Lately, I’ve looked into various terms regarding mortality — macabre, I know, but it doesn’t seem so much like it, when using more sterile terms like “mortality” instead of “death.”
“Fetal demise” is the loss of a fetus at any stage, and includes fetal deaths that occur prior to “the complete expulsion or extraction of the products of conception from the mother.” (See what I mean about using “sterile terms”?) It can be early (prior to 20 weeks), intermediate (20-27 weeks), or late (28 weeks and up). It includes miscarriages, stillbirths and intrapartum deaths, but does not include induced abortions. However, the requirement to report fetal deaths varies by state, and also by country.
Then there’s “miscarriage” which is generally agreed to be a fetal loss up to about 20 weeks; however, sometimes the term “late miscarriage” can refer to fetal loss after that time. Typically, “early stillbirth” is used for deaths after 20 weeks. But the definition of terms can change — my next-door neighbor had a “miscarriage” about 25 years ago when she was 7 months along. It would now be called a stillbirth.
Perinatal mortality also has a wide and varying definition — it can include fetal losses as early as 20 weeks, although it typically refers to fetal loss from 22 weeks onward, up to 7 days postpartum. But not always. Some countries don’t start counting until 24 weeks, and many countries (especially the “developing” and “less developed” countries) may not even really count it at all, whether because the woman didn’t seek prenatal care and therefore didn’t report the early stillbirth, or because the baby’s death was intentionally ignored by the government, to make statistics look better.
Neonatal mortality is the death of a baby from the point of live birth to 7 completed days of life (early neonatal period) or 28 days of life (late neonatal period). So, it overlaps with “perinatal” mortality, but does not include any stillbirths or intrapartum deaths.
Infant mortality is the death of a baby from the point of live birth up through the end of the first year, regardless of reason. The cause of death can be as varied as “shaken baby” syndrome, SIDS, influenza, car wrecks, or roadside bombs.
Problems arise when trying to compare and contrast different countries’ rates of fetal or infant demise because of numerous factors. Typically, when I think of what “infant mortality” or “neonatal mortality” means, I think of it as being a reflection on the state of health care in our country. And it is… sort of. There are many factors involved in these statistics, though, that may affect how our country appears to stand, in relation to other countries.
More on that in a future post.