Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. 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 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, and ends seven completed days after birth", but other definitions have been used.
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.
|Other names||Perinatal death|
|Infant, neonatal, and postneonatal mortality rates: United States, 1940-2005|
Preterm birth is the most common cause of perinatal mortality, causing almost 30 percent of neonatal deaths. Infant respiratory distress syndrome, in turn, is the leading cause of death in preterm infants, affecting about 1% of newborn infants. Birth defects cause about 21 percent of neonatal death.
Fetal mortality refers to stillbirths or fetal death. 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 labor, antenatal (antepartum) death, and death during labor, intranatal (intrapartum) death.
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 Rate.
|Top ten countries|
with the highest perinatal mortality rates - 2012
|3||Sierra Leone||30.8||8||Republic of the Congo||28.3|
|As per 2014 "Save the Children" report for intrapartum stillbirths|
and neonatal deaths on first day of birth (per 1,000 total births)
The PNMR refers to the number of perinatal deaths per 1,000 total births. It is usually reported on an annual basis. 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 . The WHO has not published contemporary data.
An abdominal pregnancy can be regarded as a form of an ectopic pregnancy where the embryo or fetus is growing and developing outside the womb in the abdomen, but not in the Fallopian tube, ovary or broad ligament.While rare, abdominal pregnancies have a higher chance of maternal mortality, perinatal mortality and morbidity compared to normal and ectopic pregnancies; on occasion, however, a healthy viable infant can be delivered.Because tubal, ovarian and broad ligament pregnancies are as difficult to diagnose and treat as abdominal pregnancies, their exclusion from the most common definition of abdominal pregnancy has been debated.Others—in the minority—are of the view that abdominal pregnancy should be defined by a placenta implanted into the peritoneum.Alireza Marandi
Alireza Marandi (Persian: علیرضا مرندی) is an Iranian physician and Professor of Pediatrics and Neonatology at Shahid Beheshti University. He was also an associate professor at Wright State University before returning to Iran, during the Revolutionary days.
Marandi is a former two-term Minister of Health (and Medical Education) during the premiership of Mir Hossein Mousavi as well as the second term presidency of Mr. H. Rafsanjani. During his nine years in office, medical education was integrated with health care delivery. In each of the 29 provinces, one University of Medical Sciences was established, thus making the country self-sufficient in health human resources. In addition to being Minister, Dr. Marandi also served as Deputy Minister and Advisory to the Minister.
Marandi is Chairman of the Iranian Society of Neonatologists; the Board of Directors of the Islamic Republic of Iran Breastfeeding Promotion Society; and the National Committee for the Reduction of Perinatal Mortality and Morbidity. He is also the laureate recipient of the United Nations Population Award (1999) and WHO's Eastern Mediterranean Region's Shousha Award (2000). He is currently a commissioner of the World Health Organization (WHO) Commission on Social Determinants of Health and a leading international expert on health issues.
Of his major contributions, was a highly successful national vaccination program (which also included a program for terminating polio in Iran), the significant reduction of infant and child mortality rates, as well as organizing one of the most successful national birth control programs in the World.Marandi was elected as an MP from the city of Tehran in the 2008 Iranian parliamentary elections in which around 1,700 candidates were barred from running by the Guardian Council vetting body, the Supervisory and Executive Election Boards.
He has written his second letter to United Nations Secretary General (Ban Ki-Moon) on 21 Aug 2013 about barbaric sanction on Iranian children, women and people.Cervical conization
Cervical conization (CPT codes 57520 (Cold Knife) and 57522 (Loop Excision)) refers to an excision of a cone-shaped sample of tissue from the mucous membrane of the cervix. Conization may be used either for diagnostic purposes as part of a biopsy, or for therapeutic purposes to remove pre-cancerous cells.Types include:
cold knife conization (CKC). Usually outpatient, occasionally inpatient.
loop electrical excision procedure (LEEP). Usually outpatient.Conization of the cervix is a common treatment for dysplasia following abnormal results from a pap smear.Child mortality
Child mortality, also known as child death, refers to the death of children under the age of 14 and encompasses national mortality, under-5 mortality, and mortality of children aged 5–14. Many child deaths go unreported for a variety of reasons, including lack of death registration and lack of data on child migrants. Without accurate data on child deaths, we cannot fully discover and combat the greatest risks to a child's life.
Reduction of child mortality is reflected in several of the United Nations' Sustainable Development Goals. Rapid progress has resulted in a significant decline in preventable child deaths since 1990, with the global under-5 mortality rate declining by over half between 1990 and 2016. While in 1990, 12.6 million children under age five died, in 2016 that number fell to 5.6 million children. However, despite advances, there are still 15,000 under-five deaths per day from largely preventable causes. About 80 per cent of these occur in sub-Saharan Africa and South Asia, and just 6 countries account for half of all under-five deaths: India, Nigeria, Pakistan, the Democratic Republic of the Congo, Ethiopia and China. 45% of these children died during the first 28 days of life.Chronic histiocytic intervillositis
Chronic Histiocytic Intervillositis (CHI or CHIV) also known as Chronic Intervillositis of Unknown (A)etiology (CIUE) and Massive Chronic Intervillositis (MCI) is defined as a diffuse infiltration of mononuclear cells (histiocytes, lymphocytes, monocytes) of maternal origin into the intervillous space within the placenta. It often results in severe intrauterine growth restriction which can lead to miscarriage or stillbirth. Overall perinatal mortality rate is high: 41%. to 77%. Recurrence rate is also high: 67% to 100%Dead on arrival
Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.
