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OBJECTIVE: To analyze the temporal trend of fetal mortality and its components, of avoidable and ill-defined causes according to two avoidability classifications in Recife, Pernambuco, 2010-2021. METHOD: Ecological study of temporal trends of fetal mortality in Recife, 2010-2021. The Brazilian List of Avoidable Causes of Death for fetal deaths (LBE-OF) and Brazilian List of Avoidable Causes of Death for children under five years of age (LBE < 5) were used. The Joinpoint regression model was applied to analyze the temporal trends. RESULTS: Trends in fetal mortality and its components were stationary. The group of avoidable causes presented higher mortality rates in both classifications, with an increasing trend according to the LBE-OF (Annual Percentage Change-APC: 2,1; p = 0,018) and stationary according to the LBE < 5. There was a decreasing trend in mortality from ill-defined causes only according to the LBE-OF (APC: -12,3; p < 0,001). CONCLUSION: The results showed the stagnation of the temporal trend in fetal mortality, the avoidability of most deaths, and the potential of LBE-OF in monitoring the quality of information on the basic causes and avoidability of fetal deaths.

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Este artigo se baseia em um estudo de série temporal sobre os óbitos fetais por malformações congênitas no estado do Maranhão relativo ao período de 2006 a 2016. Foram construídos indicadores epidemiológicos para estimar o risco de morte fetal e sua tendência ao longo da série estudada. Os dados são provenientes do Departamento de Informática do SUS e sua análise realizada por modelos de regressão linear. Foram registrados 17.843 óbitos fetais no período abordado pelo estudo, 528 dos quais decorrentes de malformações congênitas (2,96%). Observou-se uma tendência significativa de aumento do coeficiente de mortalidade fetal geral, correspondente a 6,99% (ß1=0,17; p=0,004) e do específico por malformações congênitas, equivalente a 5,13% (ß1=0,01; p=0,04). Os resultados deste estudo corroboram a tendência histórica dos serviços de saúde negligenciarem os óbitos fetais. É importante destacar que parte destes óbitos são preveníveis e potencialmente evitáveis. Desse modo, a implementação dos comitês de investigação de óbitos fetais e infantis e a sua vigilância adequada poderiam melhorar a assistência prestada tanto no pré-natal quanto no parto.

This article bases on a time series study about fetal deaths due to congenital malformations in the state of Maranhão, Brazil, occurred from 2006 to 2016. Epidemiological indicators were constructed to estimate the risk of fetal death and its trend throughout the series studied. The data were obtained in the Department of Informatics of SUS and analyzed by linear regression models. There were 17,843 fetal deaths during the analysed period, from which 528 were a direct result of congenital malformations (2.96%). A significant tendency towards an increase in the coefficient of general fetal mortality corresponding to 6.99% (ß1=0.17; p=0.004) and in the coefficient of specific fetal mortality due to congenital malformations equivalent to 5.13% (ß1=0.01; p=0.04) were observed. The end results of this study corroborate the historical trend toward negligence in Brazilian health centres with regard to fetal deaths. It is important to remark that some of these deaths can be presumed and potentially preventable. Thus, the implementation of the fetal and infant death investigation committees and their adequate surveillance could improve care during prenatal and delivery.

Este artículo se basa en un estudio de serie temporal acerca de muertes de fetos por malformaciones congénitas en el estado de Maranhão, Brasil, concerniente al periodo de 2006 a 2016. Se construyeron indicadores epidemiológicos para estimar el riesgo de la muerte fetal y su tendencia a lo largo de la serie estudiada. Los datos son provenientes del Departamento de Informática del SUS y fueron analizados por modelos de regresión lineal. Se registraron 17.843 muertes de fetos en el período estudiado, de los cuales 528 fueron resultado de malformaciones congénitas (2,96%). Se observó una tendencia significativa al aumento del coeficiente de mortalidad fetal general correspondiente a 6.99% (ß1=0,17; p=0,004) y del específico, por malformaciones congénitas, equivalente a 5,13% (ß1=0,01; p=0,04). Los resultados del estudio corroboran la tendencia histórica a la negligencia de los centros de salud brasileños con respecto a las muertes de los fetos. Por su importancia debemos destacar que parte de esas muertes son presumibles y pueden ser evitadas. De ese modo, la implementación de los comités de investigación de muertes de fetos y infantiles y su vigilancia adecuada podrían mejorar la asistencia prestada en el prenatal y en el parto.

