marker to assess the quality of health care delivery. Comparisons between different rates may be hampered by varying definitions, registration bias, and differences in the underlying risks of the populations.

PNMRs vary widely and may be below 10 for certain developed countries and more than 10 times higher in developing countries.<ref>{{Cite web|url=http://www.cih.uib.no/journals/EJHD/ejhdv14-n3/ejhd-14-3-page-335.htm|title = Centre for International Health}}</ref> The WHO has not published contemporary data.

== Effects of neonatal nutrition on neonatal mortality ==
Probiotic supplementation of preterm and low birthweight babies during their first month of life can reduce the risk of blood infections, bowel sickness and death in low- and middle-income settings.  However, supplementing with Vitamin A does not reduce the risk of death and increases the risk of ''bulging fontanelle,'' which may cause brain damage.<ref>{{Cite journal|last1=Imdad|first1=Aamer|last2=Rehman|first2=Faseeha|last3=Davis|first3=Evans|last4=Ranjit|first4=Deepika|last5=Surin|first5=Gamael S. S.|last6=Attia|first6=Suzanna L.|last7=Lawler|first7=Sarah|last8=Smith|first8=Abigail A.|last9=Bhutta|first9=Zulfiqar A.|date=2021|title=Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review|journal=Campbell Systematic Reviews|language=en|volume=17|issue=1|pages=e1141|doi=10.1002/cl2.1141|pmid=37133295 |pmc=8356300 |s2cid=240864559|issn=1891-1803|doi-access=free}}</ref>

==See also==
*[[Maternal death]]
*[[Miscarriage]]
*[[Neonatal intensive care unit]]
*[[Neonaticide]]
*[[Pregnancy and Infant Loss Remembrance Day]]
*[[Stillbirth]]

==References==
{{Reflist}}

== External links ==
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*[https://www.who.int/whr/2005/media_centre/facts_en.pdf WHO 2005 report]
*[http://www.europeristat.com/images/doc/Peristat%202013%20V2.pdf European Perinatal Health Report 2010]
{{Women's health|state=collapsed}}
{{Death}}
{{Certain conditions originating in the perinatal period}}
{{Authority control}}

{{DEFAULTSORT:Perinatal Mortality}}
[[Category:Medical aspects of death]]
[[Category:Obstetrics]]
[[Category:Infant mortality]]
[[Category:Medical terminology]]
[[Category:Midwifery]]
[[Category:Pregnancy with abortive outcome]]

[[fi:Kohtukuolema]]