Skip to main content

Advertisement

SpringerLink
Log in

Fetal Deaths in Brazil: Historical Series Descriptive Analysis 1996–2012

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objective We seek to comprehensively assess stillbirths in Brazil, to compare the Brazilian findings with global trends and to identify the limitations of the fetal death record system. Method We studied fetal deaths in Brazil between 1996 and 2012 within the following five regions of the country: the North, Northeast, Southeast, South, and Central-West, through an analysis of data obtained from the Unified Health System’s (SUS) Informatics Department. The rates of stillbirth in Brazil and in these regions were calculated in relation to the maternal and gestational age and education, birth weight, type of pregnancy, delivery type, weight ranges and cause of death. Results There were 579,661 recorded fetal deaths and a decrease of 22.9 % in the stillbirth rate. In 2012, the overall rate was 10.0/1000 births; the North and Northeast regions had the highest rates (10.3 and 12.1, respectively) and the South region had the lowest rate (7.7/1000 births). Two-thirds of the deaths occurred in pregnancies of 28 or more weeks. Low education was an important risk factor, with rates of 24.3/1000 birth in women with no formal education and 4.7/1000 birth in women with 12 or more years of study in 2012. More than 40 % of the causes of deaths were nonspecific. Conclusions Despite the gradual decline in stillbirth rates, Brazil still has stillbirth rates that are nearly two times higher than those found in developed countries. There are inequalities between country regions portrayed by the significant variation in mortality rates specified by cause.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Mcclure, E. M., Wright, L. L., Goldenberg, R. L., Goudar, S. S., Parida, S. N., Jehan, I., et al. (2007). The global network: A prospective study of stillbirths in developing countries. American Journal of Obstetrics and Gynecology, 197(3), 2471–2475.

    Article  Google Scholar 

  2. CLAP, OPAS, OMS. (2011). Estrategias para el abordaje de la salud materna y perinatal en el próximo decenio: Una visión desde la salud pública. Punta del Este: Centro Latinoamericano de Perinatología–Salud de la Mujer y Reproductiva CLAP/SMR.

  3. Fonseca, S. C., & Coutinho, E. S. F. (2004). Perinatal mortality research in Brazil: Review of methodology and results. Caderno de Saúde Pública, 20(1), S7–S19.

    Article  Google Scholar 

  4. Stanton, C., Lawn, J. E., Rahman, Hz, Wilczynska-Ketende, K., & Hill, K. (2006). Stillbirth rates: delivering estimates in 190 countries. The Lancet, 367, 1487–1494.

    Article  Google Scholar 

  5. The Partnership for Maternal NaCH. (2011). Make Stillbirths Count: The Partnership for Maternal, Newborn and Child Health. Available from: http://portal.pmnch.org/.

  6. WHO. (2011). National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995. World Health Organization.

  7. Aminu, M., Unkels, R., Mdegela, M., Utz, B., Adaji, S., & van den Broek, N. (2014). Causes of and factors associated with stillbirth in low- and middle-income countries: A systematic literature review. An International Journal of Obstetrics & Gynaecology, 121(4), 141–153.

    Article  Google Scholar 

  8. Frøen, J. F., et al. (2009). Making stillbirths count, making numbers talk: Issues in data collection for stillbirths. BMC Pregnancy and Childbirth, 9, 58.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Beringhs, E. M., Gallo, P. R., & Reis, A. O. A. (2008). Stillbirths registers in the municipality of São Paulo: A descritive approach to fillingout of registration forms. Revista Brasileira de Saúde Materno Infantil, 8(3), 319–323.

    Article  Google Scholar 

  10. Maranhão, A. G. K., Vasconcelos, A. M. N., Aly, C. M. C., Neto, D. L. R., Porto, D. L., Oliveira, H., et al. (2010) As the Brazilians die: Characterization and geographic distribution of deaths in Brazil, 2000, 2005 and 2009. In: Health Brazil 2010: An analysis of the health and selected evidence of impact health surveillance actions. Brasilia: Ministério da Saúde do Brasil.

  11. MacDorman, M. F., Kirmeyer, S, & Statistics D. V. (2009). The challenge of fetal mortality. NCHS data brief centers for disease control and prevention—National Center for Health Statistics.

  12. Laurenti, R., & Buchalla, C. M. (1997). Maternal and child health indicators: Implications of the tenth revision of the international classification of diseases. Revista Panamericana de Salud Pública/Pan American Journal of Public Health, 2(1), 13–17.

    Article  Google Scholar 

  13. Yakoob, M. Y., Lawn, J. E., Darmstadt, G. L., & Bhutta, Z. A. (2010). Stillbirths: Epidemiology, Evidence, and Priorities for Action. Seminars in Perinatology, 34, 387–394.

