THE ASSOCIATION BETWEEN SMALL-SIZE FOR GESTATIONAL-AGE AND PERINATAL AND NEONATAL DEATH IN A UK-REGIONAL-HEALTH-AUTHORITY

Confidential enquiry into stillbirth and death in infancy is a health service requirement in England, Wales and Northern Ireland. A confiden tial review of perinatal death has been conducted in South-East Thames Region since 1988. Data collected for this review are analysed here. Among the 1662 singleton deaths in the enquiry from 1988 to 1991, 530 (32%) babies were small for gestational age (SGA <10th centile): 338 o f these (64%) were <3rd centile and the remainder were between 3rd-l0t h centile. Small size for gestational age was significantly associated with a previous SGA baby (P = 0.02), proteinuric hypertension (P = 0. 001) and increased placental-birthweight ratio (P = 0.008). Only 135 ( 25%) SGA fetuses were identified antenatally and multiple logistic reg ression showed that antenatal detection was independently related to p roteinuric hypertension [odds ratio (OR) = 2.47, 95% confidence interv al (CI) 1.47-4.17, P = 0.001) and to being <3rd centile rather than 3r d-l0th centile (OR = 3.16, 95% CI 1.96-5.10, P = 0.001). Although conf idential enquiries have been criticised for a lack of objectivity the study indicates how data from such an enquiry can increase knowledge o f events influencing peri- and neonatal outcome allowing strategies to be devised to effect change.