A taxa de mortalidade perinatal (TMP) é um dos importantes indicadores de saúde que refletem a qualidade da assistência prestada durante a gestação, o parto e ao recém nascido. A TMP possui dois componentes: a taxa e mortalidade fetal e a taxa de mortalidade infantil neonatal precoce. O objetivo do presente estudo foi analisar a mortalidade perinatal na região do Médio Paraíba, estado do Rio de Janeiro, Brasil no período de 2005 a 2009, segundo causa básica dos óbitos, componentes do período perinatal e critérios de evitabilidade. Foram utilizados os dados referentes aos óbitos fetais e infantis neonatais precoces e de nascidos vivos, registrados, respectivamente, nos Sistemas de Informações sobre Mortalidade (SIM) e Nascidos Vivos (SINASC). A TMP na região foi de 18,4 óbitos por mil nascimentos totais. As taxas de mortalidade fetal e infantil neonatal precoce no período alcançaram, espectivamente 10,7 óbitos por mil nascimentos totais e 7,7 óbitos por mil nascidos vivos. A TMP apresentou redução ao longo do quinquênio analisado associada à queda do componente neonatal precoce, mantendo-se estável o componente fetal. As principais causas básicas dos óbitos perinatais, segundo a lista de mortalidade CID BR, foram as afecções originadas no período perinatal (89%) e as malformações congênitas, deformidades e anomalias cromossômicas (10,5%). Utilizando os critérios de evitabilidade segundo Ortiz, para os óbitos infantis neonatais precoces foi observado que mais de 41% eram reduzíveis por diagnósticos e tratamento precoces. Ressalta-se a necessidade da implementação de ações de assistência à saúde da gestante e de cuidados com o recémnascido com vistas à redução da mortalidade perinatal na região do Médio Paraíba. / The perinatal mortality rate (PMR) is an important health indicator that reflects the quality of health care provided during pregnancy, childbirth and to the newborns. The PMR has two components: the fetal mortality rate and the early neonatal mortality rate. The objective of this study was to analyze the perinatal mortality in the Médio Paraíba region, Rio de Janeiro state, Brazil between 2005 and 2009, according to the underlying cause of deaths, components of the perinatal period and criteria of avoidability. Data regarding fetal and early neonatal deaths and live births was provided by the National Death (SIM) and Live Birth (SINASC) Information Systems, respectively. The PMR in the region was 18.4 deaths per thousand total births. Fetal and early neonatal mortality rates reached 10.7 deaths per thousand total births and 7.7 deaths per thousand live births, respectively. The PMR declined during the five year period, associated with the fall of its early neonatal component, remaining stable the fetal component. The main underlying causes of perinatal deaths, according to the ICD Mortality List for use in Brazil - ICD BR, were certain conditions originating in the perinatal period (89%) and congenital malformations, deformations and chromosomal abnormalities (10,5%). Using the criteria of avoidability according to Ortiz, for early neonatal infant deaths was observed that over 41% were avoidable through early diagnosis and treatment . Efforts aimed at improving health care during pregnancy and childbirth are needed in order to reduce perinatal mortality levels in the Médio Paraíba region.

