BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter V. Infant Mortality
75
Preeclampsia of pregnancy
Premature separation of placenta
Immaturity
Respiratory distress syndrome
Hemorrhagic disease of the newborn
(terminal)
At the time of death neither the maternal
nor the placental conditions were acting
upon this child. The immaturity or prematurity
was a consequence of the preeclampsia
and its complication (premature
separation of placenta) and at the same
time was an important factor in the development
of the respiratory distress and
hemorrhagic condition. The only cause
mentioned in the medical certificate of
cause of death was prematurity, yet all the
necessary information related to the underlying
cause and its consequences was available
in the hospital record. The sequence
element is very important to an understanding
of the cause-effect relationship within
the multiple-cause constellation in this age
period, and it is essential that the maternal,
fetal, obstetric, and postnatal factors be
taken into account in order to provide adequate
medical care.
Undoubtedly, official mortality statistics
would improve greatly if all the diagnoses
stated in the death certificate were used in
the analyses of causes of death. A consultant
group convened by the World
Health Organization in October 1969 for-
connected with an obstetric or prenatal condition.
The diabetic mother, for example,
could after difficult labor give birth to an
abnormally large baby susceptible to hypoglycemia
and respiratory distress.
The following example taken from the
Investigation illustrates the complexity of
multiple causes of death in this age group.
A child who died at 3 days of age was a
product of a seven-month pregnancy and
born to a preeclamptic mother who had a
partial separation of placenta prior to
delivery. At birth, the infant's weight was
1,030 grams and its condition fair. The
clinical course was characterized by pro­
gresssive respiratory distress and death
occurred on the third day after an episode
of bleeding from the respiratory and diges­
tive systems.
The multiple causes assigned were:
762.1 Underlying cause
770.1
777
776.2 Consequences
778.2
mulated similar recommendations in regard
to analyses and basic tabulations of multiple
causes of mortality using death certificates
as source of data (WHO, 1969).
An even greater benefit would be obtained
if selected centers, at least, could
routinely collect information complementary
to the medical certificate of death,
using data from clinical histories and
autopsies (Puffer, 1970). All actions aimed
at improving the quality of clinical histories,
autopsies, and death certificates will
contribute toward improvement of the information
needed for a successful study of
multiple causes of mortality.
Only through the multiple-cause approach
is it possible to measure the real
magnitude of serious health problems that
have remained occult because studies were
based only on single causes. The method
used in this Investigation involves a
sequential or chronological interrelationship,
which is at times difficult to establish.
Nevertheless, the effort made is recommended
for other community-centered in­
vestigations since it provides an excellent
epidemiologic experience with aspects that