The high-risk perinatal registry. A systematic approach for reducing perinatal mortality.

A systematic and comprehensive review of all 320 perinatal deaths occurring in Nassau County in 1973 reveals that one-quarter of these deaths might have been prevented if modalities of care that were known and available at that time had been utilized appropriately. Preventability--the presence or absence of avoidable factors which might have materially lessened the risk of death --was determined for each perinatal death. Preventable deaths were disproportionately higher among postmature (P less than .01) and large-for-gestational-age (P less than .05) perinatal deaths, neonatal deaths after the first day of life (P less than .05), intrapartum fetal deaths (P less than .01), and perinatal deaths secondary to anoxia and idiopathic respiratory distress syndrome (P less than .01). The study concludes that rigorous application of currently available medical knowledge, the establishment of local perinatal mortality review committees, and vigorous outreach to practitioners are urgently needed to bridge the time gap between the development of new modalities of care and their application.