Classification of perinatal and late neonatal deaths in Iceland. A survey from a defined population.

A retrospective case record analysis of all perinatal and late neonatal deaths in Iceland in the periods 1976-80 and 1981-85 was done and the causes of death classified according to the extended Aberdeen classification. There was a significant (p less than 0.0001) reduction in number of deaths between the two periods with perinatal mortality rates declining from 10.6/1000 in 1976-80 to 6.8/1000 in 1981-85. In 1976-80 there were 81 (33%) antepartum, 37 (15%) intrapartum and 128 (52%) neonatal deaths compared to 61 (38%) antepartum, 13 (8%) intrapartum and 86 (54%) neonatal deaths in 1981-85. Fetal abnormality was the most common cause of death in both periods followed by the category Low birthweight in 1976-80. In 1981-85 increased morphological detection of infection in infants of very low birthweight by placental examination and autopsies lead to a shift from the category Low birthweight to Maternal Disease, the second most common cause in that period. To achieve lower perinatal mortality rates efforts should be directed towards lowering antepartum losses near term and increasing survival of very low birthweight infants.

Can we expect to lower perinatal and neonatal mortality?

In a retrospective study of all perinatal and neonatal deaths in Iceland in 1976-85, the circumstances surrounding each death were carefully evaluated to assess the quality of care given and to identify cases of suboptimal care. In 1976-80, 87 or 35% of peri- and neonatal deaths were associated with suboptimal care and 46 or 29% of peri- and neonatal deaths in 1981-85. Most of the infants weighed more than 1500 g. Suboptimal care was most commonly seen in conjunction with antenatal care in both five-year periods, with a 25% (N.S.) reduction of cases in 1981-85. Suboptimal intrapartum care was significantly reduced (p less than 0.05) and there was a substantial reduction (62%), although not significant (0.1 greater than p greater than 0.05), of suboptimal neonatal care between the two periods. A few cases were attributable to maternal decisions taken against medical advice, most of them in the latter period. Perinatal care improved during the study period. The task of further lowering perinatal mortality rates depends on vigilance to abnormal findings in routine antenatal care.