    Article  PubMed  Google Scholar 

  14. RCOG. (2010). Late Intrauterine Fetal Death and Stillbirth. NHS Evidence, 55.

  15. Lee, E. J., Gambatese, M., Begier, E., Soto, A., Das, T., & Madsen, A. (2014). Understanding perinatal death: A systematic analysis of New York City Fetal and neonatal death vital record data and implications for improvement, 2007–2011. Maternal and Child Health Journal, 18, 1945–1954.

    Article  PubMed  Google Scholar 

  16. Lorenzi, D. R. S. D., Tanaka, A. C. A., Bozzetti, M. C., Riba, S. F. E., & Weissheimer, L. (2009). The stillbirthas perinatal health indicator. Caderno de Saúde Pública, 17(1), 141–146.

    Google Scholar 

  17. Jorge, M. H. P. M., Laurenti, R., & Gotlieb, S. L. D. (2007). Quality analysis of Brazilian vital statistics: The implementation experience of SIM and SINASC. Ciência & Saúde Coletiva, 12(3), 643–654.

    Article  Google Scholar 

  18. Lansky, S., França, E., & Leal, M. C. (2002). Perinatal mortality and evitability: a review (Mortalidade perinatal e evitabilidade: revisão da literatura). Revista de Saúde Pública, 36(6), 759–772.

    Article  PubMed  Google Scholar 

  19. Brasil. (2009). Surveillance manual child and fetal death and committee to prevent of child and fetal death. Brasilia: Ministério da Saúde.

  20. Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). The Brazilian health system: History, advances, and challenges. The Lancet, 377, 1778–1797.

    Article  Google Scholar 

  21. Brasil. BRAZIL: General information about the different regions. Public Domain Portal. Available from: http://www.dominiopublico.gov.br/pesquisa/DetalheObraForm.do?select_action=&co_obra=84372.

  22. Barbeiro, F. M. S., Fonseca, S. C., Tauffer, M. G., Ferreira, M. S. S., Silva, F. P., Ventura, P. M., et al. (2015). Fetal deaths in Brazil: A systematic review. Revista de Saúde Pública, 49, 22.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Victora, C. G., Aquino, E. M. L., Leal, M. C., Monteiro, C. A., Barros, F. C., & Szwarcwald, C. L. (2011). Health in Brazil 2—Health of mothers and children in Brazil: Progress and challenges. Available at www.thelancet.com.

  24. Laurenti, R., & Buchalla, C. M. (1997). Maternal and child health indicators: implications of the ICD-10. Revista Panamericana de Salud Pública/Pan American Journal of Public Health, 2(1), 13–17.

    Article  Google Scholar 

  25. Flenady, V., Koopmans, L., Middleton, P., Froen, J. F., Smith, G. C., Gibbons, K., et al. (2011). Major risk factors for stillbirth in high-income countries: A systematic review and meta-analysis. The Lancet, 377(9774), 1331–1340.

    Article  Google Scholar 

  26. Flenady, V., Middleton, P., Smith, G. C., Duke, W., Erwich, J. J., Khong, Y., et al. (2011). Stillbirths: The way forward in high-income countries. www.thelancet.com. doi:10.1016/S0140-6736(11)60064-0.

  27. Zeitlin, J., Mortensen, L., Cuttini, M., Lack, N., Nijhuis, J., Haidinger, G., et al. (2015). Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project. Journal of Epidemiology and Community Health. doi:10.1136/jech-2015-207013

  28. Gramani, M. C. N. (2014). Interregional performance of the public health system of a high-inequality country. PLoS ONE, 9, 1.

    Article  Google Scholar 

  29. IBGE. (2010). Civil register statistics 1010. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística.

    Google Scholar 

  30. Beauclair, R., Petro, G., & Myer, L. (2014). The association between timing of initiation of antenatal care and stillbirths: A retrospective cohort study of pregnant women in Cape Town, South Africa. BMC Pregnancy and Childbirth, 14(204). http://www.biomedcentral.com/1471-2393/14/204.

  31. Mcclure, E. M., Pasha, O., Goudar, S. S., Chomba, E., Garces, A., Tshefu, A., et al. (2011). Epidemiology of stillbirth in low-middle income countries: A global network study. Acta Obstetricia et Gynecologica Scandinavica, 90(12), 1379–1385. doi:10.1111/j.1600-0412.2011.01275.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Huang, L., Sauve, R., Birkett, N., Fergusson, D., & Walraven, C. V. (2008). Maternal age and risk of stillbirth: A systematic review. CMAJ, 178(2), 165–172.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Fretts, R. (2010). Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clinical Obstetrics and Gynecology, 53(3), 588–596.

    Article  PubMed  Google Scholar 

  34. Asare, M., & Laar, A. S. (2016). Accessing the prevalence of stillbirth rate and associated factors among women who delivered in a rural hospital: A retrospective cross-sectional analysis. International Journal of Health Sciences and Research, 6(1), 341–347.

