AN EUROPEAN CONCERTED ACTION INVESTIGATING THE VALIDITY OF PERINATAL-MORTALITY AS AN OUTCOME INDICATOR FOR THE QUALITY OF ANTENATAL AND PERINATAL-CARE

In this paper the concepts, objectives, design, and data analysis proc edures of the EuroNatal study are described. This sutdy started in 199 6 and is a concerted action including 14 countries in Europe. The Euro Natal study aims at determining the validity of national perinatal mor tality rates as an outcome indicator for the quality of antenatal and perinatal care. It is based on a conceptual model describing the relat ionships between differences in quality of antenatal and perinatal car e, maternal and infant risk factors, variation in applied definitions, reliability of registration procedures and practices, and the outcome in terms of ''true'' and ''observed'' differences in perinatal mortal ity. In the first part of the study data is collected at national and aggregate level; in the second part data is collected retrospectively on individual cases of perinatal mortality in a regional sample area. Analysis of the individual cases of perinatal mortality will be by mea ns of a perinatal audit conducted by an international expert panel. Th e project builds upon the work done by the participants in their respe ctive countries. By applying common research protocols, international comparability of data collection will be enhanced and will help to cre ate a common body of knowledge in the area of perinatal epidemiology a nd perinatal care. Comparison between countries is likely to lead to n ew insights into the strenghts and weaknesses of antenatal and perinat al care systems of individual countries.