‘Normal but dead’: perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

Abstract

Summary. The case notes relating to 75 of the 91 perinatal deaths of nonmalformed babies of birthweight ≥2.5 kg born in the Northern Region in 1983 were examined. The major groups involved antepartum deaths of unknown cause (40%), and deaths due to intrapartum anoxia or trauma (35%). A case‐control study compared each of the 75 cases with two controls matched for place of birth, obtained by taking the next two babies born in the same maternity unit (excluding perinatal deaths, birthweight <2.5 kg, and malformations). Four factors were found to be significantly associated with risk of perinatal death in this group: primigravidity, parity ≥3, not booked for antenatal care by 20 weeks, and corrected birthweight <3.2 kg (adjusted for gestation). Two further factors were related only to the risk of perinatal death consequent upon intrapartum events: labour post‐term and malpresentation in labour. All four factors relevant to the whole group remained independently associated with risk of perinatal death after multivariate analysis by two techniques. Adjusted odds ratios (95% CI) were estimated as: primigravidity 2.1 (1.1 to 4.1); parity three or more 5.7 (1.9 to 17); not booked for antenatal care by 20 weeks 15.7 (3.0 to 81); and corrected birthweight <3.25 kg 2.5 (1.3 to 4.6). An avoidable factor, as defined, was detected in 50% of deaths. In 30% of deaths there was an avoidable factor (grade 2) such that absence may have been expected to lead to a different outcome had all other factors remained equal. Of the avoidable factors detected, 61% related to intrapartum management, as did 76% of the grade 2 factors. Most of these involved failure to respond to evidence of fetal distress in labour. The defined group constituted 21% of all perinatal deaths, suggesting that this is an important category, particularly as their potential for normal survival should otherwise have been high.

Substandard factors in perinatal care in The Netherlands: a regional audit of perinatal deaths

“…Percentages of perinatal deaths with substandard care factors range from 14% to 30% (13)(14)(15)(16). Percentages of perinatal deaths with substandard care factors range from 14% to 30% (13)(14)(15)(16).…”

Substandard factors in perinatal care in The Netherlands:

“…International comparison of audit results is complicated because of the diversity in study populations, the definition of perinatal mortality, the number of cases in the study, and the case‐finding procedure. Percentages of perinatal deaths with substandard care factors range from 14% to 30% (13–16). In the European study a standardized comparison of substandard factors in cases of perinatal death in eight countries has been made.…”

Computerised measurement of fetal heart rate variation in a case of fetomaternal haemorrhage

“…Fetomaternal transfusion causes about 3% of fetal deaths (Kirkup & Welch 1990) and about 14% of otherwise unexplained deaths (Laube & Schauberger 1982). The proportion of pregnancies in which fetomaternal transfusion causes fetal death is about 0.04% (Laube & Schauberger 1982).…”