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Perinatal mortality

Nikolaos Zacharias, MD, FACOG
Section Editor
Leonard E Weisman, MD
Deputy Editor
Melanie S Kim, MD


Mortality rates in the perinatal period are used to evaluate the outcome of pregnancy and monitor the quality of perinatal (prenatal and neonatal) care. The perinatal mortality rate encompasses late fetal and early neonatal mortality.


The use of standard terminology facilitates comparisons of mortality rates among states and countries. A 2016 clinical report from the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn established standard terminology for fetal, infant, and perinatal deaths, based on standards set by the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) [1]. The following definitions are recommended and used in this review. Standard definitions for reporting reproductive health statistics are published by the NCHS [2].

Live birth — Live birth is defined as complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy, which shows any evidence of life (ie, heartbeats, umbilical cord pulsations, breathing, or voluntary muscle movement), regardless of whether the umbilical cord has been cut or the placenta is attached. Heartbeats should be distinguished from transient cardiac contractions and breathing distinguished from fleeting respiratory efforts or gasps.

Fetal death (stillbirth) — A fetus is defined from weeks after conception until term while in the uterus. Death of the fetus occurs prior to complete expulsion or extraction from the mother, irrespective of the duration of the pregnancy, that is not an induced pregnancy termination. Fetal death is indicated by no signs of life after delivery (eg, heartbeats, umbilical cord pulsations, breathing, or voluntary muscle movement, as noted above). Heartbeats should be distinguished from transient cardiac contractions, and breathing from fleeting respiratory efforts or gasps. (See "Fetal death and stillbirth: Incidence, etiology, and prevention".)

The NCHS reports fetal deaths that occur ≥20 weeks gestation, which are also referred to as "stillbirth." For statistical purposes, the NCHS further subdivides fetal death as "early" (20 to 27 weeks gestation) or "late" (≥28 weeks gestation). The WHO defines stillbirth as at or after 28 weeks gestation. Pregnancies resulting in fetal demise before 20 weeks are categorized as miscarriages.


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Literature review current through: Dec 2016. | This topic last updated: Fri Jun 03 00:00:00 GMT 2016.
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  1. Barfield WD, Committee on fetus and newborn. Standard Terminology for Fetal, Infant, and Perinatal Deaths. Pediatrics 2016.
  2. National Center for Health Statistics www.cdc.gov/nchs (Accessed on July 20, 2011).
  3. Standard terminology for reporting of reproductive health statistics in the United States. In: Guidelines for Perinatal Care, 7th ed, Riley LE, Stark AR (Eds), American Academy of Pediatrics, Elk Grove Village 2012. p.497.
  4. ACOG Committee opinion. Perinatal and infant mortality statistics. Number 167, December 1995. Committee on Obstetric Practice. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1996; 53:86.
  5. Model State and Viatal Statistics Act and Regulations. www.cdc.gov/nchs/data/misc/mvsact92b.pdf (Accessed on July 20, 2011).
  6. Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP. The perinatal mortality rate as an indicator of quality of care in international comparisons. Med Care 1998; 36:54.
  7. Graafmans WC, Richardus JH, Macfarlane A, et al. Comparability of published perinatal mortality rates in Western Europe: the quantitative impact of differences in gestational age and birthweight criteria. BJOG 2001; 108:1237.
  8. World Health Organization. International statistical classification of disease and related health problems. Tenth revision. Geneva: World Health Organization, 1993.
  9. Osterman MJ, Kochanek KD, MacDorman MF, et al. Annual summary of vital statistics: 2012-2013. Pediatrics 2015; 135:1115.
  10. Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet 2005; 365:891.
  11. Kusiako T, Ronsmans C, Van der Paal L. Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh. Bull World Health Organ 2000; 78:621.
  12. Darmstadt GL, Bhutta ZA, Cousens S, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005; 365:977.
  13. Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen OP. Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Helsinki Ultrasound Trial. Lancet 1990; 336:387.
  14. Saari-Kemppainen A, Karjalainen O, Ylöstalo P, Heinonen OP. Fetal anomalies in a controlled one-stage ultrasound screening trial. A report from the Helsinki Ultrasound Trial. J Perinat Med 1994; 22:279.
  15. Liu S, Joseph KS, Kramer MS, et al. Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. JAMA 2002; 287:1561.
  16. MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep 2009; 57:1.
  17. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2004 period linked birth/infant death data set. Natl Vital Stat Rep 2007; 55:1.
  18. Zhang X, Kramer MS. Variations in mortality and morbidity by gestational age among infants born at term. J Pediatr 2009; 154:358.
  19. Centers for Disease Control and Prevention (CDC). Unregistered deaths among extremely low birthweight infants--Ohio, 2006. MMWR Morb Mortal Wkly Rep 2007; 56:1101.
  20. Raju TN, Mercer BM, Burchfield DJ, Joseph GF Jr. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2014; 210:406.
  21. Misra DP, Ananth CV. Infant mortality among singletons and twins in the United States during 2 decades: effects of maternal age. Pediatrics 2002; 110:1163.
  22. Pitkin RM. Fetal death: diagnosis and management. Am J Obstet Gynecol 1987; 157:583.
  23. Gaudino JA, Hoyert DL, MacDorman MF, et al. Fetal Deaths. In: From Data to Action, CDC's Public Heath Surveillance for Women, Infants, and Children, Wilcox LS, Marks JS (Eds), US Department of Health and Human Services, Public Health Service, Washington, DC 1994.
  24. ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol 2009; 113:748.
  25. Barfield WD, Tomashek KM, Flowers LM, Iyasu S. Contribution of late fetal deaths to US perinatal mortality rates, 1995-1998. Semin Perinatol 2002; 26:17.
  26. Hoyert DL, Mathews TJ, Menacker F, et al. Annual summary of vital statistics: 2004. Pediatrics 2006; 117:168.
  27. Vintzileos AM. Evidence-based compared with reality-based medicine in obstetrics. Obstet Gynecol 2009; 113:1335.
  28. Divon MY, Ferber A, Sanderson M, et al. A functional definition of prolonged pregnancy based on daily fetal and neonatal mortality rates. Ultrasound Obstet Gynecol 2004; 23:423.
  29. Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat Rep 1999; 47:1.
  30. Rudan I, Chan KY, Zhang JS, et al. Causes of deaths in children younger than 5 years in China in 2008. Lancet 2010; 375:1083.
  31. Callaghan WM, MacDorman MF, Rasmussen SA, et al. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006; 118:1566.
  32. Kochanek KD, Kirmeyer SE, Martin JA, et al. Annual summary of vital statistics: 2009. Pediatrics 2012; 129:338.
  33. Cifuentes J, Bronstein J, Phibbs CS, et al. Mortality in low birth weight infants according to level of neonatal care at hospital of birth. Pediatrics 2002; 109:745.
  34. Chien LY, Whyte R, Aziz K, et al. Improved outcome of preterm infants when delivered in tertiary care centers. Obstet Gynecol 2001; 98:247.
  35. Goodman DC, Fisher ES, Little GA, et al. The relation between the availability of neonatal intensive care and neonatal mortality. N Engl J Med 2002; 346:1538.
  36. MacDorman MF, Atkinson JO. Infant mortality statistics from the 1997 period linked birth/infant death data set. Natl Vital Stat Rep 1999; 47:1.