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Among reproductive disorders in dairy and beef cattle worldwide, embryonic mortalities stand out as one of the most frequent. Because of the multifactorial etiology, the clinical and laboratory diagnoses of embryonic mortality causes in cattle are quite complex. Often, infectious causes may account for up to 50% of bovine embryonic mortality rates after 30 days of conception. This review will address the main causes of early and late embryonic mortality, with emphasis on infectious causes and, particularly, those more frequent in the Brazilian cattle herds. In addition, we will discuss ways of controlling and prophylaxis including those related to reproductive and sanitary management, with emphasis on immunoprophylaxis of the three most frequent reproductive infectious diseases in Brazilian dairy and beef cattle herds.

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Among reproductive disorders in dairy and beef cattle worldwide, embryonic mortalities stand out as one of the most frequent. Because of the multifactorial etiology, the clinical and laboratory diagnoses of embryonic mortality causes in cattle are quite complex. Often, infectious causes may account for up to 50% of bovine embryonic mortality rates after 30 days of conception. This review will address the main causes of early and late embryonic mortality, with emphasis on infectious causes and, particularly, those more frequent in the Brazilian cattle herds. In addition, we will discuss ways of controlling and prophylaxis including those related to reproductive and sanitary management, with emphasis on immunoprophylaxis of the three most frequent reproductive infectious diseases in Brazilian dairy and beef cattle herds.(AU)

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INTRODUCTION: Few studies have established a relationship between adverse social conditions by geographic area (GA) and fetal mortality (FM). Objective. To assess health inequalities in relation to FM by GA. POPULATION AND METHODS: Descriptive, ecological study. The principal components of 525 GAs were analyzed. A socioeconomic status indicator and indices of inequality were developed and estimated, and the FM ratio was calculated. RESULTS: The Kunst and Mackenbach relative index of inequality ranged from 1.8 to 1.4 in the 2007/2008 and 2013/2014 biennia, and a higher FM ratio was estimated for the highly unfavorable socioeconomic level stratum. CONCLUSION: The FM ratio is higher in this stratum. The gap between the ends of the socioeconomic spectrum narrowed towards the latest biennium. Regardless of this, in the GAs with a very unfavorable socioeconomic status, the FM ratio reduced in the latest biennium and increased in those with a very favorable socioeconomic status.

Introducción. Pocos estudios relacionaron las condiciones sociales adversas en cuanto a áreas geográficas (AG) con la mortalidad fetal (MF). Objetivo. Evaluar la desigualdad en salud en la MF según las AG. Población y métodos. Estudio descriptivo ecológico. Se analizaron los componentes principales de 525 AG. Se construyó y calculó el indicador de situación socioeconómica e índices de desigualdad, y se estimó la razón de mortalidad fetal (RMF). Resultados. El índice relativo de desigualdad de Kunst y Mackenbach varió de 1,8 a 1,4 para los bienios 2007/2008-2013/2014, y se estimó la mayor RMF para el estrato de situación socioeconómica muy desfavorable. Conclusión. La RMF es mayor para dicho estrato. La brecha entre los extremos de situación socioeconómica disminuyó hacia el último bienio. Independientemente, para las AG de situación socioeconómica muy desfavorable, la RMF descendió en el último bienio y, para las de situación socioeconómica muy favorable, se incrementó.

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BACKGROUND: Infant mortality rate (IMR), or number of infant deaths per 1000 livebirths, varies widely across the US While fetal deaths are not included in this measure, reported infant deaths do include those delivered at previable gestations, or ≤20 weeks gestation. Variation in reporting of these events may have a significant impact on IMR estimates. METHODS: This retrospective analysis used US National Center for Health Statistics 2007-2013 data from 2391 US counties. Counties were categorised by US region, demographic characteristics, and state-level fetal death reporting requirements. County percentage of fetal deaths among all 17-20 week fetal and infant deaths was evaluated using multivariable linear regression. County-level characteristics were then included in multivariable linear regression to determine the associated change in county IMR. RESULTS: County percentage of deaths at 17-20 weeks reported as fetal ranged from 0% to 100% (mean 63.7%). Every 1 point increase in this percentage was associated with a 0.02 point decrease in county IMR (95% confidence interval (CI) 0.02, 0.03). When county IMRs were recalculated holding the percentage of fetal vs. infant deaths at 17-20 weeks constant at 63.7%, results suggest that the predicted gap in county IMR between Northeast and Midwest regions would narrow by 0.45 points. CONCLUSIONS: Variable reporting of previable fetal and infant deaths may compromise the validity of county IMR comparisons. Improved consistency and accuracy of fetal and infant death reporting is warranted.

