European Journal of Obstetrics & Gynecology and Reproductive Biology
Ethnic differences in perinatal mortality: A perinatal audit on the role of substandard care
Introduction
In most European countries perinatal mortality is reported as being higher among ethnic minorities than among the native population, in registries as well as in specific studies [1], [2], [3], [4], [5]. The literature reports that several determinants of perinatal mortality, e.g. maternal age and obstetrical history, are related to ethnic background [3], [6], [7]. Though often put forward as a potential explanation [8] little is known about the systematic role of antenatal and perinatal care in explaining ethnic differences in perinatal mortality. Recently, a Swedish study suggested that substandard care was an important indicator for the higher perinatal mortality among East African women compared with native Swedish mothers [9]. This single observation requires confirmation and further elaboration. In addition, more insight should be obtained into the background of substandard care, (such as cause of death, duration of pregnancy) as this may indicate possible improvements that can be made.
The present study compares the perinatal death rates among ethnic groups living in the city of Amsterdam, the Netherlands, as indicator for perinatal care. We first studied differences in perinatal mortality among ethnic groups. This was followed by an audit procedure to specifically elicit the role of care inadequacies as causal factors, including the possible involvement of the mother.
Section snippets
Methods
We included all consecutive cases of perinatal mortality from 16 weeks’ gestation onwards until 28 days after delivery from February until October 1999.
Perinatal deaths were included from 16 weeks’ gestation since there is a known difference in the prevalence of very early preterm deliveries among ethnic groups [1].
Perinatal death is registered in the Dutch birth register from 16 weeks’ gestation onwards. The numbers of perinatal deaths are presented in Table 1, Table 2, Table 3, Table 4, Table
Results
During the study period, 137 consecutive cases of extended perinatal death were included (beyond 16 weeks’ gestation and including the first 4 weeks of life). A total of 6922 deliveries occurred during the study period in the city of Amsterdam [12].
Forty-two percent of the women were nulliparous. The median maternal age was 31, with no difference among ethnic groups. Only one mother was under 18 years of age. All but three deliveries occurred at the hospital under the supervision of the
Discussion
In line with previous studies, we observed a higher perinatal mortality rate among Surinamese women and women from other non-Western countries, with a similar trend among Turkish and Moroccan mothers. Among Moroccan mothers early preterm deliveries account for all excess perinatal mortality. In Surinamese mothers too, preterm delivery was a major cause of perinatal death. Despite thorough postmortem analysis, one-third of cases were unexplained antepartum foetal deaths.
Substandard care (all
Acknowledgements
We would like to thank D.J. Bekedam, P.J.E. Bindels, A.B. Dijkman, K.F. Heins, N. Jorna, J.C. Kaandorp, M. Knuist, J.H. Kok, D. Lesscher, G.L.M. Lips, S. Logtenberg, N. Menelik, J.A.M. van der Post, J.I. Puyenbroek, M.K. Sanders, L. van Toledo, A.J. van Veelen, G. van Waveren, M. Wieringa-de Waard, who participated in the Amsterdam perinatal audit.
Financial support for this study was granted by the Health Insurance Fund of the city of Amsterdam.
All researchers were independent of the
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