Risk factors for perinatal mortality in West Africa:: a population-based study of 20 326 pregnancies

The aim of the study was to identify simple clinical risk factors for perinatal mortality (PNM) in different areas of West Africa, to quantify their prevalence among pregnant women and to estimate their relative contribution in the definition of high-risk status of PNM. The MOMA study was a prospective population-based study in which data were collected on 20 326 pregnant women in various, primarily urban, areas of Burkina Faso, Ivory Coast, Mall, Mauritania, Niger and Senegal. The present report analyses 19 870 singleton births and 31 simple clinical variables with univariate and multivariate methods. The mean PNM ratio was 42 per 1000 total births, and 62% of these deaths were stillbirths. In the crude analysis, after adjustment or taking prevalence into account, the principal risk factors were: vaginal bleeding (immediately antenatal and intrapartum), hypertension (especially during labour), dynamic (prolonged labour and use of oxytocin) and mechanic (non-cephalic presentation) dystocia, and infection (prolonged rupture of the membranes and intrapartum fever). Conclusions: Most of the principal risk factors for PNM cannot be detected during antenatal care visits but only in early labour. High-risk status should not be based solely on antenatal care visits, but should also take into account monitoring during labour.