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Background: It has been observed that the increase in preterm births was accompanied by a decrease in fetal mortality. Objective: To evaluate the relationship between fetal mortality and prematurity in Argentina. Methods: Ecological design. The population included all live births and fetal demise in Argentina between 2003 and 2013. Outcomes: total fetal mortality rate (TFMR), fetal mortality rate by birth weight, fetal mortality rate, neonatal mortality rate, perinatal mortality rate, trends in fetal mortality rates specific for gestational age (GA), and prematurity (<37+ 0 weeks). Independent variables: age (<19 and > 35 years), education <8 years, with partner, parity 1 and > 4, multiple pregnancy and birth rate. Statistical analysis: linear regression analysis adjusted for covariates. Results: TFMR showed an annual reduction of 0.18 per thousand births that decreased with the increase of GA, being the largest reduction below 28+0 weeks (68%), while prematurity increased 0.07% per year, being the largest increase (0.75%) between 32+0 and 36+6 weeks. Linear regression model showed an inverse relationship between TFMR and prematurity (adjusted R2 0.76, p = 0.010), being the highest between 32+0 and 36+6 weeks (adjusted R2 = 0.98, p < 0.001). Conclusions: The reduction in fetal mortality was associated with the observed increase in preterm births in Argentina.

Antecedentes: Se ha observado que el aumento de nacimientos prematuros fue acompañado por una disminución en la mortalidad fetal. Objetivo: Evaluar la relación entre la mortalidad fetal y la prematurez en Argentina. Material y Métodos: Diseño ecológico; la población incluyó a todos los nacidos vivos y muertos de Argentina entre 2003 y 2013. Variables Resultado: tasa de mortalidad fetal total (TMFT), tasa de mortalidad fetal por peso, razón de mortalidad fetal, tasa de mortalidad neonatal, tasa de mortalidad perinatal, tendencias de las tasas de mortalidad fetal específicas por edad gestacional (EG), y Prematurez (PP,<37+0 semanas). Variables independientes: edad (<19 y > 35 años), educación <8 años, con pareja, paridad 1 y > 4, embarazo múltiple y tasa de natalidad. Análisis estadístico: análisis de regresión lineal ajustado para covariados. Resultados: La TMFT mostró una reducción anual del 0,18 por mil y disminución con el aumento de la EG, siendo la mayor reducción en menores a 28+0 semanas (68%), mientras que el parto prematuro aumentó 0,07% por año, siendo el mayor incremento (0,75%) entre la 32+0 y 36+6 semanas. La regresión lineal mostró un R2 ajustado de 0,76 (p = 0,010) y la mayor relación inversa entre la TMFT y el PP se observó en prematuros entre 32+0 a 36+6 semanas (R2 = 0,98, p = <0,001). Conclusiones: La reducción de la mortalidad fetal se asoció con el incremento observado de los nacimientos vivos prematuros en la Argentina.

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BACKGROUND: There is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil? METHODS: The time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010. RESULTS: Preterm births showed the highest annual increase (3.2%) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4%) in the same gestational age group. There was an increase of cesarean section births and it was higher in the < 28 weeks group (6.1%). There was a decreased annual trend of mothers with inadequate prenatal care (6.1%) and low education (8.8%) and an increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2% of all pregnancies resulted in preterm births (0.9% in fetal deaths and 7.3% in live births). In 2010, the preterm birth increased to 9.4% (0.8% were preterm fetal deaths and 8.6% preterm live births). CONCLUSIONS: The results suggest that 45.2% could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.

