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Questions and Answers
What is the percentage of neonatal deaths and third trimester stillbirths that occur in low- and middle-income countries?
What is the percentage of neonatal deaths and third trimester stillbirths that occur in low- and middle-income countries?
What is the primary barrier to healthcare seeking for women giving birth outside of a health facility?
What is the primary barrier to healthcare seeking for women giving birth outside of a health facility?
What is the estimated number of babies that die soon after birth each year?
What is the estimated number of babies that die soon after birth each year?
What are the three main components of birth outcomes?
What are the three main components of birth outcomes?
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What is the definition of preterm birth?
What is the definition of preterm birth?
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Which of these is NOT considered a birth outcome?
Which of these is NOT considered a birth outcome?
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What is the term used to describe the death of a fetus in utero, with a birth weight of over 1000 grams and at least 28 completed weeks of gestation?
What is the term used to describe the death of a fetus in utero, with a birth weight of over 1000 grams and at least 28 completed weeks of gestation?
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What is the period generally considered to be the postnatal period?
What is the period generally considered to be the postnatal period?
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What is the estimated worldwide average stillbirth rate in 2009?
What is the estimated worldwide average stillbirth rate in 2009?
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Which region has the highest estimated rate of stillbirths in 2009?
Which region has the highest estimated rate of stillbirths in 2009?
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What is the defining characteristic of an intra-partum stillbirth?
What is the defining characteristic of an intra-partum stillbirth?
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According to the provided text, what percentage of under-five deaths globally are attributed to neonatal deaths?
According to the provided text, what percentage of under-five deaths globally are attributed to neonatal deaths?
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Where are preterm birth rates highest?
Where are preterm birth rates highest?
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Which birth outcome represents the leading cause of neonatal and child deaths in most high and middle-income countries?
Which birth outcome represents the leading cause of neonatal and child deaths in most high and middle-income countries?
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What is the estimated worldwide total of preterm births in 2010?
What is the estimated worldwide total of preterm births in 2010?
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What is the gestation period of a post-term birth?
What is the gestation period of a post-term birth?
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Which of the following is NOT considered a risk factor for adverse birth outcomes related to maternal size?
Which of the following is NOT considered a risk factor for adverse birth outcomes related to maternal size?
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What is the main focus of COMMUNITY CARE in reducing preterm birth rates?
What is the main focus of COMMUNITY CARE in reducing preterm birth rates?
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Which of the following has the HIGHEST odds ratio for adverse birth outcomes?
Which of the following has the HIGHEST odds ratio for adverse birth outcomes?
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Which of the following factors is MOST commonly associated with adverse birth outcomes in low-income countries?
Which of the following factors is MOST commonly associated with adverse birth outcomes in low-income countries?
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Which of the following is NOT mentioned as a risk factor for adverse birth outcomes during pregnancy?
Which of the following is NOT mentioned as a risk factor for adverse birth outcomes during pregnancy?
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Which of the following interventions has been identified as a cost-effective approach to improving maternal and birth outcomes?
Which of the following interventions has been identified as a cost-effective approach to improving maternal and birth outcomes?
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Which of the following is NOT a key aspect of COMMUNITY CARE?
Which of the following is NOT a key aspect of COMMUNITY CARE?
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Which of the following factors is associated with an increased risk of perinatal mortality in high-income countries?
Which of the following factors is associated with an increased risk of perinatal mortality in high-income countries?
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What is the estimated global neonatal mortality rate per 1,000 live births?
What is the estimated global neonatal mortality rate per 1,000 live births?
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Which of the following countries is NOT among the six countries with the highest neonatal mortality in 2009?
Which of the following countries is NOT among the six countries with the highest neonatal mortality in 2009?
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Which cause accounted for the highest percentage of neonatal deaths globally in 2010?
Which cause accounted for the highest percentage of neonatal deaths globally in 2010?
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What proportion of neonatal deaths in countries with high neonatal mortality rates is typically caused by infections?
What proportion of neonatal deaths in countries with high neonatal mortality rates is typically caused by infections?
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Which condition is a significant risk factor for both neonatal and post-neonatal deaths?
Which condition is a significant risk factor for both neonatal and post-neonatal deaths?
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What was the estimated number of neonatal deaths due to intra-partum related conditions in 2010?
What was the estimated number of neonatal deaths due to intra-partum related conditions in 2010?
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What chronic maternal condition is known to significantly affect birth outcomes?
What chronic maternal condition is known to significantly affect birth outcomes?
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Which infection during pregnancy is a major treatable cause of stillbirths and preterm births?
Which infection during pregnancy is a major treatable cause of stillbirths and preterm births?