A taxa de mortalidade perinatal (TMP) é um dos importantes indicadores de saúde que refletem a qualidade da assistência prestada durante a gestação, o parto e ao recém nascido. A TMP possui dois componentes: a taxa e mortalidade fetal e a taxa de mortalidade infantil neonatal precoce. O objetivo do presente estudo foi analisar a mortalidade perinatal na região do Médio Paraíba, estado do Rio de Janeiro, Brasil no período de 2005 a 2009, segundo causa básica dos óbitos, componentes do período perinatal e critérios de evitabilidade. Foram utilizados os dados referentes aos óbitos fetais e infantis neonatais precoces e de nascidos vivos, registrados, respectivamente, nos Sistemas de Informações sobre Mortalidade (SIM) e Nascidos Vivos (SINASC). A TMP na região foi de 18,4 óbitos por mil nascimentos totais. As taxas de mortalidade fetal e infantil neonatal precoce no período alcançaram, espectivamente 10,7 óbitos por mil nascimentos totais e 7,7 óbitos por mil nascidos vivos. A TMP apresentou redução ao longo do quinquênio analisado associada à queda do componente neonatal precoce, mantendo-se estável o componente fetal. As principais causas básicas dos óbitos perinatais, segundo a lista de mortalidade CID BR, foram as afecções originadas no período perinatal (89%) e as malformações congênitas, deformidades e anomalias cromossômicas (10,5%). Utilizando os critérios de evitabilidade segundo Ortiz, para os óbitos infantis neonatais precoces foi observado que mais de 41% eram reduzíveis por diagnósticos e tratamento precoces. Ressalta-se a necessidade da implementação de ações de assistência à saúde da gestante e de cuidados com o recémnascido com vistas à redução da mortalidade perinatal na região do Médio Paraíba. / The perinatal mortality rate (PMR) is an important health indicator that reflects the quality of health care provided during pregnancy, childbirth and to the newborns. The PMR has two components: the fetal mortality rate and the early neonatal mortality rate. The objective of this study was to analyze the perinatal mortality in the Médio Paraíba region, Rio de Janeiro state, Brazil between 2005 and 2009, according to the underlying cause of deaths, components of the perinatal period and criteria of avoidability. Data regarding fetal and early neonatal deaths and live births was provided by the National Death (SIM) and Live Birth (SINASC) Information Systems, respectively. The PMR in the region was 18.4 deaths per thousand total births. Fetal and early neonatal mortality rates reached 10.7 deaths per thousand total births and 7.7 deaths per thousand live births, respectively. The PMR declined during the five year period, associated with the fall of its early neonatal component, remaining stable the fetal component. The main underlying causes of perinatal deaths, according to the ICD Mortality List for use in Brazil - ICD BR, were certain conditions originating in the perinatal period (89%) and congenital malformations, deformations and chromosomal abnormalities (10,5%). Using the criteria of avoidability according to Ortiz, for early neonatal infant deaths was observed that over 41% were avoidable through early diagnosis and treatment . Efforts aimed at improving health care during pregnancy and childbirth are needed in order to reduce perinatal mortality levels in the Médio Paraíba region.

Introdução: O presente estudo trata da evolução da mortalidade perinatal hospitalar do município de Fortaleza-Ceará em dois momentos: 1995 e 2005. O interesse para a realização desta pesquisa parte da relevância dos cuidados oferecidos à mulher grávida e ao recém nascidocomo importante indicador da saúde materno infantil.Objetivos: Avaliar a evolução dos indicadores de saúde perinatal referentes aos nascimentos hospitalares de Fortaleza, Ceará, ocorridos em 1995 e em 2005.Metodologia: Estudo epidemiológico, do tipo ecológico, que estuda a evolução da saúde perinatal em Fortaleza, de 1995 a 2005, a partir da análise dos dados de dois estudos de base hospitalar. Todos os nascimentos foram acompanhados desde o parto até a alta ou óbito em hospital.Fizeram parte da população, todos os nascimentos e respectivos óbitos perinatais ocorridos em hospitais/maternidades públicas e particulares, conveniados com o SUS, no município de Fortaleza, CE, em 1995 e em 2005, disponíveis em dois bancos de dados já existentes.Resultados: Os resultados evidenciaram que nos dez anos (1995-2005) houve melhoria nos indicadores de saúde perinatal em Fortaleza. Os coeficientes de mortalidade perinatal hospitalar, fetal e neonatal precoce tiveram redução de 29 por cento, 19,0 por cento e de 42 por cento respectivamente. Em crianças com baixo peso ao nascer,observou-se declínio na mortalidade perinatal, fetal e neonatal precoce em todas as categorias. Chama-se atenção para a redução do coeficiente de mortalidade perinatal no grupo de recém nascidos de muito baixo peso (< 1500g), que passou de 821,1/1000 NV em 1995 para 532,2/1000 NV em 2005, com um declínio de 35,2 por cento. Quanto ao coeficiente de mortalidade neonatal precoce, a redução foi de 53,8 por cento, passando de 703,0/1000 NV para 324,7/1000 NV. Foi possível evidenciar mudanças referentes à reorganização da atenção perinatal em Fortaleza, quando se detectou uma maior participação dos hospitais públicos, que realizou um maior número de partos nos dez anos em 121 por cento por cento. Em 1995 a proporção de partos foi de 32,4 por cento e em 2005 de 71,7 por cento. Quanto à idade materna, os coeficientes de mortalidade perinatal, fetal e neonatal precoce nos dez anos tiveram reduções, com ênfase entre os filhos de mães adolescentes (10 a 19 anos). Para este grupo, o coeficiente de mortalidade perinatal obteve