The importance of quality of care in perinatal mortality: a case-control study in Chiapas, Mexico.

Background This study was undertaken in order to ascertain the relative importance of different risk factors for perinatal mortality (PM) in a community of Chiapas, Mexico stressing the importance of antenatal and neonatal medical care. Methods Cases were stillbirth and early neonatal death (END). Two children born in the same hospital and/or day as the case were randomly selected as controls, in Tapachula, Chiapas, Mexico. Socioeconomic, cultural, maternal, pregnancy, delivery, product and medical care factors were recorded. Two analyses were performed using multiple logistic regression: one for stillbirths, the other for END. Results PM rate was 46.7/1000; 142 cases and 284 controls were studied. Fifteen cases were excluded due to congenital malformations; 62 stillbirth and 65 END were analyzed. For stillbirth, pregnancy–delivery and maternal medical care factors resulted in the most strongly associated risk factors for PM (OR = 27.5 95% CI 6.4–116.8), and within this index insufficient prenatal care had the strongest impact on PM (%population attributable risk (%PAR) = 24%). For END, fetal conditions and the newborn medical care index had the strongest association with PM (OR = 9.5 95% CI 1.5–60.3), and within the index inappropriate medical care of the newborn (%PAR = 27%) was the most important variable. Conclusions Our results support the fact that insufficient prenatal care and failure to comply with the standards of care for labor, delivery and for the care of the newborn are strong predictors of PM.