Perinatal audit on avoidable mortality in a Dutch rural region: a retrospective study

Objective: To analyse the mode and cause of perinatal mortality. Setting: a rural Dutch region. Study design: Over a two-year period ;(1994-1995), dat a were collected in the 's Hertogenbosch region. A perinatal audit group in vestigated and classified the cause of death in an "intention to treat" and concensus model. We then analyzed who was responsible for the patient at t he moment perinatal death occurred, or became inevitable. Results: Out of 8 509 newborns, 73 died between the 24th week of pregnancy till the 7th day p ost-partum (8.58 promille). Twenty-three cases (31.50%) were classified as probably or possibly avoidable. In the primary health care group (midwives, general practitioners) 6 out of 32 (18.75%), in the secondary care group ( obstetricians) 15 out of 35 (44.86%) and in the tertiary care group 1 out o f 4 (25.00%) were judged as probably or possibly avoidable. The degree of c oncensus in the perinatal audit committee was high (Kappa=0.9). Impact: The analysis of perinatal mortality identifies the cause of death and may help to improve perinatal health care. Conclusion: In this study, 31.55% of per inatal mortality was avoidable in the three levels of care. Intra-uterine g rowth retardation, congenital malformations and antepartum haemorrhage were the most determinant factors for perinatal mortality. The Dutch obstetrica l care system as such, for example home deliveries, did not effect the peri natal mortality rate. Perinatal mortality rates presented by the Dutch Cent ral Bureau of Statistics still shows a slight underregistration. (C) 2000 E lsevier Science Ireland Ltd. All rights reserved.