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Flashcards
Moderate Preterm Birth
Moderate Preterm Birth
Birth occurring between 32 and 37 weeks of gestation.
Term Birth
Term Birth
Birth that occurs between 37 and 42 completed weeks of gestation.
Post Term Birth
Post Term Birth
Birth that occurs at or after 42 weeks of gestation.
Stillbirth
Stillbirth
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Stillbirth Rate
Stillbirth Rate
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Intra-partum Stillbirths
Intra-partum Stillbirths
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Preterm Birth Rate
Preterm Birth Rate
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Neonatal Deaths
Neonatal Deaths
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Global Neonatal Mortality Rate
Global Neonatal Mortality Rate
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Major Causes of Neonatal Deaths (2010)
Major Causes of Neonatal Deaths (2010)
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Preterm Birth
Preterm Birth
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Infections in Neonates
Infections in Neonates
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Neonatal Death Causes (Distribution, 2010)
Neonatal Death Causes (Distribution, 2010)
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Maternal Health Impact
Maternal Health Impact
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Importance of Infection Treatment
Importance of Infection Treatment
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Maternal HIV Infection
Maternal HIV Infection
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Neonatal Mortality
Neonatal Mortality
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Third Trimester Childbirth Death
Third Trimester Childbirth Death
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Birth Outcomes
Birth Outcomes
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Perinatal Mortality
Perinatal Mortality
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Extremely Preterm
Extremely Preterm
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Very Preterm
Very Preterm
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Global Birth Statistics
Global Birth Statistics
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Malaria in Pregnancy
Malaria in Pregnancy
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Family Planning
Family Planning
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Undernutrition
Undernutrition
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Obesity-related Conditions
Obesity-related Conditions
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Maternal Age Risk Factors
Maternal Age Risk Factors
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Antenatal Risk Factors
Antenatal Risk Factors
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Intrapartum Factors
Intrapartum Factors
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Community Care Practices
Community Care Practices
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Study Notes
Birth Outcomes: A Global Perspective
- Neonatal mortality (death in first 28 days after birth) and third-trimester childbirths (death of a fetus in utero weighing over 1000 grams or after 28 completed weeks of gestation) are overwhelmingly prevalent in low- and middle-income countries.
- Half of these deaths occur at home.
- Many babies in impoverished communities are unnamed and unrecorded.
- Distance from healthcare facilities often hinders access to care for women giving birth outside of these facilities (60 million annually).
- Cultural norms frequently conceal pregnancies and discourage care-seeking outside the home, especially during and after childbirth (up to 6 weeks postpartum).
- In wealthy countries, the death of a newborn is highly scrutinized and considered a critical failing if healthcare services are inadequately provided.
- Birth is the period of life with the highest risk of death.
- An estimated 720,000 babies die soon after birth. This relates significantly to intrapartum-related complications and at least 1.2 million stillbirths from complications during labor.
- Maternal deaths and neonatal deaths combined amount to approximately 2 million deaths at birth.
- Perinatal mortality includes deaths that occur before or soon after birth, including stillbirths and neonatal deaths.
- Epidemiological definitions often include stillbirths, preterm birth, and neonatal mortality, when defining birth outcomes.
Defining Birth Outcomes
- Birth Outcomes: Stillbirths, preterm birth, and neonatal mortality.
- Perinatal mortality: Death occurring before or soon after birth, including stillbirths and neonatal deaths.
Preterm Birth
- WHO defines preterm birth as birth before 37 completed weeks of gestation, or fewer than 259 days since the first day of a woman's last menstrual period.
- Subcategories of preterm birth:
- Extremely preterm: less than 28 weeks gestation
- Very preterm: 28 to 32 weeks gestation
- Moderate preterm: 32 to <37 completed weeks gestation
Stillbirth
- Stillbirth is defined as birth without signs of life.
- A baby weighing over 1000 grams or greater than 28 weeks of gestation is considered a stillbirth and not a miscarriage (differentiation).
- Approximately 80% of stillbirths in high-income nations are reported to occur prematurely.
Overview of Birth Outcomes - Stillbirths
- In 2009, the predicted number of stillbirths globally was 2.6 million, translating to a worldwide average rate of 18.9 per 1,000 births.
- In 1995, the estimated worldwide average rate of stillbirths was 22.1 per 1,000 births.
- Southern Asia and sub-Saharan Africa had the highest stillbirth rates in 2009 (26.5 and 28.4 per 1,000 births, respectively).
- Finland and Singapore had the lowest stillbirth rates, at 2.0 per 1,000 births.