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Indigenous populations experience higher rates of poverty, disease and mortality than non-indigenous populations. To gauge current and future risks among Tsimane Amerindians of Bolivia, I assess mortality rates and growth early in life, and changes in risks due to modernization, based on demographic interviews conducted Sept. 2002-July 2005. Tsimane have high fertility (total fertility rate = 9) and infant mortality (13%). Infections are the leading cause of infant death (55%). Infant mortality is greatest among women who are young, monolingual, space births close together, and live far from town. Infant mortality declined during the period 1990-2002, and a higher rate of reported miscarriages occurred during the 1950-1989 period. Infant deaths are more frequent among those born in the wet season. Infant stunting, underweight and wasting are common (34%, 15% and 12%, respectively) and greatest for low-weight mothers and high parity infants. Regression analysis of infant growth shows minimal regional differences in anthropometrics but greater stunting and underweight during the first two years of life. Males are more likely to be underweight, wasted, and spontaneously aborted. Whereas morbidity and stunting are prevalent in infancy, greater food availability later in life has not yet resulted in chronic diseases (e.g. hypertension, atherosclerosis and diabetes) in adulthood due to the relatively traditional Tsimane lifestyle.

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El objetivo fue estudiar la mortalidad fetal, conocer su frecuencia, determinar características maternas, condiciones obstetricas y factores relacionados. Es un estudio observacional, descriptivo de 347 muertes fetales sucedidas entre 2005-2009. Para el mismo lapso se registraron 17406 nacimientos en el Departamento de Obstetricia y Ginecología. Hospital "Dr. Adolfo Prince Lara". Puerto Cabello-Estado Carabobo. La mortalidad fetal para el período fue 19,94 por mil nacidos o 1 por cada 50 nacimientos. Hubo predominio de pacientes de 24 años y menos (40,35%), en antecedentes familiares destacó la hipertensión arterial (18,44%) y diabetes e hipertensión arterial crónica (9,8%), en los personales la hipertensión arterial (17,58%). El diagnóstico de ingreso fue feto muerto 47,26%, rotura prematura de membrana 14,7% y patología hipertensiva 14,12%. No realizaron control prenatal 48,7%; eran multigestas 43,24%, con edad de embarazo menor igual 36 semanas 70,03%, y resuelto en parto vaginal 77,52%. Predominaron los fetos masculinos (57,06%), con peso menor igual 2500 g (75,5%) y talla menor igual 49 cm (65,13%). El factor de muerte directo conocido prevaleciente en 178 casos fue la insuficiencia placentaria (36,52%), desencadenada principalmente por patología hipertensiva; seguida de patología hemorrágica placentaria (25,28%), liderizada por desprendimiento normoplacentario. La tasa de mortalidad fetal se encuentra elevada, por lo cual se recomienda una estrategia de atención precoz del embarazo, enfatizar control de las patologías relacionadas: hipertensivas, diabetes, prematurez y hemorragias placentarias. La vigilancia intra-parto debe ser rutinaria, en especial en estas patologías

The objetive wasto study fetal mortality, to know its impact, to determine the maternal characteristics, obstetric conditions and related factors. It is an observational descriptive study of 347 fetal death accurred between 2005-2009. For the same period there were 17406 birth in the Department of Obstetrics and Gynecology Hospital "Dr. Adolfo Prince Lara". Puerto Cabello, Estado Carabobo. Fetal mortality for the period was 1994 per thousand births or 1 per 50 births. Most of them were patients of 24 years or less (40.35%), with family history of hypertension (18.44%) and diabetes and cronic arterial hypertension (9.8%); and personal history of hypertension (17.58%). The admission diagnosis was stillbirth 47.26%, premature rupture of membranes 14.7%, and hypertension disease 14.12%. No prenatal care 48.7%, were multiparous 43.24%. with gestational age < igual 36 weeks 70.03%. and vaginal delivery 77.52%. A predominance of male fetuses (57.06%), weight < igual 36 weeks 70.03, and vaginal delivery 77.52%. A predominance of male fetuses (57.06%), weightv< igual 2.500 g (75.5%) and heidht < igual 49 cm (63.13%). The known factor of prevalent direct death in 178 cases was placental insufficiency (36.52%), mosthy triggered by hipertensive pathology, , followed by placental hemorrhage (25.28%), lead by placental abruption. The fetal mortality rate is high, so it is recommended a strategy of early attention of pregnancy, and stress control of related conditions: hypertensive disorders, diabetes, pematurity and placental bleeding, Intrapartum monitoring should be routine, especially in these conditions