In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.Death messenger
Death messengers, in former times, were those who were dispatched to spread the news that an inhabitant of their city or village had died. They were to wear unadorned black and go door to door with the message, "You are asked to attend the funeral of the departed __________ at (time, date, and place)." This was all they were allowed to say, and were to move on to the next house immediately after uttering the announcement. This tradition persisted in some areas to as late as the mid-19th century.Death rattle
Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.It is sometimes misinterpreted as the sound of the person choking to death, or alternatively, that they are gargling.Dignified death
Dignified death is a somewhat elusive concept often related to suicide. One factor that has been cited as a core component of dignified death is maintaining a sense of control. Another view is that a truly dignified death is an extension of a dignified life. There is some concern that assisted suicide does not guarantee a dignified death, since some patients may experience complications such as nausea and vomiting. There is some concern that age discrimination denies the elderly a dignified death.Home birth
A home birth is an act of giving birth in one's own home. Prior to the advent of modern medicine, a residence or where the mother found shelter, rather than a hospital or dedicated birthing center, was the default type of birth location. Home births may be attended by a midwife, or lay attendant with experience in managing home births.Lazarus sign
The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies). The phenomenon is named after the Biblical figure Lazarus of Bethany, whom Jesus Christ raised from the dead in the Gospel of John.List of causes of death by rate
The following is a list of the causes of human deaths worldwide for the year 2002, arranged by their associated mortality rates. There were 57,029,000 deaths tabulated for that year. Some causes listed include deaths also included in more specific subordinate causes (as indicated by the "Group" column), and some causes are omitted, so the percentages do not sum to 100. According to the World Health Organization, about 58 million people died in 2005, using the International Statistical Classification of Diseases and Related Health Problems (ICD). According to the Institute for Health Metrics and Evaluation, 52.77 million people died in 2010.Megadeath
Megadeath (or megacorpse) is one million human deaths, usually caused by a nuclear explosion. The term was used by scientists and thinkers who strategized likely outcomes of all-out nuclear warfare.Monochorionic twins
Monochorionic twins are monozygotic (identical) twins that share the same placenta. If the placenta is shared by more than two twins (see multiple birth), these are monochorionic multiples. Monochorionic twins occur in 0.3% of all pregnancies. 75% of monozygotic twin pregnancies are monochorionic; the remaining 25% are dichorionic diamniotic. If the placenta divides, this takes place after the third day after fertilization.National Child Development Study
The National Child Development Study (NCDS) is a continuing, multi-disciplinary longitudinal study which follows the lives of 17,415 people born in England, Scotland and Wales from 17,205 women during the week of 3–9 March 1958. The results from this study helped reduce infant mortality and were instrumental in improving maternity services in the UK.Pallor mortis
Pallor mortis (Latin: pallor "paleness", mortis "of death"), the first stage of death, is an after-death paleness that occurs in those with light/white skin.Personal Child Health Record
A Personal Child Health Record or PCHR is a form of personal health record that records a child's growth, development, and use of health services.Sylvester Sanfilippo
Sylvester Sanfilippo (January 1, 1926 – May 2, 2013) was a pediatrician from Edina, Minnesota, who first described a mucopolysaccharide storage disease which bears his name. Sanfilippo was born in Rochester, New York. After graduating from the University of Rochester in 1947, he moved to Salt Lake City to pursue postgraduate studies. There he received a Master of Science degree in Biochemistry and earned his medical degree in 1955. He acquired his pediatric training at the University of Minnesota, interrupted by a two-year stint as a pediatrician in the United States Navy Medical Corps in Portsmouth and Norfolk, Virginia.
In 1960 Sanfilippo was awarded a postdoctoral research fellowship and began a comprehensive study of children with mucopolysaccharide storage disease at the University of Minnesota. The investigative approach combined the chemical measurement and identification of urinary acid mucopolysaccharides with a thorough clinical evaluation of each patient.
The work of Sanfilippo and his colleagues described eight mentally challenged children with mucopolysacchariduria of a single compound, heparitin sulfate. In contrast, their thirteen patients with Hunter–Hurler syndrome showed mucopolysacchariduria of two compounds, heparitin sulfate and chondroitin sulfate B. The majority of the heparitin sulfate excretors had a normal or near-normal facial appearance and displayed mild to slight somatic and radiographic manifestations in comparison with their Hunter–Hurler counterparts, who showed more severe involvement. These observations indicated the existence of a new inborn error of the mucopolysaccharide metabolism.
Sanfilippo presented the results of the study at the annual American Pediatric Society Meeting in May 1963, and published a report later that year.
He entered the private practice of Pediatrics in April 1962, but continued his research at the University of Minnesota for several more years. During his practice years he participated in regional health care planning and published a perinatal mortality review study (1976). Sanfilippo enjoyed his teaching experiences with medical students and physicians-in-training. He retired from private practice in June 1988.Sanfilippo died on May 2, 2013, aged 87.TRPV2
Transient receptor potential cation channel subfamily V member 2 is a protein that in humans is encoded by the TRPV2 gene. TRPV2 is a nonspecific cation channel that is a part of the TRP channel family. This channel allows the cell to communicate with its extracellular environment through the transfer of ions, and responds to noxious temperatures greater than 52 °C. It has a structure similar to that of potassium channels, and has similar functions throughout multiple species; recent research has also shown multiple interactions in the human body.
|Maternal factors and|
complications of pregnancy,
labour and delivery
|Length of gestation|
and fetal growth