- Pakistan, Nigeria, and Bangladesh had exceptionally high rates (above 35 per 1,000).
Intra-Partum Stillbirths
- Intra-partum stillbirths commonly refer to stillbirths occurring after the onset of labor, or as fresh stillbirths with intact skin, indicating death less than 12 hours before birth, and weighing over 1000 grams, and at least 28 weeks gestation.
- The annual count of intra-partum stillbirths is estimated at 1.2 million (one-third of all stillbirths globally).
Preterm Births - Overview
- The estimated total of preterm births for 2010 was 14.9 million, correlating to an average rate of 11.1% globally.
- Southeast Asia, South Asia, and Sub-Saharan Africa had the highest preterm birth rates in 2010.
- Preterm birth rates are significantly higher in low-income countries (11.8%), followed by lower-middle-income countries (11.3%), and are lowest in upper-middle and high-income countries (9.3%).
Neonatal Deaths
- Neonatal deaths now represent 41% of under-five deaths globally.
- Estimated global neonatal mortality is 23.9 per 1,000 live births.
- Out of 40 countries with the highest neonatal mortality in 2009, only six were outside of the African continent (Afghanistan, Pakistan, India, Bhutan, Myanmar, and Cambodia).
- India had the highest number of neonatal deaths between 1990 and 2009.
- Major causes of neonatal deaths (globally in 2010):
- Complications from preterm birth (35%)
- Asphyxia (23%)
- Infections (sepsis and pneumonia) (27%)
Preterm Birth as a Risk Factor
- Preterm birth is a significant risk factor for neonatal and post-neonatal deaths, with at least 50% being preterm-related.
- Estimated distribution of causes of 3.1 million neonatal deaths in 193 countries in 2010
- Preterm birth complications (1.08 million)
- Intrapartum related (0.72 million)
- Neonatal infections (0.83 million)
- Congenital anomalies (270,000)
- Other neonatal conditions (181,000)
Maternal Health and Care
- Maternal health significantly influences birth outcomes, particularly chronic conditions like hypertension and diabetes.
- Infections during pregnancy, especially STIs like syphilis, remain linked to stillbirths, preterm birth, and growth restriction.
- HIV and malaria in pregnancy are critical risk factors, notably in high-prevalence regions and areas with unstable transmission.
- Improving maternal and birth outcomes is closely associated with effective family planning, adequately addressing unmet needs for modern contraceptives.
- Undernutrition in low-income nations is a significant concern, exacerbating pregnancy deficiencies and negatively impacting maternal and neonatal health. Maternal conditions related to obesity, like diabetes, are also major risk factors, particularly in high-income nations.
Risk Factors for Adverse Birth Outcomes
- Life Cycle Factors:
- Maternal age (<18 or >35 years)
- Maternal size (height < 150 cm, pre-pregnancy weight <47 kg)
- Parity (especially primigravida, and parity >6)
- Obstetric history (poor)
- Antenatal Factors:
- Multiple pregnancy
- Hypertensive disorders (pre-eclampsia, eclampsia)
- Bleeding per vagina after 8th month
- Maternal jaundice
- Maternal anemia
- Maternal malaria (positive blood test)
- Syphilis (perinatal death)
- HIV (infant death)
- Intrapartum Factors:
- Malpresentation (breech)
- Obstructed labor
- Prolonged second stage
- Maternal fever during labor (>38 degrees centigrade)
- Rupture of membranes > 24 hours
- Meconium staining of liquid
Interventions
- Smoking cessation and progesterone are identified as potential interventions to reduce preterm birth rates in low-income countries.
Community Care
- Community care focuses on promoting healthy practices (diet, avoiding tobacco and indoor air pollution, family involvement).
- Encouraging demand for safe childbirth, emphasizing properly trained healthcare workers and appropriately equipped facilities.
- Protocol-based referral systems for cases needing advanced obstetric and neonatal care.
Summary
- High neonatal death rates (over 3 million), stillbirths (2.6 million), and preterm births (14.9 million), are major global health concerns.
- Despite these alarming numbers, issues like these are not always prioritized as global health emergencies, and often overshadowed by other serious issues like HIV and malaria.
- A critical aspect is the value and vulnerability associated with babies, especially preterm babies, and often this is not recognized in the immediate aftermath of the loss of a child.
- Data recognition may not immediately translate to improved outcomes unless communities and leaders realize the need to address these issues.
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Description
Test your knowledge on neonatal deaths, stillbirths, and their impact in low- and middle-income countries. Explore key definitions, statistics, and healthcare barriers related to maternal and infant health. This quiz will enhance your understanding of crucial birth outcomes.