declínio de 54,2 por cento o de mortalidade fetal de 16,2 por cento e o de mortalidade neonatal precoce de 36,8 por cento. Conclusões: A mudança nos indicadores da saúde perinatal no município de Fortaleza mostra que houve uma melhora da atenção ao longo dos dez anos, revelando um cenário favorável na atenção prestada à mulher grávida e ao recém nascido na capital. Contudo, sabe-se que aspectos relacionados com o processo de trabalho e a organização da rede, ainda permanecem em níveis inferiores em relação , quando compara-se com outras capitais brasileiras, sendo necessárias medidas governamentais para que estas lacunas sejam remediadas / Introduction: This study deals with the evolution of perinatal mortality hospital in Fortaleza, Ceara on two occasions: 1995 and 2005. The interest for this research part of the relevance of care offered to pregnant women and newborn care as an important indicator of maternal and infant health.Objectives: To evaluate perinatal health indicators relating to hospital births in Fortaleza, occurring in 1995 and 2005.Methodology: Epidemiological study of ecological type, which studies the evolution of perinatal health in Fortaleza, from 1995 to 2005, based on the analysis of data from two hospital-based studies. All births were followed from birth until discharge or death in hospital. The population was composed of all births and perinatal deaths occurred in their hospitals / public hospitals and private contracts with the SUS in the city of Fortaleza, in1995 and 2005, available in two databases that already exist.Results: The results showed that within ten years (1995-2005) found a reduction in perinatal health indicators in Fortaleza. The hospital perinatal mortality rates, fetal and early neonatal fell by 29 per cent, 19.0 per cent and 42 per cent respectively. As birth weight were obtained decline in perinatal mortality, fetal and early neonatal in all categories. Attention is drawn to the reduction of perinatal mortality rate in the group of infants with very low birthweight (<1500g), now 821.1 / NV in 1000 to 532.2 in 1995 / 1000 NV in 2005, with a declining 35.2 per cent. As for early neonatal mortality rate, the reduction was 53.8 per cent, from 703.0 / 324.7 for 1000 NV / NV 1000. The results showed changes related to the reorganization of perinatal care in Fortaleza, when it detected a greater involvement of public hospitals, which increased the number of births in the ten years 121 per cent per cent. In 1995 the proportion of births was 32.4 per cent and 71.7 per cent in 2005. As for maternal age, perinatal mortality rates, fetal and early neonatal ten years have had reductions, with emphasis among the children of teenage mothers (10-19 years). For this group, the perinatal mortality rate decline of 84.7 per cent was obtained, the fetal mortality of 46.8 per cent and early neonatal mortality rate of 88.7 per cent.Conclusions: The change in perinatal health indicators in Fortaleza shows that there was an improvement of attention over the ten years, revealing a favorable outlook on care provided to pregnant women and newborn in capital.Contudo, it is known that aspects related to the work process and organization of the network, are still inconsistent when it is compared with other Brazilian cities, requiring government measures to these deficiencies are remedied

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background South Africa is burdened by consistently high maternal and perinatal mortality rates. In a move to alleviate this burden the South African National Department of Health (DoH) instructed the adoption of the Basic Antenatal Care (BANC) approach in all antenatal care (ANC) facilities. Whereas many facilities have begun the implementation of the BANC approach, in the eThekwini district, not all of the facilities have been successful in doing so. The study was conducted in those eThekwini Municipality Primary Health Care (PHC) facilities that have been successful in order to identify the factors influencing their success in implementing BANC. Methods The facilities that had been successful in implementing BANC were identified, followed by a review of the past records of the patients who had completed their ANC and had given birth. This was done in order to establish whether the facilities that were said to be implementing BANC, were in fact, following BANC guidelines. The factors that influenced successful implementation of BANC were identified based on information obtained from the midwives who were working in the ANC facilities that were successfully implementing BANC. The sample size was comprised of 18 PHC facilities that were successfully implementing BANC from which a total of 59 midwives were used as the study participants. Results Several positive factors that influenced successful implementation of BANC were identified. These factors included; availability and accessibility of BANC services: Policies, Guidelines and Protocol; various means of communication; a comprehensive iii package of services and the integration of services; training and in-service education; human and material resources and the support and supervision offered to the midwives by the PHC supervisors. Other factors included BANC programme supervisors’ understanding of the programme and the levels of experience of midwives involved in implementation of BANC. There were, however, certain challenges and negative factors that were identified and these included: shortage of staff; lack of cooperation from referral hospitals; lack of in-service training; problems in transporting specimens to the laboratory; lack of material resources; lack of management support and the unavailability of BANC guidelines.

