Mortalidade perinatal, morbidade materna grave e near miss materno: protocolo de um estudo integrado à pesquisa Nascer no Brasil II / Mortalidad perinatal, morbilidad materna severa y near miss materna: protocolo de un estudio integrado con la encuesta Nacer en Brasil II / Perinatal mortality, severe maternal morbidity and maternal near miss: protocol of a study integrated with the Birth in Brazil II survey

Resumo: O Brasil apresenta elevada morbimortalidade materna e perinatal. Casos de morbidade materna grave, near miss materno e óbitos perinatais são indicadores importantes de saúde e compartilham dos mesmos determinantes sociais, tendo estreita relação com as condições de vida e qualidade da assistência perinatal. Este artigo pretende apresentar o protocolo de estudo que visa estimar a taxa de mortalidade perinatal e a incidência de morbidade materna grave e near miss materno no país, assim como identificar seus determinantes. Trata-se de estudo transversal integrado à pesquisa Nascer no Brasil II, realizada entre 2021 e 2023. Serão incluídas neste estudo 155 maternidades públicas, mistas e privadas, com mais de 2.750 partos por ano, participantes do Nascer no Brasil II. Nessas maternidades, será realizada coleta retrospectiva de dados de prontuário materno e neonatal de todas as internações ocorridas num período de 30 dias, com aplicação de uma ficha de triagem para identificação de casos de morbidade materna e de óbito perinatal. Dados de prontuário de todos os casos identificados serão coletados após a alta hospitalar, utilizando instrumento padronizado. Casos de morbidade materna grave e near miss materno serão classificados por meio da definição adotada pela Organização Mundial da Saúde. Será estimada a taxa de mortalidade perinatal e a incidência de morbidade materna grave e near miss materno. Os casos serão comparados a controles obtidos na pesquisa Nascer no Brasil II, pareados por hospital e duração da gestação, visando a identificação de fatores associados aos desfechos negativos. Espera-se que os resultados deste artigo contribuam para o conhecimento sobre a morbidade materna e a mortalidade perinatal no país, bem como para a elaboração de estratégias de melhoria do cuidado.

Resumen: Brasil tiene una alta morbimortalidad materna y perinatal. Los casos de morbilidad materna severa, maternal near miss y muertes perinatales son importantes indicadores de salud y comparten los mismos determinantes sociales, y tienen una estrecha relación con las condiciones de vida y la calidad de la asistencia perinatal. Este artículo pretende presentar el protocolo de estudio que tiene como objetivo estimar la tasa de mortalidad perinatal y la incidencia de morbilidad materna severa y maternal near miss en el país, así como identificar sus determinantes. Se trata de un estudio transversal integrado a la investigación Nacer en Brasil II, realizada entre el 2021 y el 2023. Este estudio incluirá 155 maternidades públicas, mixtas y privadas, con más de 2.750 partos al año, que participan en el Nacer en Brasil II. En estas maternidades, se realizará una recopilación retrospectiva de datos de las historias clínicas maternas y neonatales de todas las hospitalizaciones ocurridas en un período de 30 días, con la aplicación de un formulario de triaje para identificar casos de morbilidad materna y de muerte perinatal. Los datos de las historias clínicas de todos los casos identificados se recopilarán tras el alta hospitalaria, mediante un instrumento estandarizado. Los casos de morbilidad materna severa y maternal near miss se clasificarán por medio de la definición adoptada por la Organización Mundial de la Salud. Se estimará la tasa de mortalidad perinatal y la incidencia de morbilidad materna severa y maternal near miss. Los casos se compararán con los controles obtenidos en el estudio Nacer en Brasil II, emparejados por hospital y duración del embarazo, para identificar factores asociados con desenlaces negativos. Se espera que los resultados de este artículo contribuyan al conocimiento sobre la morbilidad materna y la mortalidad perinatal en el país, así como a la elaboración de estrategias para mejorar el cuidado.

Abstract: Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health indicators and share the same determinants, being closely related to living conditions and quality of perinatal care. This article aims to present the study protocol to estimate the perinatal mortality rate and the incidence of severe maternal morbidity and maternal near miss in the country, identifying its determinants. Cross-sectional study integrated into the research Birth in Brazil II, conducted from 2021 to 2023. This study will include 155 public, mixed and private maternities, accounting for more than 2,750 births per year, participating in the Birth in Brazil II survey. We will collect retrospective data from maternal and neonatal records of all hospitalizations within a 30-day period in these maternities, applying a screening form to identify cases of maternal morbidity and perinatal deaths. Medical record data of all identified cases will be collected after hospital discharge, using a standardized instrument. Cases of severe maternal morbidity and maternal near miss will be classified based on the definition adopted by the World Health Organization. The perinatal deaths rate and the incidence of severe maternal morbidity and maternal near miss will be estimated. Cases will be compared to controls obtained in the Birth in Brazil II survey, matched by hospital and duration of pregnancy, in order to identify factors associated with negative outcomes. Results are expected to contribute to the knowledge on maternal morbidity and perinatal deaths in Brazil, as well as the development of strategies to improve care.

Mortalidad perinatal en el municipio de Panchimalco, San Salvador: una serie de casos / Perinatal mortality in the municipality of Panchimalco, San Salvador: a case series

RESUMEN La mortalidad perinatal es un indicador que refleja el impacto de la atención materno-infantil de un país. Este estudio presenta nueve casos de la mortalidad perinatal ocurridos en el municipio de Panchimalco, El Salvador. La información se obtuvo de los informes de auditorías. Las madres de los fallecidos tenían edades entre 17 a 43 años, sin uso de anticonceptivos, con controles prenatales incompletos y un promedio de edad gestacional de 31 semanas, tres partos fueron atendidos en la comunidad. La mayoría de muertes perinatales ocurrieron antes del parto de causa desconocida y los nacidos vivos fueron prematuros. Se identificaron factores como el déficit en la atención integral a la mujer. Se requiere de nuevos estudios para determinar los principales factores que influyen en las muertes perinatales en El Salvador.

