A Perinatal Audit of Stillbirths in Three Danish Counties

Abstract

All stillbirths in 1985 and 1986 in three Danish counties were assessed in a perinatal audit. The aim was to investigate if departure from generally accepted standards of satisfactory perinatal care might have contributed to stillbirths, and also to investigate if differences in the structure of antenatal care and the delivery systems might have any influence on the rate of stillbirths. 119 cases were evaluated, 70 were classified as unavoidable deaths, in 48 cases a different treatment might have improved the infant's possibility of survival and in one case consensus was not reached. The most frequent cause of suboptimal care was inadequate antenatal care of obvious signs of intrauterine growth retardation. Directives for visitation between surgical and obstetric departments were essential to the rate of stillbirth. The results indicate that it might be possible to achieve a further decrease in the number of stillbirths by intensifying the postgraduate training of the professionals and by issueing guidelines for the sharing of care responsibilities.

Keywords

Perinatal audit stillbirths.

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References

1. Births in the Nordic Countries. Registration of outcome of pregnancy 1979–1983. Nomesko Reykjavik 1987.

2. The Medical Birth Register 1983, Number 1: 15: 1985. National Board of Health in Denmark.

3. The Medical Birth Register 1985, Number 1: 20: 1987. National Board of Health in Denmark.

4. The Medical Birth Register 1986, Number 1: 23: 1988. National Board of Health in Danmark.

5. Guidelines for antenatal care and delivery system service. National Board of Health in Denmark 1976.

6. Cole SK , Hey EN , Thomson AM . Classifying perinatal death: an obstetric approach. Br J Obstet Gynaecol 1986; 93: 1204–12.

7. Donabedian A . Evaluating the quality of medical care. Science 1978; 200: 856–64.

8. Andersen KV, Hermann N. Reliability in Medical audit. Forwarded to Scand J Soc Med.

9. Kamper J , Lenstrup C , eds. Perinatal Service in Denmark. Danish Society of Gynecology and Obstetrics and Danish Society of Pediatrics, 1988.

10.

10. Perinatal audit in Norway 1980. Norwegian Institute of Hospital Research. NIS-rapport 7/82.

11.

11. Mersey Region Working Party on Perinatal Mortality Confidential inquiry into perinatal deaths in the Mersey region. Lancet 1987; i: 491–4.

12.

12. Antenatal care in Denmark. Training, supervison and postgraduate education of the professionals. Kristensen FB, Andersen KV, Andersen AMN, Nielsen HK, Knudsen VW, Hermann N. Ugeskr Læg 1989; 151: 3408–11.

13.

13. Bakketeig LS, Hoffman H, Sternthal P. Obstetric service and perinatal mortality in Norway. Acta Obstet Gynecol 1978; suppl. 77: 3–19.

14.

14. Kristensen FB . Weight and cause specific perinatal mortality in low risk hospital births in Denmark 1983–85. XI Nordic Congress of Perinatal medicine. Reykjavik, Iceland, June 1987.

15.

15. Augensen K , Bergsjöe P , Eikeland T , Askvik K , Carlsen J . Randomized comparison of early versus late induction of labor in post-term pregnancy. Br Med J 1987; 294: 1192–5.