Obstructed labour contributes significantly to the morbidity and mortality among both mothers and babies in Ethiopia nationwide, and also in the West-Wollega region where this study was conducted. The researcher used a retrospective hospital based review of maternity files to quantify the problem of obstructed labour in the selected hospital. The findings revealed that maternal and perinatal mortality due to obstructed labour amounted to 1.4% and 7.5% respectively. Most of these complications could be prevented by proper antenatal care and careful attentive monitoring during delivery with proper use of the partogram which will indicate the occurrence of complications in good time when successful and life saving interventions are still available. The findings clearly show that poor documentation in general and very sporadic usage of the partogram in particular contributes significantly to the complications for mother and child. Re-introduction of proper documentation and careful use of the partogram are advocated / Health Studies / M.A. (Public Health)

United Nations has lately stated ambitious health targets for 2030 in the Sustainable Development Goal agenda, following the already achieved progress between 1990 and 2015 when the number of children dying before the age of five was reduced by more than half. However, the mortality reduction in the first month of life after birth has not kept the same pace. Furthermore, a large number of stillbirths have previously not been accounted for. The aim of this thesis was to evaluate the impact of clinical training in neonatal resuscitation, and to identify strategies for an effective implementation at a maternal health facility in Nepal. Focus group discussions were used to explore the perceptions of teamwork among staff working closest to the infant at the facility. A prospective cohort study with nested referents was applied to determine effect on birth outcomes after an intervention with Helping Babies Breathe, a simplified protocol for neonatal resuscitation. Sustainability of the acquired skills after training was addressed by employing a quality improvement cycle. Video recordings of health workers performance were collected to analyse adherence to protocol. Midwives described the need for universal protocols in neonatal resuscitation and management involvement in clinical audit and feedback. There was a reduction of intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and neonatal mortality within 24 hours of life (aOR 0.51, 95% CI 0.31–0.83) after the intervention. Ventilation of infants increased (OR 2.56, 95% CI 1.67–3.93) and potentially harmful suctioning was reduced (OR 0.13, 95% CI 0.09–0.17). Neonatal death from intrapartum-related complications was reduced and preterm infants survived additional days in the neonatal period after the intervention. Low birth weight was not found to be a predictor of deferred resuscitation in the studied context. This study confirmed the robustness of Helping Babies Breathe as an educational tool for training in neonatal resuscitation. Accompanied with a quality improvement cycle it reduced intrapartum stillbirth and mortality on the day of delivery in a low-income facility setting. Improved postnatal care is needed to maintain the gains in survival through the neonatal period. Increased management involvement in audit and quality of care could improve clinical performance among health workers.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)

O presente estudo tem como objetivo descrever a mortalidade perinatal em gestações trigemelares, e analisar os fatores preditores dos seguintes desfechos: número de crianças vivas no momento da alta hospitalar, nenhuma criança viva no momento da alta hospitalar (desfavorável) e pelo menos uma criança viva no momento da alta hospitalar (favorável). Realizado de forma retrospectiva, envolveu pacientes com gestações trigemelares que apresentavam três fetos vivos na primeira ultrassonografia realizada após 11 semanas, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), no período de 1998 a 2012. Foram incluídas 67 pacientes das quais 77,6% referiam concepção espontânea. Quanto à corionicidade, 49,2% eram tricoriônicas e 50,8% eram não tricoriônicas; 16,4% apresentavam antecedente clínico prévio à gestação e 49,2% eram nulíparas. Em relação às intercorrências, a incidência de complicações obstétricas e/ou clínicas na gestação foi de 52,2%, e de intercorrências fetais, 25,2%, dentre as quais: 13,4% mal formações, 