ABSTRACT Perinatal mortality is an indicator that reflects the impact of maternal and infant care in a country. This study presents nine cases of perinatal mortality that occurred in the municipality of Panchimalco, El Salvador. The information was obtained from audit reports. The mothers of the deceased infants were aged between 17 and 43 years, did not use contraceptive methods, had incomplete prenatal controls and averaged a gestational age of 31 weeks. Three deliveries were attended in the community. Most perinatal deaths occurred before delivery due to unknown causes, and live births were preterm. We identified factors such as deficits in comprehensive care for women. Further studies are needed to determine the main factors influencing perinatal deaths in El Salvador.

Analysis of the perinatal mortality rate in the metropolitan region of grande Vitória, Espírito Santo, Brazil, between 2008 and 2017

Introduction: perinatal mortality is characterized by fetal deaths that occur after the 22nd week of management and neonatal deaths that precede six full days of life. This indicator has been a matter of concern and discussion on the part of entities and organizations involved in comprehensive health care for women and children.Objective: to characterize perinatal deaths in the Metropolitan Region of Greater Vitória (RMGV) in Espírito Santo and identify associated maternal factors in the period between 2008 and 2017.Methods: ecological and descriptive study with a quantitative approach, carried out in 2019 on perinatal mortality from 2008 to 2017 at RMGV. Data collection was performed by extracting data from the SIM, SINASC, IBGE databases of the Espírito Santo State Health Department, about perinatal deaths and associated maternal factors. The research respects the ethical precepts of resolution 466/12 of the National Health Council.Results: the distribution of deaths did not occur homogeneously in the municipalities in the RMGV. The municipality of Vitória had the lowest perinatal mortality rates during the study period, on the other hand, in the comparative analysis between the different municipalities that make up the RMGV, the municipality of Fundão presents the worst scenario regarding perinatal mortality over the years. Regarding the underlying causes of death, it is noted that in this study, the three causes with the highest number of occurrences are complications of the placenta, umbilical cord and maternal affections, not necessarily related to the current pregnancy and intrauterine hypoxia.Conclusion: there were no significant changes in mortality rates in the Metropolitan Region of Greater Vitória. However, the main deaths occurred in neighborhoods with greater socioeconomic inequalities. Maternal causes were highly representative of deaths, raising issues associated with the improvement of public health policies.

Introdução: a mortalidade perinatal caracteriza-se pelos óbitos fetais que ocorrem a partir da 22ª semana de gestão e os óbitos neonatais que antecedem seis dias completos de vida. Este indicador tem sido motivo de preocupação e discussão por parte de entidades e organizações envolvidas na atenção à saúde integral da mulher e da criança. Objetivo: caracterizar os óbitos perinatais da Região Metropolitana da Grande Vitória (RMGV) no Espírito Santo e identificar fatores maternos associados, no período entre 2008 e 2017. Método: estudo ecológico e descritivo de abordagem quantitativa, realizado no ano de 2019 acerca da mortalidade perinatal entre os anos de 2008 a 2017 na RMGV. A coleta de dados foi realizada através extração dos dados das bases SIM, SINASC, IBGE da Secretaria de Saúde do Estado do Espírito Santo, acerca dos óbitos perinatais e fatores maternos associados. A pesquisa respeita os preceitos éticos da resolução 466/12 do Conselho Nacional de Saúde. Resultados: a distribuição dos óbitos não ocorreu de forma homogênea nos municípios na RMGV. O município de Vitória apresentou os menores índices de mortalidade perinatal durante o período estudado, em contrapartida, na análise comparativa entre os diferentes municípios que compõe a RMGV, o município de Fundão apresenta o pior cenário relativo à mortalidade perinatal ao longo dos anos. Acerca das causas bases de óbitos, nota-se que neste estudo, as três causas com maior número de ocorrência são complicações da placenta, do cordão umbilical e afecções maternas, não obrigatoriamente relacionadas com a gravidez atual e hipóxia intrauterina. Conclusão: não houve mudanças significativas nas taxas de mortalidade na Região Metropolitana da Grande Vitória. Contudo, os principais óbitos ocorreram em bairros com maiores desigualdades socieconomicas. As causas maternas representaram uma grande representatividade frente aos óbitos, levantando questões associadas a melhora de políticas públicas de saúde.

Complicaciones obstétricas y edad materna avanzada

La edad materna avanzada guarda relación directamente proporcional con el riesgo de complicaciones obstétricas y no obstétricas durante la gestación, tanto para la gestante como para el feto. Esto es particularmente importante debido a que a las tasas de fecundidad de las mujeres de mayor edad han aumentado. En Estados Unidos, el 10% del primer nacimiento y el 20% de todos los nacimientos ocurren en mujeres con 35 años o más. Históricamente la edad materna avanzada se ha definido como una edad mayor o igual a 35 años, punto de corte que sustentado en la disminución de la fecundidad y el mayor riesgo de anomalías genéticas en la descendencia de las mujeres mayores a esta edad. Sin embargo, los efectos relacionados al aumento de edad son continuos y el riesgo es mayor mientras mayor sea la edad al momento de la concepción más que como efecto de pasar el umbral de los 35 años. Diferentes investigaciones han mostrado que las gestantes añosas tienen mayor riesgo de complicaciones tempranas de la gestación como aborto espontáneo, embarazo ectópico, anomalías cromosómicas y malformaciones congénitas, así como, preeclampsia, diabetes gestacional, patología placentaria, parto pretérmino, peso bajo al nacer, mortalidad perinatal, embarazo múltiple, parto distócico, parto por cesárea y mortalidad materna. En este artículo se revisa publicaciones recientes sobre el tema y se incluye estadística de un importante hospital de Lima, Perú, y de la Encuesta Nacional de Demografía y Salud Familiar - ENDES 2022.

