A new method to examine very low birth weight fetal and hebdomadal mortality in a regionalized system of perinatal care.
OBJECTIVE
Aggressive maternal transport of very low birth weight (VLBW) live births from community hospitals to regional perinatal centers may artificially increase community fetal death rates. By allocating maternal transports according to the location of antepartum and intrapartum care and separately computing antepartum and intrapartum fetal mortality rates, a more appropriate measure of hospital-based mortality may be determined.


METHODS
Delivery charts were reviewed for 568 VLBW deliveries (including 97 fetal deaths and 77 hebdomadal deaths) occurring between 1990 and 1992 in a geographically defined perinatal region. Maternal transports were analyzed with community hospitals for antepartum mortality rates and with the regional center for intrapartum mortality rates.


RESULTS
Using traditional methods, the fetal mortality rates for community hospitals and the regional center were antepartum 385.1 vs. 45.2, respectively, and intrapartum 120.9 vs. 24.9, respectively. When regional center live births (maternal transports) are placed with community hospitals for analysis of antepartum mortality, the new antepartum mortality rates were 185.7 vs. 72.8, respectively. The hebdomadal mortality rate for community hospitals was 250.0 as compared to 145.8 for the regional center.


CONCLUSIONS
Maternal transports to a regional center represent successful antepartum management by community care providers. Even though they delivered in the regional center, they should be analyzed with community hospitals for antepartum fetal mortality comparisons. Therefore, antepartum and intrapartum fetal mortality should be examined separately in a functioning regionalized perinatal care program where the location of patient care differs from location of delivery.
Hulsey
T C
TC
Division of Pediatric Epidemiology, Medical University of South Carolina, Charleston 29425, USA.
McComb
T F
TF
Ebeling
M
M
Geddes
K
K
Kuenneth
C A
CA
Johnson
D
D
Alexander
G R
GR
Pittard
W B
WB
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D005313:Fetal Death; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D016017:Odds Ratio; D010360:Patient Transfer; D018743:Perinatal Care; D011247:Pregnancy; D020379:Risk Adjustment / Q000379:methods*; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology