Ethnic differences in perinatal mortality. A perinatal audit on the role of substandard care.
OBJECTIVE
The objective was to investigate the contribution of substandard care to ethnic inequalities in perinatal mortality.


METHODS
Perinatal audit in Amsterdam, the Netherlands. The study population consisted of 137 consecutive perinatal death cases (16 weeks GA-28 days after delivery). A standardized procedure to establish the cause of death and substandard care by perinatal audit was developed. The main outcome measures were perinatal mortality rates in ethnic groups, cause of death classified by extended Wigglesworth classification, presence of substandard care (unlikely to be, possibly or likely to be related to perinatal death), and component of care considered to be substandard.


RESULTS
In Surinamese and other non-Western mothers (mainly from Ghana) perinatal mortality, beyond 16 weeks' gestation, was statistically significantly higher than among native Dutch mothers. (4.01, 2.50, and 1.07%, respectively). In Surinamese and Moroccan mothers, we observed a higher rate of early preterm deliveries. The prevalence of substandard care differed statistically significantly among ethnic groups (p=0.034), with the highest prevalence among Surinamese mothers. These differences were especially apparent in the prevalence of (more) maternal substandard care factors among Surinamese and Moroccan mothers. These factors consisted of a later start date for antenatal care or a later notification by the caregiver about obstetrical problems (e.g. rupturing of membranes, decrease in foetal movements).


CONCLUSIONS
The higher perinatal mortality in Surinamese and other non-Western groups is mainly due to a higher rate of early preterm deliveries. No differences in care were observed among ethnic groups during labour and delivery. Among Surinamese mothers, however, the results indicate that substandard care with maternal involvement plays a role in explaining their higher perinatal mortality rates.
Alderliesten
Marianne E
ME
Academic Medical Center Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands. Marianne@alderliesten.com
Stronks
Karien
K
van Lith
Jan M M
JM
Smit
Bert J
BJ
van der Wal
Marcel F
MF
Bonsel
Gouke J
GJ
Bleker
Otto P
OP
D000328:Adult; D002423:Cause of Death; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D008485:Medical Audit; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*