Advanced maternal age is directly proportional to the risk of obstetric and nonobstetric complications during gestation, both for the pregnant woman and the fetus. This is particularly important because the fertility rates of older women have increased. In the US, 10% of first births and 20% of all births occur to women 35 years of age or older. Historically, advanced maternal age has been defined as an age greater than or equal to 35 years, a cutoff point that is supported by declining fertility and the increased risk of genetic abnormalities in the offspring of women older than this age. However, the effects related to increasing age are continuous and the risk is greater the older the age at conception rather than as an effect of passing the 35 years threshold. Research has shown that older pregnant women are at increased risk of early pregnancy complications such as miscarriage, ectopic pregnancy, chromosomal abnormalities and congenital malformations, as well as, preeclampsia, gestational diabetes, placental pathology, preterm delivery, low birth weight, perinatal mortality, multiple pregnancy, dystocic delivery, cesarean delivery and maternal mortality. This article reviews recent publications on the subject and includes statistics from a major hospital in Lima, Peru, and from the National Demographic and Family Health Survey - ENDES, 2022.

Factores de riesgo maternos asociados con la muerte fetal tardía en el contexto santaclareño / Maternal risk factors associated with late fetal death in the Santa Clara context

Introducción: La muerte fetal es uno de los accidentes obstétricos más difíciles de enfrentar, tanto para la paciente y su familia como para el personal de salud que atiende a la gestante. Objetivo: Identificar los factores de riesgo maternos asociados con la muerte fetal tardía en el contexto santaclareño. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo en el municipio Santa Clara, provincia Villa Clara, en el período comprendido de enero de 2015 a diciembre de 2019. La población estuvo conformada por 71 gestantes con fetos muertos en una etapa tardía y sus productos; en el análisis y procesamiento de los datos, se usó el software SPSS versión 20 para Windows. Resultados: Existió predominio de gestantes multíparas (56,3 %), en edad reproductiva óptima (69 %) y con uno a tres factores de riesgo (71,8 %). Conclusiones: Los factores maternos asociados con mayor frecuencia a la muerte fetal tardía pueden agruparse en: los vinculados a las enfermedades crónicas, en primer lugar la hipertensión arterial y en segundo el hipotiroidismo, y los relacionados con las afecciones del tracto genital, entre las que prevalece la vaginitis.

Introduction: fetal death is one of the most difficult obstetric accidents to face, both for patients and their families as well as for the health personnel who take care of the pregnant women. Objective: to identify the maternal risk factors associated with late fetal death in the Santa Clara context. Methods: a descriptive, longitudinal and retrospective study was carried out in Santa Clara municipality, Villa Clara province, from January 2015 to December 2019. The population consisted of 71 pregnant women with late fetal demise and their products; the SPSS software version 20.0 for Windows was used in the data processing and analysis. Results: multiparous pregnant women predominated (56.3%), in optimal reproductive age (69%) and from one to three risk factors (71.8%). Conclusions: the most frequently maternal factors associated with late fetal death can be grouped into those that were linked to chronic diseases, firstly arterial hypertension and secondly hypothyroidism, and those related to disorders of the genital tract, among which vaginitis prevails.

The Maternal and Fetal Outcome of Placenta Praevia in Term Pregnancy

Background: Placenta praevia refers to a placenta that is Inserted either completely or partially in the lower uterine segment. In placenta praevia, placenta is implanted in the lower uterine segment within the zone of effacement and dilatation of cervix, resulting in obstruction to decent of the Presenting part. The aim of this study is to find out the maternal and fetal outcome of Placenta praevia in term pregnancy. Material & Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of obstetrics and gynecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2013 to June 2013. The duration of the period from Data was entered in MS Excel and Statistical analysis was done using SPSS 24 version. Results: This study shows that Maternal age range was 18 to 45 years and the commonest age group of placentas previa was 25-29 years (60.0%). Four percent were between 20-24 years age group. Twenty percent were more than 35 years of age. Conclusion: The study subjects were selected only who were found high maternal morbidity and perinatal mortality which was 8% due to placenta preavia. So, the observed result of this study might not reflect the expected real outcome. In population therefore further prospective studies with a large sample should be carried out for comprehensive evaluation of placenta Preavia on maternal and neonatal outcome.

Desigualdades en salud en mortalidad perinatal durante el Plan Decenal de Salud Pública 2012-2021. Cauca, Colombia

Objetivo: identificar desigualdades en salud asociadas a la mortalidad perinatal durante el Plan Decenal de Salud Pública 2012-2021 en los 42 municipios del Departamento de Cauca Colombia. Métodos: estudio ecológico que abordó el periodo 2012-2021 a partir de datos de fuentes secundarias procedentes del Departamento Administrativo Nacional de Estadística. La población de estudio fueron mujeres entre los 12 y 49 años residentes en Cauca. Se calcularon desigualdades por rangos y modelos de regresión de acuerdo con el Índice de Desigualdad de la Pendiente, el Índice de Desigualdad Relativa y el Índice de Concentración. Resultados: 42 municipios reportaron 3 110 muertes perinatales. La edad media de las mujeres afectadas fue de 25,3 años con predominio del grupo de 20 a 24 años. La región Pacifico reportó la mayor tasa de mortalidad. La pertenencia étnica, el analfabetismo y el Índice de Pobreza Multidimensional, se asociaron estadísticamente con la mortalidad. Se observó una desigualdad más pronunciada en la tasa de mortalidad perinatal en los municipios con condiciones socioeconómicas más desfavorables. Conclusiones: a pesar de la operacionalización del Plan Decenal de Salud Pública, la mortalidad perinatal en el Cauca continúa siendo un reto en el proceso salud/enfermedad. Existe disparidad en la mortalidad perinatal en relación con el nivel socioeconómico; aunque se ha observado disminución en la desigualdad en el transcurso de los años, aún persisten brechas significativas. Los hallazgos subrayan la necesidad de monitorear y dar cuenta de las desigualdades en salud al diseñar, implementar y evaluar las políticas públicas de prevención de la mortalidad perinatal.

Objective: to identify health inequalities associated with perinatal mortality during the Ten-Year Public Health Plan 2012-2021 in the 42 municipalities of the Department of Cauca, Colombia. Methods: ecological study that addressed the period 2012 - 2021 based on data from secondary sources from the National Administrative Department of Statistics. The study population was women between 12 and 49 years of age residing in Cauca. Rank inequalities and regression models were calculated according to the Slope Inequality Index, the Relative Inequality Index and the Concentration Index. Results: 42 municipalities reported 3 110 perinatal deaths. The mean age of the affected women was 25,3 years with a predominance of the 20-24 years age group. The Pacific region reported the highest mortality rate. Ethnicity, illiteracy and the Multidimensional Poverty Index were statistically associated with mortality. There was greater inequality in perinatal mortality in municipalities with worse socioeconomic status. Conclusions: despite the operationalization of the Ten-Year Public Health Plan, perinatal mortality in Cauca continues to be a challenge in the health/disease process. There is disparity in perinatal mortality in relation to socioeconomic level, and although a decrease in inequality has been observed over the years, significant gaps still persist. The findings underscore the need to monitor and account for health inequalities in the design, implementation and evaluation of public policies to prevent perinatal mortality.

