title: Suboptimal care in stillbirths - a retrospective audit study.
abstract: BACKGROUND
  Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub-optimal factors in stillbirths were more frequent among non-western than western women.
  
  
  METHODS
  Population-based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998-2003 (4.2 per 1,000 deliveries); of these 31% were born to non-western women. By audit, the stillbirths were attributed to optimal or sub-optimal care factors. Multivariate methods were used to analyse the data.
  
  
  RESULTS
  Sub-optimal factors were identified in 37% of the deaths. When compared to western women, non-western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3-3.8), and an increased risk of sub-optimal care (OR: 2.4; 95% CI: 1.5-3.9). More often, non-western women received sub-optimal obstetric care (p<0.001), as e.g. failure to act on non-reassuring fetal status or incorrect assessment of labour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non-western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non-western mothers; an interpreter was used in 29% of these cases.
  
  
  CONCLUSIONS
  Non-western women constituted a risk group for sub-optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non-western women.
authors.affiliation: Ulleval University Hospital, Oslo, Norway. eli.saastad@hiak.no
authors.forename: Eli
authors.initials: E
authors.lastname: Saastad
authors.forename: Siri
authors.initials: S
authors.lastname: Vangen
authors.forename: J Frederik
authors.initials: JF
authors.lastname: Frøen
mesh_terms: D000328:Adult; D003142:Communication; D003144:Communication Barriers; D005006:Ethnicity; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008485:Medical Audit; D009035:Mothers / Q000523:psychology*; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000401:mortality; D016017:Odds Ratio; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D011296:Prenatal Diagnosis; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care; D050497:Stillbirth / Q000453:epidemiology* / Q000208:ethnology*