Perinatal deaths in a Norwegian county 1986-96 classified by the Nordic-Baltic perinatal classification: Geographical contrasts as a basis for quality assessment

Background. Quality assessment of perinatal care can be carried out by clas sifying perinatal deaths. In the following we have analyzed the geographica l contrasts in perinatal deaths according to the Nordic-Baltic perinatal de ath classification in a sparsely populated Norwegian county. Material and methods. All stillbirths (greater than or equal to 28 weeks of gestation) and neonatal deaths (gestational age greater than or equal to 2 2 weeks; death less than or equal to 28 days) in 1986-96 from Nordland coun ty (240 000 inhabitants) were classified. For comparison the county was geo graphically divided into six general local hospital areas and one central h ospital area. Results. The classification showed a well acceptable inter and intra observ er variation. One hundred and seventy-one stillbirths and 155 neonatal deat hs were analyzed. The death rate (pr 1000 births) for single, non-malformed , antenatal stillbirths was higher in the central hospital area than in the local hospital areas (3.22 vs. 2.02). The death rate for extreme preterm i nfants (22-27 weeks of gestation) was on the other hand higher in the local hospital areas (2.45 vs. 1.05). One of the general local hospital areas wa s singled out with an especially high neonatal death rate among extreme pre term infants. This was to some extent explained by the death of extreme pre term twins and triplets. Conclusion. The Nordic-Baltic perinatal death classification system is a co nsistent and reproducible tool also for studying perinatal death in restric ted geographical areas. The observed contrasts in perinatal deaths were use d as basis for programs aimed at improving perinatal care. The observation of an unexplained increased number of antenatal stillbirths in the central hospital area resulted in a program for prospective recording and better ch aracterization of the placenta and umbilical cord. Proposals for a better a ntenatal program preventing extreme preterm birth of twins for the whole co unty has been launched. In utero transfer to a hospital with a neonatal int ensive care unit seems crucial in improving the prognosis for these infants .