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Com os dados coletados na granja de suínos da Faculdade de Medicina Veterinária e Zootecnia, no período de 1997 a 2007, estudaram-se os efeitos de ordem de parto (OP), estação de parto (ESP), ano de parto (ANOP) e de porcas (PORCAS), nas variáveis:- número de leitões nascidos vivos/parto (NV), número de leitões nascidos mortos/parto (NM), total de nascidos/parto (TN), número de leitões mortos do nascimento ao desmame/parto (MND) e total de desmamados/parto (TD). As médias ajustadas de NNV, NM, TN, MND e TD foram respectivamente 9,541±2,520, 1,041±1,311, 10,582±2,656, 1,365±1,461 e 8,176±2,417. Não houve efeito de ESP sobre nenhuma das variáveis estudadas e de ano apenas para MND e TD. A ordem de parto (OP) teve efeito quadrático significativo sobre NNV, TN, e TD, com melhores resultados obtidos no terceiro parto e linear para NM, com piores resultados na primeira parição.

With the data collected in the swine farm of the College of Medicine Veterinary and Animal Science, in the period of 1997 to 2007, the effect of childbirth order (CBO), season of childbirth (SCB), year of childbirth (YCB) were studied, in the variable: number of alive piglets at birth (NA), number of death piglets at birth (ND), number of total piglets at birth (NTP), number of piglets death to birth at weaned (NPDW) and total weaned piglets (TWP). The averages adjusted of NA, ND, NTP, NPDW and TWP was 9.541±2.520, 1.041±1.311, 10.582±2.656, 1.365±1.461 and 8.176±2.417, respectively. Do not observe effect of SCB on the all variable studied, and to YCB was observed a positive effect on the NPDW and TWP. The childbirth order (CBO) had significant quadratic effect on ND, NTP, and TWP, with better resulted observed in the third childbirth and linear to ND, with worse resulted in the first childbirth.

Con los datos, que fueron obtenidos en la granja de porcinos de la Facultad de Medicina Veterinaria y Zootecnia, correspondiente al periodo de 1997 a 2007, se estudiaron los efectos de número de parto (NP), estación de parto (ESP), año de parto (ANOP) y de cerdas (CERDAS), sobre las variables:- número de lechones nacidos vivos/parto (NNV), número de lechones nacidos muertos/parto (NM), total de nacidos/parto (TN), número de lechones muertos del nacimiento al destete/parto (MND y total de destetados/parto (TD). Los promedios ajustados de NNV, NM, TN, MND y TD fueron respectivamente 9,541±2,520, 1,041±1,311, 10,582± 2,656, 1,365±1,461 y 8,176±2,417. No hubo efecto de ESP sobre ninguna de las variables estudiadas y de año apenas para MND y TD. El NP tuvo efecto cuadrático significativo sobre NNV, TN, y TD, con los mejores resultados obtenidos en el tercer parto y lineal para NM, con peores resultados en la primera parición.

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Com os dados coletados na granja de suínos da Faculdade de Medicina Veterinária e Zootecnia, no período de 1997 a 2007, estudaram-se os efeitos de ordem de parto (OP), estação de parto (ESP), ano de parto (ANOP) e de porcas (PORCAS), nas variáveis:- número de leitões nascidos vivos/parto (NV), número de leitões nascidos mortos/parto (NM), total de nascidos/parto (TN), número de leitões mortos do nascimento ao desmame/parto (MND) e total de desmamados/parto (TD). As médias ajustadas de NNV, NM, TN, MND e TD foram respectivamente 9,541±2,520, 1,041±1,311, 10,582±2,656, 1,365±1,461 e 8,176±2,417. Não houve efeito de ESP sobre nenhuma das variáveis estudadas e de ano apenas para MND e TD. A ordem de parto (OP) teve efeito quadrático significativo sobre NNV, TN, e TD, com melhores resultados obtidos no terceiro parto e linear para NM, com piores resultados na primeira parição.(AU)

