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. 2022 Jul 6:26:100523.
doi: 10.1016/j.lanwpc.2022.100523. eCollection 2022 Sep.

Trend and causes of maternal death, stillbirth and neonatal death over seven decades in Hong Kong

Ka Wang Cheung  1 , Mimi Tin Yan Seto  1 , Weilan Wang  1 , Chi Tao Ng  2 , William Wing Kee To  3 , Ernest Hung Yu Ng  1
Affiliations

Trend and causes of maternal death, stillbirth and neonatal death over seven decades in Hong Kong

Ka Wang Cheung et al. Lancet Reg Health West Pac. .

Abstract

Background: Reducing maternal and perinatal mortality is a global objective. Hong Kong is a city with low maternal and perinatal mortality but little is known about the trend and causes of these deaths in this high-income city. We analyzed the maternal death, stillbirth and neonatal death since 1946 in Hong Kong.

Methods: Data were extracted from vital statistics, based on the number of registered deaths and births, provided by the Department of Health, the Government of the HKSAR. The annual change rate of mortality was evaluated by regression analysis. Contextual factors were collected to assess the association with mortality.

Findings: Between 1946 and 2017, the stillbirth rate (per 1,000 total births) reduced from 21·5 to 2·4; early and late neonatal deaths (per 1,000 live births) reduced from 14·1 and 18·1 to 0·7 and 0·4 in 2017, respectively. The maternal mortality ratio (per 100,000 live births) declined from 125 to 1·8.The causes of maternal and perinatal deaths were available since 1981 and 1980 respectively. The leading causes of death were thromboembolism (37·0%) and obstetric haemorrhage (30·4%) for maternal death; congenital problem (30·1%) and prematurity (29·0%) for neonatal death. No data on causes of stillbirth were available. No specific shift of pattern was observed in the causes of maternal and neonatal death with time. There were no cases of maternal death due to sepsis and only 2 cases (2·2%) of maternal deaths due to indirect cause.

Interpretation: The maternal and perinatal death have reduced significantly in Hong Kong and maintained at the lowest level globally. Indirect maternal death and sepsis were unusual causes of maternal deaths. Use of ICD-PM stillbirth classification, setting up a maternal death confidential enquiry and adding pregnancy checkbox could be the next step to identify and categorize hidden burden.

Funding: Nil.

Keywords: Congenital; Death; Haemorrhage; Maternal; Mortality; Neonatal; Obstetrics; Prematurity; Preterm; Stillbirth; Thromboembolism.

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Conflict of interest statement

All authors declare no conflicts of interests.

Figures

Figure 1
Figure 1
The numbers of maternal death, stillbirths, early and late neonatal deaths, and post-neonatal deaths from 1946 to 2017.
Figure 2
Figure 2
The number (A) and proportion (B) of maternal deaths according to different causes of death between 1981 and 2017.
Figure 3
Figure 3
The number (A) and proportion (B) of neonatal deaths according to different causes of death between 1980 and 2017.
See this image and copyright information in PMC

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