Evolução da mortalidade perinatal na região sudeste no período de 2000 a 2020

Abstract

Introduction: Perinatal mortality represents the main priority for the reduction of infant mortality and its inequalities in Brazil. Objective: To analyze the trend in perinatal mortality rate of the largest municipalities of each state in the southeastern region and their capitals, from 2000 to 2020. Method: Ecological study, of historical series with quantitative approach involving three indicators, perinatal mortality and its components, fetal and early neonatal, and causes of antepartum perinatal deaths, prematurity and congenital anomalies according to the modified Wigglesworth classification. Prais-Winsten analysis was applied. The trend was classified as increasing, decreasing or stationary according to the regression coefficient of the annual percentage change (APC). Results: A decreasing trend in perinatal and early neonatal mortality was observed in all studied municipalities, with Cachoeiro do Itapemirim showing the highest reduction in both rates (-4.81% and -3.9%, respectively). In fetal mortality only three municipalities showed a decreasing trend, Cachoeiro do Itapemirim (-5.65%), Rio de Janeiro (-0.53%) and Campos dos Goytacazes (-1.97%), the others showed a stationary evolution. Comparing the evolution of these rates between the large cities and their respective capitals, Cachoeiro do Itapemirim and Campos dos Goytacazes showed a greater tendency to decrease than Vitória and Rio de Janeiro for perinatal and fetal mortality. Among the causes of perinatal deaths, antepartum was the first, followed by prematurity and congenital anomalies, in that order. The antepartum mortality rate increased in São Paulo (10.6%), decreased only in Cachoeiro de Itapemirim (-5.66%) and Campos dos Gytacazes (-1.42%) and was stationary in the other municipalities. Prematurity mortality was increasing in Cachoeiro do Itapemirim (3.22%), decreasing in Rio de Janeiro (-1.39%) and Campos dos Goytacazes (-2.19%) and stationary in the others. And finally, mortality from congenital anomalies was increasing in Belo Horizonte (1.85%) and Rio de Janeiro (3.98%), decreasing in Cachoeiro do Itapemirim (-2.75%) and stationary in the others. Conclusion: Although the decrease in rates of perinatal and early neonatal mortality was verified in all studied municipalities, the stationary evolution of the fetal component in more than half of the municipalities configures reason for investigation. And even though the numbers show that the international goal of reducing the fetal mortality rate (with the exception of Rio de Janeiro) has been reached before the established deadline, they are still high when compared to those of developed countries. And finally, the stability of antepartum causes in more than half of the studied municipalities indicate a reason for concern with the quality of care given to women during prenatal care. These results demonstrate the need to investigate the existence of vulnerable groups for the proper planning of policies in the maternal and child area, in order to eliminate preventable deaths and ensure the right to life for all Brazilian children.