With the data collected in the swine farm of the College of Medicine Veterinary and Animal Science, in the period of 1997 to 2007, the effect of childbirth order (CBO), season of childbirth (SCB), year of childbirth (YCB) were studied, in the variable: number of alive piglets at birth (NA), number of death piglets at birth (ND), number of total piglets at birth (NTP), number of piglets death to birth at weaned (NPDW) and total weaned piglets (TWP). The averages adjusted of NA, ND, NTP, NPDW and TWP was 9.541±2.520, 1.041±1.311, 10.582±2.656, 1.365±1.461 and 8.176±2.417, respectively. Do not observe effect of SCB on the all variable studied, and to YCB was observed a positive effect on the NPDW and TWP. The childbirth order (CBO) had significant quadratic effect on ND, NTP, and TWP, with better resulted observed in the third childbirth and linear to ND, with worse resulted in the first childbirth.(AU)

Con los datos, que fueron obtenidos en la granja de porcinos de la Facultad de Medicina Veterinaria y Zootecnia, correspondiente al periodo de 1997 a 2007, se estudiaron los efectos de número de parto (NP), estación de parto (ESP), año de parto (ANOP) y de cerdas (CERDAS), sobre las variables:- número de lechones nacidos vivos/parto (NNV), número de lechones nacidos muertos/parto (NM), total de nacidos/parto (TN), número de lechones muertos del nacimiento al destete/parto (MND y total de destetados/parto (TD). Los promedios ajustados de NNV, NM, TN, MND y TD fueron respectivamente 9,541±2,520, 1,041±1,311, 10,582± 2,656, 1,365±1,461 y 8,176±2,417. No hubo efecto de ESP sobre ninguna de las variables estudiadas y de año apenas para MND y TD. El NP tuvo efecto cuadrático significativo sobre NNV, TN, y TD, con los mejores resultados obtenidos en el tercer parto y lineal para NM, con peores resultados en la primera parición.(AU)

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BACKGROUND: To establish magnitude and temporal trend of deaths by congenital malformations in Pernambuco state in Northeast of Brazil, from 1993 to 2003. METHODS: This is an observational descriptive study, with the temporal trend including all cases of death caused by congenital malformations, obtained from the database of the Mortality Information System of the Ministry for Health. RESULTS: From 1993 to 2003, 3.960 infant deaths and 989 stillbirths caused by congenital malformations were registered in Pernambuco. The coefficients of fetal, early neonatal, perinatal, neonatal and infant (< 1 year) mortality were 0.57, 1.20, 1.76, 1.59 and 2.33, respectively. A rising tendency was observed in the temporal curve from 1993 to 2003 when coefficients of early neonatal (p = 0.003), perinatal (p = 0.005), neonatal (p = 0.0007) and infant (p = 0.02) mortality were studied but no statistical significance was detected for the fetal mortality coefficient (p= 0.55). CONCLUSION: From 1993 to 2003 a rising tendency in the coefficients of early neonatal, perinatal, neonatal and infant mortality was found in the state of Pernambuco. This trend may have been be influenced by an improvement in the death registration records and by a decline of infant mortality in the state of Pernambuco.

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OBJETIVO: Determinar a magnitude e a tendência temporal dos óbitos ocorridos por malformações congênitas no Estado de Pernambuco, no período de 1993 a 2003. MÉTODOS: Trata-se de um estudo observacional, descritivo, com tendência temporal, em que foram incluídos todos os casos de óbitos por malformações congênitas, no Estado de Pernambuco, obtidos do banco de dados do Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde, no período de 1993 a 2003. RESULTADOS: Ocorreram 3.960 óbitos em menores de um ano e 989 óbitos fetais, no período de 1993 a 2003, determinados por malformações congênitas no Estado de Pernambuco. Os coeficientes de mortalidade fetal, neonatal precoce, perinatal, neonatal e em menores de um ano por malformações congênitas foram de 0,57; 1,20; 1,76; 1,59; e 2,33, respectivamente. Na curva de tendência temporal, de 1993 a 2003, observou-se uma tendência crescente para os coeficientes de mortalidade neonatal precoce (p = 0,003), perinatal (p = 0,005), neonatal (p = 0,0007) e menores de um ano (p = 0,02), porém não se encontrou significância para o coeficiente de mortalidade fetal (p = 0,55). CONCLUSÃO: No período de 1993 a 2003 houve uma tendência crescente dos coeficientes de mortalidade neonatal precoce, perinatal, neonatal e em menores de um ano por malformações congênitas no Estado de Pernambuco. Entretanto, vale ressaltar que esta tendência crescente pode ter sido influenciada pela melhora dos registros de óbitos e pela queda da mortalidade infantil no Estado de Pernambuco.

