Antenatal, neonatal and post neonatal deaths evaluated by medical audit - A population-based study in northern Norway - 1976 to 1997

Background. Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. Subjects and methods. Antenatal, neonatal and post neonatal deaths (n=472) at greater than or equal to 20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. Results. The death rate tall deaths per thousand total births) declined from 13.8 (1976-80) to 7.7 (1992-97), (p<0.001), due to a reduced death rate in preterms <greater than or equal to>24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5%, of deaths, 2.3 parts per thousand of total births), avoidable deaths (13.1% of deaths, 1.3 parts per thousand of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6 parts per thousand of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SCA new borns declined, and the level of education increased in the study population. Conclusion. The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rare of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers.