Recurrence risk of perinatal mortality in Northern Tanzania: a registrybased Study

Michael Johnson Mahande, Anne Kjersti Dalveit, Gunnar Kvaale, Blandina Theophil Mmbaga, Joseph Obure, Gileard Masenga, Rachel Manongi and Rolv Terje Lie
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Introduction and objective: Perinatal mortality is as high as 5% in many countries in sub-Saharan Africa. Little is known about heterogeneity of risk reflected in the tendency of mothers to re-experience perinatal deaths in subsequent deliveries. We compared the risk of a perinatal loss between women who did, and women who did not lose their baby in a previous pregnancy.

Methods: A prospective cohort study was conducted at Kilimanjaro (KCMC) Medical Birth registry. A total of 19,811 women who delivered singletons in two or more separate births at the KCMC hospital between 2000 and 2008 were followed for subsequent deliveries up to 2010. We used a unique maternal hospital number to identify these mothers. Women who had a multiple birth, or who were referred from rural areas for various medical reasons were excluded. We estimated perinatal mortality in a subsequent delivery depending on the outcome of the first delivery.

Results: A perinatal loss increased a woman’s likelihood to be recorded with a next pregnancy in our data from 19% to 31%. The recurrence risk of perinatal death for women who had already lost one baby was 9.1% compared with a much lower risk of 2.8% for women who already had a surviving child, for a relative risk of 3.2 (95% CI: 2.2–4.7). Recurrence contributed 15% of perinatal deaths in subsequent pregnancies. Preeclampsia, placental abruption, placenta previa, induced labour; preterm delivery and low birth weight in a previous pregnancy were also associated with increased perinatal mortality in the next pregnancy.

Conclusions: Some women in Africa carry a very high risk of losing their child in a pregnancy. Strategies of perinatal death prevention may attempt to target pregnant women who are particularly vulnerable or already have experienced a perinatal loss.