Clasificación de la hiperglucemia en el embarazo. Revisión narrativa / Classification of hyperglycemia in pregnancy. Narrative review

Resumen ANTECEDENTES: La coexistencia de hiperglucemia y embarazo se asocia con morbilidad, mortalidad y riesgo cardiometabólico para la madre y su hijo. En el año 2010, la International Association of the Diabetes and Pregnancy Study Groups (IADPSG) estableció una clasificación, aceptada por la Organización Mundial de la Salud (OMS) y la International Federation of Gynecologt and Obstetrics (FIGO) en el 2013, en la que se consideran las semanas de gestación al diagnóstico de hiperglucemia y las concentraciones séricas de glucosa en diferentes escenarios. OBJETIVO: Actualizar los escenarios de clasificación de la hiperglucemia en la embarazada y documentar, de acuerdo con lo soportado en la evidencia, su repercusión clínica. METODOLOGÍA: Búsqueda bibliográfica en las bases de datos PubMed, Google Académico y Clinicalkey de artículos publicados entre los años 2008 a 2022, que contuvieran las palabras clave (MESH): "gestational diabetes" e "hyperglycemia in pregnancy" que posteriormente se filtraron conforme a su contenido específico definido en los criterios de inclusión (estudios epidemiológicos, de diagnóstico y clasificación de la hiperglucemia en el embarazo y de desenlaces maternos y perinatales en coexistencia con hiperglucemia en el embarazo). RESULTADOS: Se identificaron 25,886 artículos, de los que solo 24 cumplieron con los criterios de inclusión (8 observacionales descriptivos, 2 de revisión sistemática y metanálisis, 13 revisiones de la bibliografía y consensos globales, y 1 ensayo clínico aleatorizado). CONCLUSIÓN: Clasificar a la hiperglucemia en diferentes escenarios clínicos es importante para su debido diagnóstico, orientación clínica, estudios adicionales y tratamiento temprano.

Abstract BACKGROUND: Hyperglycemia in pregnancy is associated with perinatal maternal morbidity and mortality and cardiometabolic risk for the mother and her offspring. In 2010, the International Diabetes and Pregnancy Study Group (IADPSG) established a classification, accepted by the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) in 2013, considering gestational age. diagnosis and serum glucose levels to be classified in different scenarios. OBJECTIVE: To update the classification scenarios of hyperglycemia in pregnant women and to document, in accordance with what is supported by the evidence, its clinical impact. MATERIALS AND METHODS: The PubMed, Google Scholar, and Clinicalkey databases were searched with the MESH terms ("gestational diabetes," "hyperglycemia in pregnancy"), subsequently filtered according to specific content, defined in the inclusion criteria (studies on epidemiology, diagnosis and classification of hyperglycemia in pregnancy and studies on maternal and perinatal outcomes in hyperglycemia in pregnancy) all articles published between 2008 and 2022. RESULTS: 25,886 articles were identified, 24 of these met the inclusion criteria; eight were descriptive observational, two systematic reviews and meta-analyses, thirteen reviews of the literature and global consensus, and one randomized clinical trial. CONCLUSION: Classifying hyperglycemia within the different clinical scenarios is important for its approach, clinical orientation, additional studies if required, and early management interventions.

Labor analgesia and its impact on the maternal and perinatal outcomes

SUMMARY OBJECTIVE: This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS: This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)—analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)—analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)—analgesia performed with cervical dilatation ≥9.0 cm. RESULTS: Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION: Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.

Diagnóstico prenatal de enfermedad de canal atrio-ventricular, análisis epidemiológico y experiencia CERPO entre 2003 y 2021 / Prenatal diagnosis of atrio-ventricular canal disease, epidemiological analysis and CERPO experience between 2003 and 2021

Antecedentes: En Chile, la mitad de los casos de mortalidad perinatal son atribuibles a anomalías congénitas, y un tercio de estas corresponde a cardiopatías congénitas. Aproximadamente un 35% de estos últimos requerirán cirugía antes del año de vida, por lo que la pesquisa prenatal impacta profundamente en el pronóstico. Objetivo: Dar a conocer los resultados perinatales de pacientes con diagnóstico prenatal de canal atrio-ventricular controlados en el Centro de Referencia Perinatal Oriente (CERPO) entre los años 2003 y 2021, su asociación a otras anomalías, características demográficas y pronóstico a un año. Métodos: En este estudio se puede apreciar que tanto el pronóstico como el plan terapéutico posnatal dependerán de la presencia de otras alteraciones morfológicas y del estudio genético. De los factores estudiados, se puede concluir que tanto la presencia de anomalías cardiacas asociadas, como el grado de insuficiencia valvular y el tipo de canal no son predictores de la sobrevida perinatal. Conclusiones: Finalmente, en relación con la sobrevida posnatal, en este estudio, la sobrevida a un año de los recién nacidos vivos fue de un 52%, pero al desglosarlo en los niños con cariotipo euploide y trisomía 21, estos valores se tornan muy distintos, 44 y 81% respectivamente.

Background: In Chile, half of the perinatal mortality cases are attributable to congenital anomalies, and one third of these correspond to congenital heart disease. Approximately 35% of the later will require surgery before one year of life, so prenatal screening has a profound impact on the prognosis. Objective: To present the perinatal results of patients with a prenatal diagnosis of atrio-ventricular canal controlled at Centro de Referencia Perinatal Oriente CERPO) between 2003 and 2021, its association with other anomalies, demographic characteristics, and 1-year prognosis. Methods: In this study it can be seen that both the prognosis and the postnatal therapeutic plan will depend on the presence of other morphological alterations and the genetic study. From the factors studied, it can be concluded that the presence of associated cardiac anomalies, the degree of valvular insufficiency, and the type of canal are not predictors of perinatal survival. Conclusions: Finally, in relation to postnatal survival, in this study, the 1-year survival of live newborns was 52%, but when broken down into children with euploid karyotype and trisomy 21, these values become very different, 44 and 81% respectively.

