Perinatal mortality in preterm births: an analysis of causes, presence of substandard care and avoiding mortality in three Dutch regions.

OBJECTIVE

To analyze the causes and underlying events in cases of perinatal mortality (PNM) in preterm children.

SETTING

Three regions within the Netherlands.

STUDY

DESIGN

For this study, we combined data of a PNM audit over a 1-year (2003-2004) with the corresponding data of its source population (n=22,189). In the perinatal audit, all cases of perinatal death have been assessed by multi disciplinary teams of professionals in perinatal care in a consensus model for cause of death and the presence of substandard care factors (SSF). In this article, we restricted our analysis to children born between 22+0 and 37+0 weeks of pregnancy (≥154 and <259 days). We also evaluated avoidability of preterm birth and avoidability of preterm perinatal mortality (PPM) in cases with and without SSF.

RESULTS

Of 1885 preterm children, 166 died perinatally (8.81%). The two most important determinants were small-for-gestational-age;ib47.6% of all cases with gestational age (GA) ≥25 weeks;ic and previous PNM (21.1%). In addition, PPM was substantially increased in mothers of non-Dutch origin (PPM 12.1% vs. 6.6% in children of Dutch mothers relative risk (RR)=1.88, 95% confidence interval=1.46-2.43) and in mothers in the age group 20-26 years (PPM 13.4% vs. <9% in all other categories, RR=1.69, 95% confidence interval=1.21-2.38). In 22.6% of the cases perinatal death was considered to be avoidable while in 17.0% perinatal death was related to SSF by caregivers.

CONCLUSIONS

Immediate and appropriate actions by both caregivers and care receivers in case of early signals of possible preterm labor may reduce PNM in this category in the Netherlands by more than 20%. Improvement in surveillance of fetal growth may reduce mortality significantly in the preterm gestational period.