A multi-country study of the "intrapartum stillbirth and early neonatal death indicator" in hospitals in low-resource settings

Int J Gynaecol Obstet. 2013 Sep;122(3):230-3. doi: 10.1016/j.ijgo.2013.04.008. Epub 2013 Jun 21.


Objective: To determine the feasibility of introducing a simple indicator of quality of obstetric and neonatal care and to determine the proportion of potentially avoidable perinatal deaths in hospitals in low-income countries.

Methods: Between September 1, 2011, and February 29, 2012, data were collected from consecutive women who were admitted to the labor ward of 1 of 6 hospitals in 4 low-income countries. Fetal heart tones on admission were monitored, and demographic and birth data were recorded.

Results: Data were obtained for 3555 women and 3593 neonates (including twins). The doptone was used on 97% of women admitted. The overall perinatal mortality rate was 34 deaths per 1000 deliveries. Of the perinatal deaths, 40%-45% occurred in the hospital and were potentially preventable by better hospital care.

Conclusion: The results demonstrated that it is possible to accurately determine fetal viability on admission via a doptone. Implementation of doptone use, coupled with a concise data record, might form the basis of a low-cost and sustainable program to monitor and evaluate efforts to improve quality of care and ultimately might help to reduce the in-hospital component of perinatal mortality in low-income countries.

Keywords: Doptone; Fetal heart tones; Hospital-based perinatal mortality; Neonatal mortality; Perinatal mortality; Stillbirth.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Developing Countries
  • Feasibility Studies
  • Female
  • Fetal Death / epidemiology*
  • Fetal Death / prevention & control
  • Fetal Heart / physiology
  • Fetal Monitoring / methods*
  • Hospital Mortality
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Pregnancy
  • Quality Indicators, Health Care
  • Quality of Health Care*
  • Stillbirth / epidemiology*