CONTRIBUTION OF CONGENITAL-MALFORMATIONS TO PERINATAL-MORTALITY - A 10-YEAR PROSPECTIVE REGIONAL STUDY IN THE NETHERLANDS

Objective: To determine the precise contribution of congenital malform ations to perinatal mortality in a region. Design: Prospective, descri ptive. Setting: Region, Delft-Westland-Oostland (DWO) in the Netherlan ds. Material and methods: The registration was based on data concernin g all deliveries of women domiciled in the health region DWO of the Ne therlands. The incidence and contribution of congenital malformations to perinatal death was evaluated by a team consisting of a gynaecologi st, a paediatrician and a paediatric pathologist. Malformations were c lassified as lethal or nonlethal and recorded separately for stillbirt h (from 28 weeks gestation) and liveborn infants with 7-day follow-up. Results: In 10 years (1993-1992) 28 983 children were born in the reg ion DWO. The perinatal mortality was calculated as 247 cases (0.85%). The overall incidence of congenital malformations in the perinatal dea th-group was 33%. Lethal congenital malformations were found in 51% of the cases in the stillbirth-group and 70% of the cases in the neonata l death-group. Congenital malformations of the central nervous system are mostly lethal in the stillbirth-group (45%). Cardiovascular- and p ulmonary-defects were more prominent in the neonatal period (27% and 3 3% respectively of the neonatal deaths). Uro-genital and minor malform ations (miscellaneous) are more often seen in perinatal deaths without being a contributor to the cause of death. Conclusions: As most conge nital malformations are multifactorial in origin, it is in the underst anding and control of such conditions that efforts and resources shoul d now be turned. Through a detailed postmortem fetal and placental exa mination and clinical-pathological correlations lethal congenital malf ormations were found in 51% in stillbirths (mainly central nervous sys tem) and 70% in neonates (mainly cardiovascular and pulmonary defects) . (C) 1998 Elsevier Science Ireland Ltd.