- Nikolaos Zacharias, MD, FACOG
Nikolaos Zacharias, MD, FACOG
- Medical Director of Perinatal Testing, Lyndon B Johnson General Hospital
- Assistant Professor of Maternal-Fetal Medicine and Obstetrics & Gynecology
- University of Texas Health Science Center - Houston
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. Standard definitions for reporting reproductive health statistics are published by the National Center for Health Statistics (NCHS) (available at www.cdc.gov/nchs)  and are adopted both by the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn and the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice [2,3]. The following definitions are recommended and used in this review.
Live birth — The newborn shows signs of life after complete expulsion or extraction from the mother (ie, heartbeats, umbilical cord pulsations, breathing, or voluntary muscle movement). Heartbeats should be distinguished from transient cardiac contractions and breathing distinguished from fleeting respiratory efforts or gasps.
In the United States, the 2002 Born-Alive Infants Protection Act defined live birth as "the complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breaths or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a natural or induced labor, cesarean section, or induced abortion" .
Fetal death (stillbirth) — Death of the fetus occurs prior to expulsion or extraction from the mother. Fetal death is determined by no signs of life after delivery. Signs of life include 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 demise and stillbirth: Incidence, etiology, and prevention".)
- National Center for Health Statistics www.cdc.gov/nchs (Accessed on July 20, 2011).
- 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.
- Barfield WD, Committee on Fetus and Newborn. Standard terminology for fetal, infant, and perinatal deaths. Pediatrics 2011; 128:177.
- Born-Alive Infants Protection Act of 2002 http://thomas.loc.gov/cgi-bin/query/D?c107:5:./temp/~c107UE5Bcc (Accessed on February 04, 2010).
- 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.
- Model State and Viatal Statistics Act and Regulations. www.cdc.gov/nchs/data/misc/mvsact92b.pdf (Accessed on July 20, 2011).
- 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.
- 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.
- World Health Organization. International statistical classification of disease and related health problems. Tenth revision. Geneva: World Health Organization, 1993.
- Osterman MJ, Kochanek KD, MacDorman MF, et al. Annual summary of vital statistics: 2012-2013. Pediatrics 2015; 135:1115.
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- Darmstadt GL, Bhutta ZA, Cousens S, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005; 365:977.
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- 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.
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- Centers for Disease Control and Prevention (CDC). Unregistered deaths among extremely low birthweight infants--Ohio, 2006. MMWR Morb Mortal Wkly Rep 2007; 56:1101.
- 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.
- 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.
- Pitkin RM. Fetal death: diagnosis and management. Am J Obstet Gynecol 1987; 157:583.
- 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.
- ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol 2009; 113:748.
- 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.
- Hoyert DL, Mathews TJ, Menacker F, et al. Annual summary of vital statistics: 2004. Pediatrics 2006; 117:168.
- Vintzileos AM. Evidence-based compared with reality-based medicine in obstetrics. Obstet Gynecol 2009; 113:1335.
- 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.
- Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat Rep 1999; 47:1.
- 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.
- 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.
- Kochanek KD, Kirmeyer SE, Martin JA, et al. Annual summary of vital statistics: 2009. Pediatrics 2012; 129:338.
- 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.
- Chien LY, Whyte R, Aziz K, et al. Improved outcome of preterm infants when delivered in tertiary care centers. Obstet Gynecol 2001; 98:247.
- 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.
- MacDorman MF, Atkinson JO. Infant mortality statistics from the 1997 period linked birth/infant death data set. Natl Vital Stat Rep 1999; 47:1.
- Live birth
- Fetal death (stillbirth)
- - Fetal death rate
- Infant death and mortality rate
- - Neonatal death and mortality rate
- - Postneonatal death
- Perinatal mortality rate (PMR)
- REPORTING REQUIREMENTS
- COMPARISON OF MORTALITY RATES
- Other countries
- - Developing countries
- Effect of prenatal diagnosis
- PERINATAL AND NEONATAL MORTALITY RATES
- Gestational age
- - Term pregnancies
- - Prematurity
- Multifetal pregnancies
- CAUSES OF FETAL DEATH (STILLBIRTH)
- CAUSES OF INFANT DEATH
- Low birth weight
- - Regional differences
- Congenital anomalies
- Other factors