Gestational, perinatal, and neonatal death is still frequent in Mexico; however, pregnancy surveillance, that is, obstetrics and gynecology consultation, serves to reduce or avoid, if possible, these complications, assures Jorge Campos Cañas, a gynecologist from the Postgraduate Program of the Faculty of Medicine of the UNAM (National Autonomous University of Mexico).
We live in a multicultural, dispersed country and there are places where there is not the same access to health systems. That is why there are complexities derived from the first world and the developing world, he considers.
The incidence of this type of death in Mexico is 14 per 1,000 births, which places it "mid-table" with developed countries at two per 1,000; and nations such as Sub-Saharan Africa at over 30 per 1,000.
Some of the 14 per thousand Mexicans correspond to rural areas, where there are infectious situations associated with the lack of access to health services, while in places with greater purchasing power, preeclampsia and diabetes occur.
World Pregnancy, Perinatal, and Neonatal Death Awareness Day -which is commemorated on October 15- seeks, in a way, to pay tribute to couples who have suffered the death of their baby during the gestation period or once the birth has taken place. And, of course, it also aims to ensure that health professionals are trained and prepared to attend to parents who have experienced a loss.
Why does fetal death occur?
Gestational or fetal death occurs when the fetus is more than 22 weeks in the womb. In the case of reaching 28 weeks, or even being born and surpassing the first week of life, and death occurs, then we speak of perinatal death. When the baby is born, but presents problems during the following 28 days and dies, this is known as neonatal or newborn death.
During pregnancy, the main causes of death are complications such as preeclampsia and gestational diabetes. With COVID-19, the incidence of vomiting increased. In death after immediate birth, the most common cause is prematurity and the difficulties associated with it, in addition to infections. In later deaths, metabolic and infectious diseases are the main causes.
This type of death is related to various factors, both genetic and environmental. There is also talk of risk causes, which may be due to the mother, the fetus, or the placenta.
Among the problems directly related are chronic diseases, infection during pregnancy, preeclampsia, hypotension, blood incompatibility, maternal age, and, in extreme cases, the death of the mother during childbirth.
When it is related to the baby, there may be various causes such as multiple gestations, delayed uterine growth, congenital malformations or anomalies, bacterial infections, and so on.
Fetal death can also be due to problems with the placenta where it detaches during pregnancy, damage to the umbilical cord, aging of the placenta, or premature rupture of the membrane covering the fetus.
Other factors have to do with the intake of certain drugs, the use of drugs or cigarettes, an accident or fall, and those related to the mother's diet and lifestyle during gestation.
Requires specific care
Most of these causes are preventable, such as infectious causes. Hence the importance of close monitoring of the pregnancy, good prenatal care and thus being able to improve the outcome of the pregnancy.
Hypertension, preeclampsia, and diabetes are frequent and their occurrence cannot be avoided, but they can be detected early and their risks can be reduced.
Any pregnant patient should have a gynecobstetric check-up every month. The timing is closer in the early stages of pregnancy when auscultation is performed every six to eight weeks to check the progression of the process.
In the final stages of gestation, after 36 weeks, the ideal is to perform a weekly checkup until the baby is born, to have a better culmination.
The World Day on this subject is important because it should be noted that pregnancy is not a pathology, nor a disease; it is a process that requires specific medical care. "We must be aware that we must have a good prenatal control, and even pregestational, which is very uncommon in our country".
The desirable thing is to plan the pregnancy so that we can control, from the beginning, the pre-existing factors such as diabetes, obesity, and hypertension, have a complete vaccination schedule, and that the couple is in the best possible conditions.