Perinatal outcomes of prenatal diagnosis of congenital pulmonary airway malformation: an experience

SUMMARY OBJECTIVE: This study aimed to assess the perinatal outcomes of pregnancies with a prenatal diagnosis of congenital cystic adenomatoid malformation. METHODS: We conducted a retrospective cohort study based on information contained in the medical records of pregnant women whose fetuses had been prenatally diagnosed with congenital cystic adenomatoid malformation by ultrasonography. RESULTS: Sample analysis was based on 21 singleton pregnancies with confirmed isolated fetal congenital cystic adenomatoid malformations. The mean maternal±standard deviation age was 28±7.7 years. Types I, II, and III congenital cystic adenomatoid malformation were detected in 19% (4/21), 52.4% (11/21), and 28.6% (6/21), respectively. All fetuses presented with unilateral congenital cystic adenomatoid malformation (21/21) without associated anomalies, and 52.3% (11/21) were in the right lung. In total, 33.3% (7/21) of fetuses presented a "congenital cystic adenomatoid malformation volume ratio" >1.6 and were managed with maternal betamethasone administration. The mean gestational age at the time of steroid administration was 28.5±0.9 weeks, with a reduction in the lesion dimensions of 9.5% (2/21) (Types I and III of congenital cystic adenomatoid malformation). The mean gestational age at delivery was 38.7±2.4 weeks, and a cesarean section was performed in 76.2% (16/21) cases. Postsurgical resection was necessary for 23.8% (5/21) of the patients, and 4.7% (1/21) of them died because of respiratory complications after surgery. Pulmonary hypoplasia occurred in 9.5% (2/21) of the patients, and 4.7% (1/21) of them died because of respiratory insufficiency. The survival rate was 90.5% (19/21), and 57.2% (12/21) remained asymptomatic. CONCLUSION: Despite the isolated prenatal diagnosis of congenital cystic adenomatoid malformation, which showed good survival, congenital cystic adenomatoid malformation is associated with significant perinatal morbidity. Maternal betamethasone administration did not significantly reduce fetal lung lesion dimensions.

Risk Association of the Development of Disseminated Intravascular Coagulation (DIC) in Obstetrical Cases

Background: Disseminated intravascular coagulation (DIC) is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, DIC is a common contributor to maternal morbidity and mortality and is associated with up to 25% of maternal deaths.Aim of the study: To determine the risk factors associated with the development of disseminated intravascular coagulation (DIC) in obstetrical cases.Material & Methods:This descriptive type of study was carried out in the Department of Obstetrics and Gynecology of Janaki Medical College Teaching Hospital, RamdaiyaBhawadi, Janakpurdham, Nepal from January 2016 to December 2021. A total of 500 pregnant women complicated with DIC admitted for termination of pregnancy were included in this study. History and clinical examination were completed. The adverse obstetrical event that causes DIC is identified from clinical diagnosis and relevant investigations. Statistical analysis of the results was obtained by using windows computer software with Statistical Packages for Social Sciences (SPSS-version 26).Results:More than half (58.0%) of the patients did not receive any antenatal checkup. Regarding the risk factors for the development of DIC; abruptio placenta was associated with 185(37.0%) cases followed by PPH 147(29.4%) and preeclampsia and eclampsia 119(23.8%). Patients with risk factors of DIC were hypertension 360(72.0%), Antepartum heamorrhage 227(45.4%) and PPH 193(38.6%) these are the most common presenting features. More than two-thirds of the patients (68.0%) had spontaneous vaginal delivery. Almost two-thirds (64.0%) of patients stayed in the hospital for 8-14 days. Maternal death was found in 60(12.0%) cases and perinatal death in 121(24.2%) cases.Conclusion:Maternal and perinatal mortality in patients with DIC were 12.0% and 24.0% respectively. The major determinant of survival is prompt identification of the underlying trigger, elimination of the cause and appropriate management.

Fatores associados à mortalidade perinatal em uma capital do Nordeste brasileiro / Factors associated with perinatal mortality in a Brazilian Northeastern capital

Resumo O objetivo do estudo foi avaliar os fatores sociodemográficos, maternos e do recém-nascido associados à mortalidade perinatal em São Luís, Maranhão. Os óbitos perinatais foram identificados na coorte e pelo Sistema de Informações sobre Mortalidade. Foram incluídos 5.236 nascimentos, sendo 70 óbitos fetais e 36 neonatais precoces. Para investigar os fatores associados utilizou-se análise de regressão logística com modelo hierarquizado. O coeficiente de mortalidade perinatal foi 20,2 por mil nascimentos. A baixa escolaridade materna e a ausência de companheiro foram associadas a maior chance de óbito perinatal. A família ser chefiada por outros familiares foi fator de proteção. Tiveram maior chance de óbito perinatal filhos de mães que não realizaram pelo menos seis consultas de pré-natal (OR=4,61; IC95%:2,43-8,74) e com gravidez múltipla (OR=9,15; IC95%:4,08-20,53). Presença de malformações congênitas (OR=4,13; IC95%:1,23-13,82), nascimento pré-termo (OR= 3,36; IC95%: 1,56-7,22) e baixo peso ao nascer (BPN) (OR=11,87; IC95%:5,46-25,82) se associaram ao óbito perinatal. A mortalidade perinatal foi associada à vulnerabilidade social, não realização do número de consultas pré-natal recomendado, malformações congênitas, nascimento pré-termo e BPN.

