title: Why babies die in unplanned out-of-institution births: an enquiry into perinatal deaths in Norway 1999-2013.
abstract: BACKGROUND
  The aims were to describe causes of death associated with unplanned out-of-institution births, and to study whether they could be prevented.
  
  
  METHODS
  Retrospective population-based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out-of-institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions.
  
  
  RESULTS
  63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub-optimal care, involving 25 cases (40%), most commonly due to sub-optimal maternal use of available care (n = 14, 22%).
  
  
  CONCLUSIONS
  Infections, neonatal, and placental causes accounted for almost two-thirds of perinatal mortality associated with unplanned out-of-institution births in Norway. Sub-optimal maternal use of available care was found in more than one-fifth of cases.
authors.affiliation: Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway.|Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Björn
authors.initials: B
authors.lastname: Gunnarsson
authors.affiliation: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Anesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Sigurd
authors.initials: S
authors.lastname: Fasting
authors.affiliation: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Anesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Eirik
authors.initials: E
authors.lastname: Skogvoll
authors.affiliation: Institute of Health Science Research, University of Akureyri, Akureyri, Iceland.|Department of Obstetrics and Gynecology, Akureyri Hospital, Akureyri, Iceland.
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smárason
authors.affiliation: Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Kjell Å
authors.initials: KÅ
authors.lastname: Salvesen
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D005865:Gestational Age; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality*; D011295:Prenatal Care; D012042:Registries; D055815:Young Adult
keywords: Medical Birth Registry of Norway; Norwegian Institute of Public Health; Out-of-institution births; causes of death and associated conditions; perinatal mortality