Are deaths due to prematurity avoidable in developing countries?

Our aim was to assess the potential for reducing the perinatal mortality rate (PNMR) related to spontaneous preterm delivery. Data from 44 Perinatal Problem Identification Program sentinel sites around South Africa were used. In each perinatal death the primary cause as well as missed opportunities and substandard care were discussed and allocated. 3045 perinatal deaths in 78,343 births of > or = 1000 g were analysed. There were 518 perinatal deaths (17%) whose primary obstetric cause of death was due to spontaneous preterm labour (PNMR 7.48/1000 births). The most common avoidable factors were delay in seeking help during labour (14.7%), lack of neonatal facilities (10.0%), lack of transport (7.3%) and inappropriate response to the presence of premature rupture membranes (4.6%). Few perinatal deaths could be ascribed to poor antenatal or intrapartum management of spontaneous preterm labour. The vast majority of spontaneous preterm births could not be prevented within the health institutions. Prevention of deaths due to prematurity outside of metropolitan areas will rely on the neonatal care being adapted to reduced resources.