    Google Scholar 

  35. Bernardes, A. C. F., Silva, R. A., Coimbra, L. C., Alves, M. T. S. S. B., Queiroz, R. C. S., Batista, R. F. L., et al. (2014). Inadequate prenatal care utilization and associated factors in São Luís, Brazil. BMC Pregnancy and Childbirth. Available at http://www.biomedcentral.com. doi:10.1186/1471-2393-14-266.

  36. Souza, J. P. (2011). Maternal mortality in Brazil: the need to strengthen health systems. Revista Brasileira de Ginecologia e Obstetricia, 33(10), 273–279.

    PubMed  Google Scholar 

  37. Brasil. (2012). Health Brazil 2011: an analysis of the situation health and surveillance of women’s health. Brasília: Ministério da Saúde, pp 373–394.

  38. Lawn, J. E., Blencowe, H., Pattinson, R., Cousens, S., Kumar, R., Ibiebele, I., et al. (2011). Stillbirths: Where? When? Why? How to make the data count? Lancet 377: 1448–1463. http://www.thelancet.com.

  39. Dassah, E. T., Odoi, A. T., & Opoku, B. K. (2014). Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: A retrospective cross-sectional analysis. BMC Pregnancy and Childbirth., 14, 289.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Pattinson, R., Kerber, K., Buchmann, E., Friberg, I. K., Belizan, M., Lansky, S., et al. (2011). Stillbirths: How can health systems deliver for mothers and babies? The Lancet, 377, 1610–1623.

    Article  Google Scholar 

  41. Vieira, M. S. M., Siebert, E. C., Ceglio, W. Q. G. W., Almeira, M. H., Batista, T. S., & Freitas, P. F. (2012). Difficulties in identifying the cause of fetal death: how to solve? Revista Brasileira de Ginecologia e Obstetricia, 34(9), 403–408.

    Article  PubMed  Google Scholar 

  42. Nascimento, M. I. D., Cunha, A. D. A., Guimarães, E. V., Alvarez, F. S., Oliveira, S. R. D. S. M., & Bôas, E. L. V. (2012). Pregnancies complicated by maternal syphilis and fetal death. Revista Brasileira de Ginecologia e Obstetricia., 34(2), 56–62.

    PubMed  Google Scholar 

  43. Amaral, E. (2012). Syphilis in pregnancy and stillbirth: Back into the future. Revista Brasileira de Ginecologia e Obstetricia, 34(2), 52–55.

    PubMed  Google Scholar 

  44. Flenady, V., et al. (2016). Stillbirths: Recall to action in high-income countries. The Lancet,. doi:10.1016/S0140-6736(15)01020-X.

    Google Scholar 

  45. Barbuscia, D. M., & Rodrigues-Júnior, A. L. (2011). Completeness of information on live birth statements and on death certificates, fetal and early neonatal, in Ribeirão Preto, São Paulo, Brazil, 2000–2007. Caderno de Saúde Pública, 27(6), 1192–1200.

    Article  Google Scholar 

  46. Pattinson, R., Kerber, K., Waiswa, P., Day, L. T., Mussell, F., Asiruddin, S., et al. (2009). Perinatal mortality audit: Counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. International Journal of Gynecology and Obstetrics, 107, S113–S122.

    Article  PubMed  Google Scholar 

  47. Almeida, M. F., Alencar, G. P., Schoeps, D., MinuciI, E. G., Silva, Z. P., Ortiz, L. P., et al. (2011). Quality of the information recorded in fetal death certificates in São Paulo. SP Revista de Saude Publica, 45(5), 845–853.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Federal University of Santa Catarina, University Campus, s/nº, Trindade, Mailbox: 5199, Florianópolis, SC, 88040-900, Brazil

    Maria Salete Medeiros Vieira

  2. Da Concórdia St., Balneário, Florianópolis, SC, 88075544, Brazil

    Maria Salete Medeiros Vieira

  3. Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, SC, Brazil

    Filipe Medeiros Vieira

  4. Department of Clinical Analysis, Center of Health Science, Federal University of Santa Catarina, University Campus, Trindade, Mailbox: 476, Florianópolis, SC, 88040900, Brazil

    Tânia Silvia Fröde

  5. Public Health Department, Center of Health Science, Federal University of Santa Catarina, University Campus, Trindade, Mailbox: 476, Florianópolis, SC, 88040900, Brazil

    Eleonora d’Orsi

Authors
  1. Maria Salete Medeiros Vieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Filipe Medeiros Vieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tânia Silvia Fröde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eleonora d’Orsi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Salete Medeiros Vieira.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vieira, M.S.M., Vieira, F.M., Fröde, T.S. et al. Fetal Deaths in Brazil: Historical Series Descriptive Analysis 1996–2012. Matern Child Health J 20, 1634–1650 (2016). https://doi.org/10.1007/s10995-016-1962-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-016-1962-8

Keywords

Search

Navigation