The incidence of, and risk factors associated with, perinatal mortality in Shanghai during 1986-1987 are examined using data from a multi-site study conducted in 29 hospitals. The overall perinatal mortality rate was 14.96 per 1000 births. The mortality rates of antepartum fetal death, intrapartum fetal death and early neonatal death were 5.97, 2.06 and 6.94 per 1000 births, respectively. The perinatal mortality rates increased in winter and late spring. Male neonates were 1.5 times more likely to die than females. Low birthweight and preterm infants had 15 to 80 times higher risk of perinatal death. Higher parity, multiple pregnancy, and maternal age greater than or equal to 35 years were the risk factors for perinatal mortality. Asphyxia, cord complications, and congenital malformations were found to be the major causes of perinatal deaths. Comparison of mortality rates between Shanghai and the US suggests that the shortage of advanced technology in perinatal care (e.g. neonatal intensive care units) is a major obstacle to the reduction of perinatal mortality in Shanghai.
PIP: Although Shanghai's perinatal mortality rate (PMR) approximates that found in some developed countries, this rate has remained stationary at about 13/1000 births for the past decade. To document the incidence of perinatal mortality and identify factors inhibiting further declines in the PMR, data were collected on perinatal deaths occurring in 1986-87 in a sample of 29 randomly selected hospitals in the Shanghai Municipality. In the 12-month monitoring period, there were 75,756 births (accounting for 40% of total births in the Municipality) and 1134 perinatal deaths, for a PMR of 14.96/1000. This figure included 452 antepartum deaths (5.97/1000), 156 intrapartum deaths (2.06/1000), and 526 early neonatal deaths (6.94/1000). Antepartum and intrapartum deaths were largely attributable to cord complications, intrapartum asphyxia, congenital malformation, and placental causes, while early neonatal deaths tended to result from asphyxia, congenital malformation, and intracranial hemorrhage. The major risk factors for perinatal mortality were birthweight under 2500 grams and prematurity. The PMRs were 678.0 and 108.5 for the 1000-1499 gram birthweight categories, respectively, compared to 8.1 for newborns weighing 2500-3999 grams, and 137.7 for the 28-26 week gestational age group compared to 9.2 for infants delivered at 37-41 weeks. An increased risk of mortality was also associated with parity over 2, multiple births, and maternal age 35 years and over. For normal birthweight and full-term infants, the PMRs recorded in this study approximated those found in the US. However, a preterm infant has a 4-fold greater risk of early neonatal death in Shanghai than the US, suggesting that a shortage of high-technology perinatal care if the major factor inhibiting further reductions in Shanghai's PMR.