Intrapartum perinatal mortality.

Intrapartum perinatal mortality, the deaths that occur during the period around birth, is a major problem in developing countries accounting for more than one million stillbirths and a similar number of neonatal deaths worldwide each year [1,2]. A number of authors have emphasized that the time encompassing labor and the 24 hours after birth is the most dangerous period for both the mother and fetus/neonate [3]. To begin to focus attention on these deaths, several authors have created a new measure of pregnancy outcome-the sum of intrapartum stillbirths and early neonatal deaths >2500g, with the denominator all births >2500g [4]. This measure, which considers mortality to fetuses alive on admission to the health facility (often determined by Doptone) through discharge of the neonate, typically at 6 or 12 hours of age, is an important concept, since it is only during this time period that care in the facility can influence the outcome. By eliminating births likely to be preterm, this measure should count only those births with a reasonable likelihood of survival – if the obstetric and early neonatal care were good. As such, some authors have advocated using this measure as an indicator of the quality of obstetric care [4,5]. In the study reported here, the authors have included fresh stillbirth as a surrogate for an intrapartum fetal death and only asphyxia-related neonatal deaths instead of all early neonatal deaths [6]. Considering only births occurring at >35 weeks or >2000g is also similar to the proposed indicator which only counts births of 2500g or more. Thus, we believe the authors have developed an appropriate outcome to measure the quality of intrapartum care [6].