Abstract This study investigated factors associated with perinatal mortality in São Luís, Maranhão, Northeastern Brazil. Data on perinatal mortality were obtained from the BRISA birth cohort and from the Mortality Information System, including records of 5,236 births, 70 of which referred to fetal deaths and 36 to early neonatal deaths. Factors associated with mortality were investigated using a hierarchical logistic regression model, resulting in a perinatal mortality coefficient equal to 20.2 per thousand births. Mothers with low education level and without a partner were associated with an increased risk of perinatal death. Moreover, children of mothers who did not have at least six antenatal appointments and with multiple pregnancies (OR= 9.15; 95%CI:4.08-20.53) were more likely to have perinatal death. Perinatal death was also associated with the presence of congenital malformations (OR= 4.13; 95%CI:1.23-13.82), preterm birth (OR= 3.36; 95%CI:1.56-7.22), and low birth weight (OR=11.87; 95%CI:5.46-25.82). In turn, families headed by other family members (OR= 0.29; 95%CI: 0.12 - 0.67) comprised a protective factor for such condition. Thus, the results indicate an association between perinatal mortality and social vulnerability, non-compliance with the recommended number of prenatal appointments, congenital malformations, preterm birth, and low birthweight.

Modelo de monitoreo de comportamientos inusuales o conglomerados de defectos congénitos en el nivel departamental, distrital y municipal, Colombia, 2018 / Monitoring model of unusual behaviors or conglomerates of birth defects at the departmental, district and municipal levels, Colombia, 2018

Resumen Introducción: La información de la vigilancia en salud pública permite la detección de patrones inusuales en los datos, con el fin de que las respuestas de salud pública sean oportunas y contribuyan a la disminución de la morbimortalidad de la población infantil. Objetivos: Describir un modelo de monitoreo diseñado para la identificación de comportamientos inusuales y conglomerados de defectos congénitos, así como el incremento en la frecuencia del evento en comparación con el número de casos notificados históricamente. Materiales y Métodos: Estudio descriptivo retrospectivo que incluye el análisis de los casos notificados al Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA) durante los últimos tres años, agrupados y comparados con las prevalencias de acuerdo con lo reportado por el ECLAM. Se usó la distribución de probabilidades de Poisson y se identificó aquellas entidades territoriales en donde se observan diferencias significativas entre lo esperado y lo observado con un valor de significancia < 0,05 (p < 0,05). Resultados: Se identificaron prevalencias superiores en holoprosencefalia, microcefalia, polidactilia, defectos por reducción de miembro inferior y coartación de la aorta. Los comportamientos inusuales de los defectos congénitos de sistema nervioso central se concentran en anencefalia, espina bífida, hidrocefalia, microcefalia. Conclusiones: Las condiciones particulares de cada municipio y/o departamento y el comportamiento de los defectos congénitos en algunas áreas podría indicar que las mujeres en estado de gestación son susceptibles a mayores riesgos en zonas particulares, y que este riesgo en particular podría ser el resultado de diversas inequidades en salud generadas por las interacciones sociales, ambientales y comportamentales.

Abstract Introduction: The public health surveillance information allows the detection of unusual patterns in the data in order that public health responses are timely and contribute to the reduction of morbidity and mortality of the child population. Objectives: To describe a monitoring model designed for the identification of unusual behaviors and conglomerates of congenital defects, as well as the increase in the frequency of the event in comparison with the number of cases reported historically. Materials and Methods: A retrospective descriptive study that includes the analysis of the cases notified to the Public Health National Surveillance System (SIVIGILA) during the last three years, grouped and compared with the prevalences according to what was reported by the ECLAM. The distribution of Poisson probabilities was used identifying those territorial entities where significant differences were observed between what was expected and what was observed with a value of significance < 0.05 (p < 0.05). Results: Superior prevalences were identified in holoprosencephaly, microcephaly, polydactyly, defects due to reduction of the lower limb and coarctation of the aorta. Unusual behaviors of congenital defects of the central nervous system are concentrated in anencephaly, spina bifida, hydrocephalus, microcephaly. Conclusions: The conditions of each municipality and / or department and the behavior of congenital defects in some areas could indicate that women in pregnancy are susceptible to greater risks areas, and that this risk could be the result of various health inequities generated by social, environmental, and behavioral interactions.

Mortalidad materna y perinatal en municipios y corregimientos de la frontera terrestre. Colombia 1998 - 2016 / Maternal and perinatal mortality in municipalities and townships of the land border. Colombia 1998 - 2016

RESUMEN La mortalidad materna y perinatal representan un asunto prioritario de salud pública cuyo control reviste especial dificultad en zonas de frontera. Objetivos. Describir el comportamiento de la mortalidad materna y perinatal en los territorios fronterizos de Colombia, entre 1998 y 2016 y establecer su asociación con factores sociodemográficos, geográficos y de atención sanitaria. Métodos. Estudio observacional retrospectivo, basado en registros oficiales. Se calcularon las razones de mortalidad materna (RMM) y perinatal (RMP) para el período 1998-2016, identificando los puntos de inflexión mediante análisis de Joinpoint. Así mismo, se realizaron análisis bivariados y multivariados. Resultados. De los 54 municipios y 12 corregimientos de frontera, pertenecientes a 12 Departamentos, se obtuvieron 687 registros de mortalidad materna y 12,786 de mortalidad perinatal. Las razones observadas fueron 88 x 100,000 NV para la RMM y 16 x 1,000 NV para la RMP. La tendencia de estos tipos de mortalidad fue descendente, Los valores más altos de mortalidad perinatal se asociaron significativamente con la edad materna de 35 a 54 años, atención por régimen subsidiado, nivel educativo bajo, mujeres sin pareja, y embarazos múltiples. Conclusión. La mortalidad materna y perinatal registrada en los municipios fronterizos está por encima del promedio nacional.

ABSTRACT Abstract: Maternal and perinatal mortality is a priority public health issue that is particularly difficult to control in border areas. Objectives: To describe the behavior of maternal and perinatal mortality in the border territories of Colombia, between 1998 and 2016; and to establish its association with sociodemographic, geographic and health care factors. Methods: Retrospective observational study, based on official records. Maternal mortality ratio (MMR) and perinatal mortality ratio (RMP) were calculated for the period 1998-2016, identifying inflection points through Joinpoint analysis. Likewise, bivariate and multivariate analyses were performed. Results: From 54 municipalities and 12 borders townships belonging to 12 Departments, 687 records maternal mortality records and 12,786 perinatal mortality records were obtained. The ratios observed were 88 x 100,000 BA for MMR and 16 x 1,000 NV for PMR. The trend of these types of mortality was downward. The highest values of perinatal mortality were significantly associated with maternal age 35-54 years, care by subsidized regime, low educational level, women without a partner, and multiple pregnancies. Conclusion: Maternal and perinatal mortality registered in border municipalities is above the national average.