7,5% sindrome da transfusão feto fetal (STFF), 5,9% óbito fetal (OF), 4,5% insuficiência placentária, 4,4% fetos unidos, 1,5% feto acárdico. A idade gestacional média do parto foi de 31,9 ± 3,1 semanas, dos quais 83,5% foram cesáreas. O peso médio dos recém-nascidos vivos de 1.683 ± 508 g. Em relação à discordância de peso ao nascer: 57% apresentaram até 20%, 23,2% entre 20 e 30% e 19,6% acima de 30%. A taxa de óbitos fetais foi de 31,7%o nascimentos (IC95%: 11,7 - 67,8) e a mortalidade perinatal 249%o nascimentos (IC95%: 189 - 317). O tempo médio de internação dos recém-nascidos, que foram de alta vivos, foi de 29,3 ± 24,7 dias. A predição dos desfechos foi investigada por meio de regressão logística \"stepwise\", e incluiu as seguintes variáveis: idade materna, paridade (nulípara ou um ou mais partos anteriores), antecedente clínico, idade gestacional do primeiro ultrassonografia no HCFMUSP, corionicidade (gestações tricoriônicas e gestações não tricoriônicas), presença de complicação obstétrica ou clínica durante a gestação, intercorrência fetal e idade gestacional do parto. O nível de significância estatística utilizado foi de 0,005. Foram fatores significativos para predição do número de crianças vivas no momento da alta hospitalar: presença de intercorrência fetal (OR 0,1, IC95%: 0,03 - 0,36; p < 0,001) e idade gestacional do parto (OR 1,55, IC95%: 1,31-1,85; p < 0,001). Para a predição dos desfechos favoráveis e desfavoráveis a idade gestacional do parto apresentou significância estatística (OR 1,84, IC95%: 1.26 - 2.7; p=0,002 e OR 0.54, IC 95%: 0.37-0.79; p=0.002, respectivamente) / The present study, involving triplet pregnancies, describes perinatal mortality and investigates predictors of the following outcomes: number of children alive, no child alive (unfavorable outcome) and at least one child alive (favorable outcome) at hospital discharge. It is a retrospective study involving triplet pregnancies with live fetuses at the first ultrasound scan, performed after 11 weeks of gestation, at the Department of Obstetrics and Gynecology, São Paulo University Medical School Hospital, between 1998 and 2012. Final sample included 67 women, 77.6% reported spontaneous conception. Regarding the chorionicity, 49.2% were trichorionic; 16.4% had a medical complication prior to pregnancy, and 49.2% were nulliparous. The incidence of obstetric and/or clinical complications during pregnancy was 52.2%, and fetal complications occurred in 25.2%, (13.4% of major fetal abnormalities, 7.5% twin-to-twin transfusion syndrome, 5.9% stillbirth, 4.5% placental insufficiency, 4.4% conjoined twins and 1.5% acardic twin). The average gestational age at delivery was 31.9 ± 3.1 weeks, and 83.5% were cesarean. The average birthweight was 1683 ± 508 g and birth weight discordance up to 20% occurred in 57% of the cases; 23,2% had 20 to 30% discordance and 19.6%, was greater than 30%. The rate of stillbirth was 31.7%o births (95%CI: 11.7 - 67.8) and the perinatal mortality was 249%o births (95%CI: 189 - 317). The average hospital stay was 29.3 ± 24.7 days amongst children that were discharged alive. Stepwise logistic regression analysis was used to investigate prediction according to: maternal age, parity (nuliparous/multiparous), prior clinical history, gestational age at the first ultrasound scan at HCFMUSP, pregnancy chorionicity (trichorionic/non trichorionic), occurrence of clinical and/or obstetric complications during pregnancy, occurrence of fetal complications and gestational age at delivery. Significance level was set at 0.05. The number of children alive at hospital discharge was correlated with the occurrence of fetal complications (OR 0,1, 95%IC: 0,03 - 0,36; p < 0,001) and gestational age at delivery (OR 1,55, IC95%: 1,31-1,85; p < 0,001). Whereas favorable and unfavorable outcome were associated with gestational age at delivery (OR 1.84, 95%CI: 1.26 - 2.7-; p=0,002 and OR 0.54, 95%CI: 0.37-0.79; p=0.002, respectively)

