BackgroundEthnic disparities in perinatal mortality are well known. This study aimed to explore the contribution of demographic, socioeconomic, health behavioural and pre-existent medical risk factors among different ethnic groups on fetal and early neonatal mortality.MethodsWe assessed perinatal mortality from 24.0 weeks' gestation onwards in 554 234 singleton pregnancies of nulliparous women in the linked Netherlands Perinatal Registry over the period 2000–2006. Logistic regression modelling was used.ResultsConsiderable ethnic differences in perinatal mortality exist especially in fetal mortality. Maternal age, socioeconomic status and pre-existent diseases could not explain these ethnic differences. Late booking visit could explain some differences. Compared with the Dutch, African women had an increased fetal mortality risk of OR 1.7 (95% CI 1.4 to 2.1); South Asian women, 1.8 (1.4 to 2.3); other non-Western women, 1.3 (1.1 to 1.6) and Turkish/Moroccan women, 1.3 (1.1 to 1.4). The risk on early neonatal mortality was only increased in other non-Western women, OR 1.3 (1.0 to 1.8). Ethnic differences were even present in the women without risk factors including preterm births. Mortality risk for East Asian and other Western women was lower or comparable with the Dutch.ConclusionImportant ethnic differences in fetal mortality exist, especially among women of African and South Asian origin. Ethnic minorities should be more acquainted with the significance of early start of prenatal care. Tailored prenatal care for women with African and South Asian origin seems necessary. More research on underlying cause of deaths is needed by ethnic group.

Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care.Design Population-based cohort study from 2000 up to and including 2006.Setting The Netherlands Perinatal Registry.Population A total of 751 926 singleton term hospital births. MethodsWe assessed the impact of travel time by car, calculated from the postal code of the woman's residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used.Main outcome measures Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit). ResultsThe mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time ( ‡20 minutes) and total mortality (OR 1.17, 95% CI 1.002-1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13-2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17-1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81-2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29-1.80) increased the risk of mortality.Conclusions A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care.

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands Ravelli, A. C. J.; Jager, K. J.; de Groot, Marieke; Erwich, Jan Jaap H. M.; Rijninks-van Driel, G. C.; Tromp, M.; Eskes, M.; Abu-Hanna, A.; Mol, B. W. J. Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. ABSTRACTThe outcome for babies delivered after 34 weeks' gestation is generally good, but deliveries at extreme prematurity between 24 and 32 weeks are at high risk of complications. Previous studies investigating risk factors predictive for premature delivery have demonstrated a clear association between ultrasonographic cervical length and preterm delivery. Another possible preterm delivery predictive risk factor is the concentration of cervical interleukin-6 (IL-6). Through increased production of prostaglandins, this cytokine seems to be involved in events leading to cervical ripening and uterine contractions.This observational prospective study was designed to investigate cervical IL-6 presence and concentrations for preterm delivery, alone and in association with cervical length as a predictive diagnostic test for preterm delivery in high-risk symptomatic women. The study subjects were 100 women between 24 and 34 weeks of gestation with intact membranes but threatened preterm labor who had been admitted to a hospital in Spain from 2006 to 2008. Cervical fluid was analyzed with transvaginal scan to determine cervical length, and a cervical swab was taken for detection of IL-6. Statistical tests performed included 2 test, Cox and logistic regression, receiver operating characteristic curve analysis, and Kaplan-Meier survival analysis.Preterm delivery occurred in 35% of the babies born before 37 weeks and in 5% before 32 weeks. Cervical length was Ͻ15 mm in 12% and Ͻ30 mm in 62% of the subjects. Receiver operating characteristic curve analysis showed that an IL-6 value Ͼ210 pg/mL and a cervical length Ͻ30 mm were useful predictors of preterm delivery within 48 hours, within 7 days, and at Ͻ32, Ͻ34, and Ͻ37 weeks; there was no difference between the predictive accuracy of IL-6 and cervical length. Their additive predictive value was greater than either alone.These findings suggest that cervical IL-6 and cervical length are predictive risk factors for preterm delivery in symptomatic women at high risk and that when combined, the predictive accuracy of both is better than each test alone. EDITORIAL COMMENT(Preterm birth is a maj...

Summary. Background: It is has been suggested that dialysis patients have lower mortality rates for pulmonary embolism than the general population, because of platelet dysfunction and bleeding tendency. However, there is limited information whether dialysis is indeed associated with a decreased mortality risk from pulmonary embolism. Objective: The aim of our study was to evaluate whether mortality rate ratios for pulmonary embolism were lower than for myocardial infarction and stroke in dialysis patients compared with the general population. Methods: Cardiovascular causes of death for 130 439 incident dialysis patients registered in the ERA-EDTA Registry were compared with the cardiovascular causes of death for the European general population. Results: The age-and sex-standardized mortality rate (SMR) from pulmonary embolism was 12.2 (95% CI 10.2-14.6) times higher in dialysis patients than in the general population. The SMRs in dialysis patients compared with the general population were 11.0 (95% CI 10.6-11.4) for myocardial infarction, 8.4 (95% CI 8.0-8.8) for stroke, and 8.3 (95% CI 8.0-8.5) for other cardiovascular diseases. In dialysis patients, primary kidney disease due to diabetes was associated with an increased mortality risk due to pulmonary embolism (HR 1.9; 95% CI 1.0-3.8), myocardial infarction (HR 4.1; 95% CI 3.4-4.9), stroke (HR 3.5; 95% CI 2.8-4.4), and other cardiovascular causes of death (HR 3.4; 95% CI 2.9-3.9) compared with patients with polycystic kidney disease. Conclusions: Dialysis patients were found to have an unexpected highly increased mortality rate for pulmonary embolism and increased mortality rates for myocardial infarction and stroke.