Mortalidade perinatal no Brasil em 2018: análise epidemiológica segundo a classificação de Wiggleworth modificada / Perinatal mortality in Brazil in 2018: an epidemiological analysis according to the modified Wigglesworth classification / Mortalidad perinatal en Brasil en 2018: análisis epidemiológico según la clasificación de Wiggleworth modificada

Resumo: A mortalidade perinatal engloba a mortalidade fetal e a neonatal precoce (0 a 6 dias). Este estudo descreveu os óbitos perinatais ocorridos no Brasil em 2018, segundo a classificação de Wigglesworth modificada. As fontes de dados foram os Sistemas de Informações sobre Mortalidade e sobre Nascidos Vivos. Foram calculadas as taxas de mortalidade fetal e perinatal por mil nascimentos totais (nascidos vivos mais natimortos) e a taxa de mortalidade neonatal precoce por mil nascidos vivos, e comparadas usando seus respectivos intervalos de 95% de confiança (IC95%). Os óbitos perinatais foram classificados nos grupos de causas anteparto, anomalias congênitas, prematuridade, asfixia e causas específicas. Foi calculado, para cada grupo de causas, o número de óbitos por faixa de peso, além das taxas de mortalidade e os respectivos IC95%, e feita a distribuição espacial das taxas de mortalidade por Unidade da Federação (UF). Foram registrados 35.857 óbitos infantis, sendo 18.866 (52,6%) neonatais precoces; os natimortos somaram 27.009. Os óbitos perinatais totalizaram 45.875, perfazendo uma taxa de mortalidade de 15,5‰ nascimentos. A maior taxa de mortalidade (7,6‰; 7,5‰-7,7‰) foi observada no grupo anteparto, seguido da prematuridade (3,6‰; 3,6‰-3,7‰). No grupo anteparto, 14 das 27 UFs (sendo oito na Região Nordeste e quatro na Região Norte) apresentaram as taxas de mortalidade perinatal acima da nacional. A taxa de mortalidade perinatal no Brasil mostrou-se elevada, e a maioria dos óbitos poderia ser prevenida com investimento em cuidados pré-natais e ao nascimento.

Abstract: Perinatal mortality includes fetal mortality and early neonatal mortality (0 to 6 days of life). The study described perinatal deaths in Brazil in 2018 according to the modified Wigglesworth classification. The data sources were the Brazilian Mortality Information System and the Brazilian Information System on Live Births. Fetal mortality and perinatal mortality rates were calculated per 1,000 total births (live births plus stillbirths) and the early neonatal mortality rate per 1,000 live births, compared using their respective 95% confidence intervals (95%CI). Perinatal deaths were classified in groups of antepartum causes, congenital anomalies, prematurity, asphyxia, and specific causes. For each group of causes, the study calculated the number of deaths by weight group, in addition to mortality rates and respective 95%CI, besides the spatial distribution of mortality rates by state of Brazil. A total of 35,857 infant deaths were recorded, of which 18,866 (52.6%) were early neonatal deaths, while stillbirths totaled 27,009. Perinatal deaths totaled 45,875, for a mortality rate of 15.5‰ births. The highest mortality rate (7.6‰; 7.5‰-7.7‰) was observed in the antepartum group, followed by prematurity (3.6‰; 3.6‰-3.7‰). In the antepartum group, 14 of the 27 states (eight of which in the Northeast and four in the North) presented perinatal mortality rates above the national rate. Perinatal mortality in Brazil was high, and most deaths could have been prevented with investment in prenatal and childbirth care.

Resumen: La mortalidad perinatal engloba la mortalidad fetal y neonatal precoz (0 a 6 días). Este estudio describió los óbitos perinatales ocurridos en Brasil en 2018, según la clasificación de Wigglesworth modificada. Las fuentes de datos fueron los Sistemas de Información sobre Mortalidad y sobre Nacidos Vivos. Se calcularon las tasas de mortalidad fetal y perinatal por 1.000 nacimientos totales (nacidos vivos más mortinatos) y la tasa de mortalidad neonatal precoz por 1.000 nacidos vivos, y se compararon usando sus respectivos intervalos de 95% de confianza (IC95%). Los óbitos perinatales se clasificaron en los grupos de causas: anteparto, anomalías congénitas, prematuridad, asfixia y causas específicas. Se calculó, para cada grupo de causas, el número de óbitos por franja de peso, además de las tasas de mortalidad y los respectivos IC95%, y se realizó la distribución espacial de las tasas de mortalidad por Unidad de la Federación (UF). Se registraron 35.857 óbitos infantiles, siendo 18.866 (52,6%) neonatales precoces; los mortinatos sumaron 27.009. Los óbitos perinatales totalizaron 45.875, ascendiendo a una tasa de mortalidad de un 15,5‰ nacimientos. La mayor tasa de mortalidad (7,6‰; 7,5‰-7,7‰) se observó en el grupo anteparto, seguido de la prematuridad (3,6‰; 3,6‰-3,7‰). En el grupo anteparto, 14 de las 27 UFs (estando ocho en la región Nordeste y cuatro en la región Norte) presentaron tasas de mortalidad perinatal por encima de la nacional. La tasa de mortalidad perinatal en Brasil se mostró elevada y la mayoría de los óbitos podría ser prevenido con inversión en cuidados prenatales y en el nacimiento.

