Pre-eclampsia as Underlying Cause for Perinatal Deaths: Time for Action

The Global Maternal Newborn Health Conference held in Mexico City in October 2015 marks an important watershed in global efforts to reduce the burden of preventable maternal and newborn deaths, bringing together—as it did—what have been two fairly distinct technical communities (maternal and newborn) to tackle their shared challenges in a post-Millennium Development Goal era. With this broadening focus embracing both mother and fetus/newborn, it is an appropriate time to reflect on where we may be allowing things to fall through the cracks and how—with a more seamless effort—we can do better. A first important observation is that although there has been growing attention in global health to maternal and newborn health and each of these areas has an active constituency, stillbirth remains relatively neglected. Yet it represents one of the starkest examples of global inequity. Risk of stillbirth is 10 times higher in South Asia and subSaharan Africa than it is in high-income countries. To focus our attention on where there is the greatest burden of preventable mortality, it can be helpful to reframe our view of mortality in a way that captures deaths late in pregnancy, during labor, and in the first hours and days after birth, recalling that globally it is estimated 73% of newborn deaths occur within 7 days of birth. Perinatal mortality comprises fetal deaths late in pregnancy (Z28 weeks gestation) and during labor, and newborn deaths through the first week after birth.