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), data were collected in the ’s Hertogenbosch region. A perinatal audit group investigated and classified the cause of death in an “intention to treat” and concensus model. We then analyzed who was responsible for the patient at the moment perinatal death occurred, or became inevitable. Results: Out of 8509 newborns, 73 died between the 24th week of pregnancy till the 7th day post-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 of 4 (25.00%) were judged as probably or possibly avoidable. The degree of concensus 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 perinatal mortality was avoidable in the three levels of care. Intra-uterine growth retardation, congenital malformations and antepartum haemorrhage were the most determinant factors for perinatal mortality. The Dutch obstetrical care system as such, for example home deliveries, did not effect the perinatal mortality rate. Perinatal mortality rates presented by the Dutch Central Bureau of Statistics still shows a slight underregistration.