Cause-specific stillbirth and neonatal death in Sweden: a catchment area-based analysis

A register-based study of the impact of obstetric and neonatal care on stil lbirth and neonatal death rate was performed on all births in Sweden in 198 3-1995. Each birth was assigned to a primary delivery hospital where the mo ther with a term singleton pregnancy was most likely to have been delivered (not possible for 25% of the deliveries), and the catchment areas of each hospital were classified according to the level of care of that hospital. O nly small differences in total mortality existed between the different leve ls of care of the primary hospital: areas served by primary hospitals with obstetric service and resources for neonatal intensive care including conti nuous positive airway pressure but without facilities for ventilator treatm ent for prolonged periods showed a 7% excess risk of stillbirth or neonatal death. Conclusion: In areas with the lowest level of care of the primary delivery hospitals (with no or only basic neonatal care) the total mortality was not increased, indicating that the referral system works well. When the analys is was repeated for specific causes of death, more marked differences were noted, especially for death due to obstetric complications where the death risk increased with decreasing level of care of the primary delivery hospit al, Even though no marked differences in total mortality were seen, a furth er reduction can be obtained by increasing referral for some specific condi tions.