The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review

Robert L. Goldenberg, Sarah Saleem, Shivaprasad S. Goudar, Janet Moore, Gowdar Guruprasad, Vardendra Kulkarni, Sangappa M. Dhaded, Shiyam Sunder Tikmani, Sidrah Nausheen, Shazia Masheer, Mangala G. Kallapur, Najia K. Ghanchi, Sheetal U. Harakuni, Imran Ahmed, Kay Hwang, S. Yogeshkumar, Manjunath S. Somannavar, Haleema Yasmin, Jean Kim, Carla M. BannRobert M. Silver, Elizabeth M. McClure

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre-eclampsia, placental abruption and a small-for-gestational-age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.

Original languageEnglish
Pages (from-to)26-35
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue numberS3
Publication statusPublished - Nov 2023


  • India
  • PURPOSe study
  • Pakistan
  • cause of death
  • preterm neonatal death
  • stillbirth


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