Introdução: Conquistar a integralidade, a mais complexa diretriz do SUS, se constitui um permanente desafio, visto que, ao contrário da universalidade do acesso e da descentralização, parece, ainda, distante de ser alcançada. Objetivo: Caracterizar óbitos perinatais ocorridos em residentes em Fortaleza, 2006, para compreender o potencial da integralidade da atenção no sistema local de saúde. Métodos: Foram utilizados métodos complementares de pesquisa - quantitativa e qualitativa. Na abordagem qualitativa realizaram-se entrevistas individuais às mães de crianças que sobreviveram ao período neonatal e mães que perderam seus conceptos no período perinatal. Estudo transversal que incluiu o universo dos óbitos perinatais, a partir de dados dos sistemas oficiais de informação sobre mortalidade e sobre nascidos vivos e do relacionamento de dados entre os mesmos, consubstanciou a pesquisa quantitativa. Resultados e Discussão: A taxa de mortalidade perinatal foi 17,0/1000 nascidos totais - 8,2 para óbitos fetais e 8,8 para neonatais precoces. As principais causas encontradas foram: asfixia (24por cento ) - 4 vezes maior entre natimortos; baixo peso ao nascer cuja mortalidade foi 30 vezes maior entre os 25por cento com menos de 2500g; prematuridade (32,4por cento ); malformações congênitas (9,5por cento ) e infecções (7,0por cento ) inclusive 03 casos de sífilis congênita. Fatores de risco potenciais, como idade da mãe de 10 -14 anos, mais freqüente entre óbitos neonatais precoces, e de 35 e mais anos entre os fetais. A mortalidade foi mais alta (98,0/1000 nascidos totais) entre filhos de mães com nenhuma escolaridade - risco potencial importante - cuja elevada freqüência foi também percebida nas entrevistas que, por sua vez, evidenciaram uma categoria acrescentada ao estudo: a relação médico-paciente, considerada falha e desatenciosa, na percepção das mães, quanto aos esclarecimentos sobre alto risco na gestação e no parto. Destacou-se, ainda, o sentimento das mães sobre a falta da visita domiciliar na gravidez e de acompanhante no parto. Conclusões e algumas considerações: A baixa escolaridade pareceu um critério de 9 evitabilidade mais apropriado para uso em países em desenvolvimento, como o Brasil, do que aqueles da classificação de Wigglesworth, inclusive de acesso mais complexo nestes países. Para gestantes com baixa ou nenhuma escolaridade, o sistema de saúde poderia ofertar atenção especial, fortalecendo atividades educativas, adotando a interconsulta especializada e acompanhante no parto / Introduction - To achieve the integrality (comprehensive health care), the more complex SUS guideline, is an ongoing challenge, because, unlike the universality of access and decentralization, it still seems very far. Objective - To characterize perinatal deaths occurred among residents in Fortaleza, 2006, in order to understand the potential of the integrality of the care in the health system. Methods - It was adopted both, quantitative and qualitative methodologies that are complementary one to another. In the qualitative approach, individual interviews were carried out to mothers of children who survived the neonatal period and mothers who lost their babies in the perinatal period. A cross-sectional study that included the universe of perinatal deaths, based on data from official systems of information on births and deaths and also using the relationship of data between them, embodied quantitative research. Results and discussion - The perinatal mortality rate was 17.0 / 1,000 births - 8.2 to 8.8 for stillbirths and early neonatal deaths, respectively. The main causes were: asphyxia (24per cent ) - four times higher among stillbirths; low birth weight whose mortality was 30 times higher among the 25per cent weighting less than 2500g; prematurity (32.4per cent ); congenital malformations (9.5per cent ) and infections (7.0per cent ) including three cases of congenital syphilis. Potential risk factors such as maternal age of 10 -14 years old, more frequent among early neonatal deaths, while the fetal deaths occurred more among mothers are 35 and more. Mortality was highest (98.0/1,000 births) among children of mothers with no education - important potential risk factor which high frequency was also seen among the interviewee that, in turn, added a new category to the study as doctor-patient relationship considered failure and disrespectful on the perception of mothers regarding the details of high risk in pregnancy and childbirth. Was highlighted, too, the feeling of mothers about the lack of home visit by community health work during pregnancy and, also, of companion at childbirth. Conclusion and considerations - The low 11 educational level seemed a criterion more suitable for use in developing countries like Brazil, to avoid perinatal deaths, than those of Wigglesworth\'s classification, which is more difficult to obtain in these countries. For pregnant women with low/no education, the health system could strength health educational activities, adopt specialized attention and companion at hospital