Ethnic differences in perinatal mortality: A perinatal audit on the role of substandard care

Alderliesten, Marianne E.; Stronks, Karien; van Lith, Jan M.M.; Smit, Bert J.; van der Wal, Marcel F.; Bonsel, Gouke J.; Bleker, Otto P.

doi:10.1016/j.ejogrb.2007.08.022

« Previous Next »European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 138, Issue 2 , Pages 164-170, June 2008

Ethnic differences in perinatal mortality:

A perinatal audit on the role of substandard care

Marianne E. Alderliesten
- Academic Medical Center Amsterdam, Department of Obstetrics and Gynecology, P.B. 22660, 1100 DD Amsterdam, The Netherlands
- Corresponding author. Tel.: +31 20 5663557/6820955; fax: +31 20 6963489.
Karien Stronks
- Department of Social Medicine, P.B. 22660, 1100 DD Amsterdam, The Netherlands
Jan M.M. van Lith
- Academic Medical Center Amsterdam, Department of Obstetrics and Gynecology, P.B. 22660, 1100 DD Amsterdam, The Netherlands
Bert J. Smit
- Erasmus MC—Sophia Children's Hospital, University Medical Center Rotterdam, Department of Neonatology, P.B. 2200, 1000 CE Amsterdam, The Netherlands
Marcel F. van der Wal
- Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands, Municipal Health Service Amsterdam, P.B. 2200, 1000 CE Amsterdam, The Netherlands
Gouke J. Bonsel
- Academic Medical Center Amsterdam, Department of Obstetrics and Gynecology, P.B. 22660, 1100 DD Amsterdam, The Netherlands
- Department of Social Medicine, P.B. 22660, 1100 DD Amsterdam, The Netherlands
Otto P. Bleker
- Academic Medical Center Amsterdam, Department of Obstetrics and Gynecology, P.B. 22660, 1100 DD Amsterdam, The Netherlands

Received 17 July 2005; received in revised form 23 May 2007; accepted 10 August 2007. published online 10 October 2007.

Abstract

Objectives

The objective was to investigate the contribution of substandard care to ethnic inequalities in perinatal mortality.

Study design

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.

Keywords: Ethnicity, Perinatal mortality, Perinatal audit, Substandard care