Perinatal mortality rates: description of the last thirty years in a tertiary care hospital
Batllori Badia E, Villar Ruiz OP, González Villalaín C, Mejía Jiménez I, Montañez Quero MD, Vallejo Pérez P.
Gynecology and Obstetrics Service, Hospital Universitario “12 de Octubre”, Madrid, Spain
To describe perinatal mortality rates (PMR) at Hospital Universitario “12 de Octubre”, Madrid.
PMR are the best tool to monitor the quality of perinatal care. Perinatal deaths refer to a combination of fetal (FD) and neonatal deaths (ND), assuming common factors may be associated with them. There are several definitions used to describe perinatal death, which vary globally and are not always well defined. There is also a huge variability in registering FD worldwide. We have been recording our PMR since 1985, using the following definitions: Early PMR. FD >28 WG and ND 28 WG and ND ≤28 days of age. National PMR. FD >22 WG and ND 22 WG and ND ≤28 days of age.
The absolute number of perinatal deaths in our hospital oscillates between 36 and 60 cases per year since 1985. Perinatal mortality has decreased until 2000, remaining stable afterwards. This reduction may respond to the introduction of antenatal corticosteroid therapy for fetal maturation. Early PMR has been around 4 to 6 ‰ since 2000, being consistent with data of other developed countries. This stability is probably due to the increasing complexity of the patient (mother, fetus and newborn), which emerges as a new challenge despite health care improvements. The comparison between the rest of PMR becomes more difficult because there is no data available.
PMR is an important tool to monitor the quality of perinatal care, but it may not be useful to improve clinical assistance. Instead, it urges to find other quality markers. During the last 10 years, we have implemented new protocols based in management of conditions like preeclampsia and fetal growth restriction, treatment and prevention of prematurity, perinatal infections and chorioamnionitis. Learning from the impact of these new clinical approaches in a high-risk population groups, may translate real changes despite the stability of PMR.
Patient data has been collected from database used during patient consultations of our perinatal mortality outpatient clinic. This data is stored and only the main authors have the right to access to personal data to ensure subject safety. No personal data has been used to write this retrospective descriptive study, therefore no ethical approval (further than Heads of Service) has been required. The authors declare no conflict of interest.