BACKGROUND: To establish magnitude and temporal trend of deaths by congenital malformations in Pernambuco state in Northeast of Brazil, from 1993 to 2003. METHODS: This is an observational descriptive study, with the temporal trend including all cases of death caused by congenital malformations, obtained from the database of the Mortality Information System of the Ministry for Health. RESULTS: From 1993 to 2003, 3.960 infant deaths and 989 stillbirths caused by congenital malformations were registered in Pernambuco. The coefficients of fetal, early neonatal, perinatal, neonatal and infant (< 1 year) mortality were 0.57, 1.20, 1.76, 1.59 and 2.33, respectively. A rising tendency was observed in the temporal curve from 1993 to 2003 when coefficients of early neonatal (p = 0.003), perinatal (p = 0.005), neonatal (p = 0.0007) and infant (p = 0.02) mortality were studied but no statistical significance was detected for the fetal mortality coefficient (p= 0.55). CONCLUSION: From 1993 to 2003 a rising tendency in the coefficients of early neonatal, perinatal, neonatal and infant mortality was found in the state of Pernambuco. This trend may have been be influenced by an improvement in the death registration records and by a decline of infant mortality in the state of Pernambuco.

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Objective: to know the late fetal mortality rate (LFMR) in Chile between 1995 and 2004. Methods: descriptive study analyzing the fetal deaths occurred in Chile in the period 1995-2004. Results: the LFMR in the period studied was 4,4 /1000newborns (NB). The LFMR in 2004 was 3.7/1000NB and the most prevalent etiologies were: gestational pathologies (49 percent), ovular pathologies (21.7 percent), intrauterine hypoxia (12.8 percent), congenital malformations (6.5 percent), maternal pathology not related with pregnancy (4.2 percent) and undetermined cause (3.7 percent). Conclusions: The LFMR and the frequency of the etiologies of fetal deaths found in our study were important to plan the prevention strategies of perinathology.

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The objective of this retrospective analysis of 344 singleton pregnancies of gestational ages greater than 24 weeks conducted at a tertiary hospital was to determine the fetal outcome in relation to the mode of delivery of the fetus with a breech presentation. Caesarean section was performed in 157 mothers, and 187 babies were delivered vaginally. There was no statistical difference in the perinatal outcome for breech fetuses delivered either abdominally or vaginally. Cord prolapse and arrest of the after-coming head were responsible for five fetal losses, four of which were delivered vaginally. Neonatal morbidity comprising nerve injury, birth asphyxia and seizures occurred in 11 newborns, nine of whom were delivered vaginally. One mother sustained a massive intra-operative haemorrhage during a caesarean section which necessitated an emergency hysterectomy. We conclude that a policy of planned vaginal birth for selected breech fetuses with a low threshold to proceed to caesarean section may be in the best interests of both mother and child.

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La mortalidad infantil ha sido considerada un parámetro que en cierto nivel de desarrollo socio-económico de un país y a pesar de que ésta ha mejorado en los últimos díez años, todavía es muy elevada en nuestro país, contríbuye a engrosar la mortalidad de todas las edades de America Latina. El presente se realizó fundamentalmente para analizar la mortalidad infantil en el Estado Mérida durante la decada 1971-1980, en referencia a su medicina, su distribución sanitaria y geografica a su causalidad y a su clasificación de acuerdo a los patrones internacionales. Se utilizó la información públicada en los armarios de Epidemiología y Estadística Vital del Ministerio de Sanida y Asistencia Social, dandole un tratamiento estadístico a través de cífras absolutas, tasas anuales y tasas promedios quinquenales, la mortalidad infantil en el Estado Mérida es mayor relativamente a la del país y refleja sus oscilaciones. La mortalidad infantil contribuye en un 25 por ciento a la mortalidad general

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