Maternal micronutrient status as a risk factor for perinatal mortality in a Tanzanian randomized controlled trial

The objective of this study was to determine if maternal micronutrient status (specifically iron) during pregnancy is a risk factor for perinatal mortality among women in Tanzania. Secondary analysis of data from a randomized, double-blind, placebo-controlled vitamin A supplementation trial conducted between August 2010-March 2013 was used to assess iron intake among women who experienced a stillbirth or early neonatal death. The mean dietary iron intake (measured using a quantitative Food Frequency Questionnaire) for this population was 12.64 mg/day (SD = 6.32). There were 206 cases of perinatal mortality. Three classifications of dietary iron intake were devised and risk ratios were calculated using the Log Binomial Regression Model: <18 mg/day (RR: 2.13), 18-27 mg/day (RR: 2.63), & >27 mg/day (the reference group to which the first two classification groups were compared).There was neither a significant relationship found among women who consumed iron levels <18 mg/day or between 18-27 mg/day of iron compared to women who consumed more than 27 mg/day of iron, but on average there was twice the risk for perinatalmortality. The current study is consistent with previous literature findings and supports the need for more efficacious nutrition strategies. (Afr J Reprod Health 2022; 26[7]: 38-48).

Causes of abortion, stillbirth, and perinatal mortality in horses / Causas de aborto, natimortalidade e morte perinatal em equinos

Causes of abortion, stillbirth, and perinatal mortality in horses were investigated in the Department of Veterinary Pathology of the Federal University of Rio Grande do Sul (SPV-UFRGS) from 2000 to 2015. In this period, 107 cases were analyzed using macroscopic, microscopic, and complementary tests. Of these, 77 were aborted fetuses, 16 were stillbirths, and 14 were perinatal deaths. Conclusive diagnosis was established in 42.8% of the fetuses analyzed, with 28.6% classified as infectious origin, 9.1% as non-infectious, and 5.1% as other. Bacterial infections, especially those related to Streptococcus spp. were the most frequently observed. In stillborn foals, diagnosis was established in 62.5% of cases, and 50% of these were related to non-infectious causes, such as dystocia and birth traumas. As for perinatal mortality, a conclusive diagnosis was reached in 78.57% of cases, and infectious causes associated with bacterial infections accounted for 64.1% of these diagnoses.(AU)

Causas de aborto, natimortalidade e mortalidade perinatal em equinos foram investigadas no Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) durante o período de 2000 a 2015. Nesse período, foram analisados 107 casos através de exames macroscópico, microscópico e exames complementares, desses 77 correspondiam a fetos abortados, 16 natimortos e 14 mortes perinatais. Diagnóstico conclusivo foi estabelecido em 42,8% dos fetos analisados e classificados como origem infecciosa em 28,6% dos casos, não infecciosa com 9,1% e outros com 5,1% dos casos. As infecções bacterianas, em especial as relacionadas a Streptococcus spp. foram as mais frequentemente observadas. Em potros natimortos, diagnostico foi estabelecido em 62,5% dos casos, e destes, 50% foram relacionados a causas não infecciosas, como distocia e traumas durante o parto. Quanto a mortalidade perinatal, em 78,57% dos casos houve um diagnostico conclusivo, e as causas infecciosas associadas a infecções bacterianas corresponderam a 64,1% desses diagnósticos.(AU)

Causes of abortion, stillbirth, and perinatal mortality in horses / Causas de aborto, natimortalidade e morte perinatal em equinos

Causes of abortion, stillbirth, and perinatal mortality in horses were investigated in the Department of Veterinary Pathology of the Federal University of Rio Grande do Sul (SPV-UFRGS) from 2000 to 2015. In this period, 107 cases were analyzed using macroscopic, microscopic, and complementary tests. Of these, 77 were aborted fetuses, 16 were stillbirths, and 14 were perinatal deaths. Conclusive diagnosis was established in 42.8% of the fetuses analyzed, with 28.6% classified as infectious origin, 9.1% as non-infectious, and 5.1% as other. Bacterial infections, especially those related to Streptococcus spp. were the most frequently observed. In stillborn foals, diagnosis was established in 62.5% of cases, and 50% of these were related to non-infectious causes, such as dystocia and birth traumas. As for perinatal mortality, a conclusive diagnosis was reached in 78.57% of cases, and infectious causes associated with bacterial infections accounted for 64.1% of these diagnoses.

Causas de aborto, natimortalidade e mortalidade perinatal em equinos foram investigadas no Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) durante o período de 2000 a 2015. Nesse período, foram analisados 107 casos através de exames macroscópico, microscópico e exames complementares, desses 77 correspondiam a fetos abortados, 16 natimortos e 14 mortes perinatais. Diagnóstico conclusivo foi estabelecido em 42,8% dos fetos analisados e classificados como origem infecciosa em 28,6% dos casos, não infecciosa com 9,1% e outros com 5,1% dos casos. As infecções bacterianas, em especial as relacionadas a Streptococcus spp. foram as mais frequentemente observadas. Em potros natimortos, diagnostico foi estabelecido em 62,5% dos casos, e destes, 50% foram relacionados a causas não infecciosas, como distocia e traumas durante o parto. Quanto a mortalidade perinatal, em 78,57% dos casos houve um diagnostico conclusivo, e as causas infecciosas associadas a infecções bacterianas corresponderam a 64,1% desses diagnósticos.

Causes of perinatal mortality and risk factors in a district of Shanghai after the implementation of universal two-child policy / 上海预防医学

Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy， and then explore effective interventions for preventing perinatal mortality. Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality， causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy. Results In total， there were 153 099 perinatal births from 2011 to 2020 in Changning District， in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births， showing an overall downward trend from 2011 to 2020 （ P <0.05）. Residents with local household registration had lower perinatal mortality， compared to those with non-local household registration， which was observed both before and after the universal two-child policy （ P <0.05）. Furthermore， the perinatal mortality showed an upward trend after the universal two-child policy （ χ 2trend=5.481， P <0.05）. The major causes of perinatal death were fetus and its accessories， fetal malformation， and maternal diseases during pregnancy before the universal two-child policy； in contrast， the causes changed to maternal diseases during pregnancy， fetus and its accessories， and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age， menstrual delivery， and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy （ P <0.05）. The most common pregnancy complication was gestational diabetes mellitus， gestational hypertension， and hypothyroidism during pregnancy after the universal two-child policy. Of them， the proportion of gestational hypertension increased from 6.56% （4/61） to 25.88% （22/85）. Conclusion Before and after the universal two-child policy， the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover， pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore， health education should be strengthened to improve the awareness of self-health care， especially for non-local women. Hierarchical perinatal health service， primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.