Audit of perinatal deaths in a tertiary level hospital in Latvia (1995-1999) using the Nordic-Baltic perinatal death classification: evidence of suboptimal care.
OBJECTIVE
The objective of this study was to explore applicability of the Nordic-Baltic perinatal death (PND) classification in a single hospital via evaluation of changes of the preventability of PND over the time period in a tertiary level perinatal care center in Latvia.


METHODS
All PND cases during the period 1995-1999 at a tertiary referral perinatal care center, the Riga Maternity Hospital (RMH), were analyzed using the common Nordic-Baltic PND classification.


RESULTS
The total perinatal mortality rate (PNMR) did not decline at the RMH over the study period. The rate of antenatal and intrapartum deaths at <28 weeks of gestation increased (p < 0.01). Early neonatal deaths at 28-33 weeks of gestation with a low 5-minute Apgar score became less frequent (p < 0.05). There was a trend towards more cases of probably suboptimal care (p < 0.005) and the proportion of preventable PND cases increased from 14.7% in 1995 to 36.4% in 1999 (p = 0.01).


CONCLUSIONS
The perinatal audit performed at the RMH using the Nordic-Baltic PND classification disclosed a requirement for further improvement of perinatal care in the hospital. The classification can be used to evaluate the preventability of perinatal death cases in a single hospital, and its application in other hospitals in Latvia could provide information necessary for the improvement of perinatal care in the country.
Jansone
M
M
Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia. m.jansone@stradini.lv
Lazdane
G
G
D001034:Apgar Score; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000401:mortality; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006771:Hospitals, Maternity / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007844:Latvia / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D047928:Premature Birth / Q000401:mortality; D050497:Stillbirth / Q000453:epidemiology*