Developing an Indicator to Measure Intrapartum Stillbirth and Immediate Neonatal Death

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The Maternal Health Task Force and the Global Alliance to Prevent Prematurity and Stillbirth sponsored a two-day meeting of researchers on February 2-3, 2011 to (1) re-evaluate the Intrapartum Stillbirth and Early Neonatal Death indicator described in “Monitoring emergency obstetric care: a handbook” and (2) establish a protocol for a prospective multi-country pilot study. The meeting consisted of presentations and discussions of intrapartum stillbirth and early neonatal mortality, including a review of the evidence, previous efforts to build an indicator in high-impact countries, opportunities for collaboration with other organizations, measuring quality of care, and basic elements of a pilot study to test the indicator.

The Intrapartum Stillbirth and Early Neonatal Death Indicator, considered to be measurable at the facility level, was intended to monitor the improvements of the quality of obstetric and newborn care provided at birth by the skilled attendants in their environment (Fauveau 2007). As it currently exists, the “intrapartum and very early newborn death rate” is constructed with (1) a numerator comprising the sum of intrapartum stillbirths (with fetal heart beats perceived at admission in labor ward) and very early newborn death (within the first 24 hours of life) in a given facility in a given year; and (2) a denominator comprising all births (above 2,500 grams) in the same facility (World Health Organization, UNFPA et al. 2009).

Discussion began in early 2010 about how to improve the indicator and to collect robust data that could be used to monitor and improve the opportunity to reduce mortality. While the indicator was identified, there was no consensus as to how to measure it. The working group continued this discussion and initiated preparations for a pilot study of an Intrapartum Stillbirth and Immediate Neonatal Death Indicator to test the indicator’s feasibility under “ideal” circumstances.

The objectives of the pilot study will be:

  1. To develop and evaluate a practical and feasible method for prospective, standardized measurement of intrapartum stillbirth and immediate neonatal death rates at health facilities performing deliveries on a routine basis;
  2. To refine (and potentially simplify) an Intrapartum Stillbirth and Immediate Neonatal Death Indicator by analyzing its components, i.e. Establish fetal heartbeat, birth weight cutoff, and gestational age, within 6 hours; and
  3. To assess the potential cost (both human and financial) and acceptability of monitoring the indicator routinely.

At the end of the meeting, participants agreed that the next steps are to draft the pilot study proposal, discuss research coordination, and seek additional sources of support. It is anticipated that the pilot study will be completed before the end of 2011 and that preliminary data will allow us to write a proposal for a larger study.