IMPACT OF INDUCED ABORTIONS AND STATISTICAL DEFINITIONS ON PERINATAL-MORTALITY FIGURES

Two problems originating from the advanced use of medical technology i n screening for malformations and in the care of preterm and low birth weight infants are presented: the impact of the increasing number of i nduced medical abortions and the differences in statistical definition s on perinatal mortality (PNM) figures. Data on 186562 births register ed in the Finnish Medical Birth Registry between 1987 and 1989 were st udied, and 65554 medical abortions (of which 1647 were performed after the sixteenth week of gestation) registered in the Abortion Registry between 1985 and 1990. A 115% increase in abortions for medical reason s in the period 1985-1990 was found. It was estimated that the trend a ccounted for up to one-third of the decline in PNM rate during that ti me. The perinatal mortality rate was strongly influenced by very small infants. The application of the Finnish version of the International Classification of Diseases, Ninth Revision (ICD-9) (including all live births and using both birthweight of 500g and gestational age of 22 we eks as the criteria) resulted in PNM rates which were about 5% higher than according to ICD-9. We suggest that the impact of medical abortio ns on perinatal statistics has reduced the value of the perinatal mort ality rate as an indicator of the standard of care.