This project aims at determining the validity of national perinatal mortality rates as an outcome indicator for the quality of antenatal and perinatal care. The specific objectives are to determine to what extent the observed variation in perinatal mortality rates is due to (1) differences in registration procedures and practices, (2) differences in risk factors for perinatal mortality, and (3) the presence of avoidable factors in the provision of antenatal and perinatal care. In this study, an extended definition of perinatal mortality will be used, which includes still-births and first month (instead of first week only) deaths.
Objective #1. Differences in registration procedures and practices will be investigated by documenting all relevant aspects of these procedures and practices. The effect of these differences on the official perinatal mortality rates will be assessed by making a complete count according to harmonized criteria of all perinatal deaths in one representative region of all participating countries, and by comparing the official with this 'true' perinatal mortality rate.
Objective #2. Three different types of risk factors will be considered: background characteristics of the mother (e.g. socio-demographic variables), specific characteristics of the mother (e.g. health status), and specific characteristics of the child (e.g. birth weight). Information on these risk factors will be collected from available statistical data sources and from the regional sample also investigated for objective #1. The effect of international differences in risk factors on the perinatal mortality rates will be assessed by multivariate statistical analysis.
Objective #3. An international expert panel will draw up a list of criteria to be used for determining the presence of avoidable factors in the antenatal and perinatal care received by foetuses and infants who died in the perinatal period. For all perinatal deaths included in the regional sample also investigated for objective #1, detailed information on the care received will be collected from the clinical case-notes. The expert panel will judge each case to determine whether avoidable factors were present, and whether another course of action might have resulted in a better outcome. The results will be compared between countries in order to see whether there is any variation in the proportion of all perinatal deaths which could have been avoided under optimal conditions with regard to the quality of antenatal and perinatal care, and whether this variation explains (part of) the international variation in the over-all level of perinatal mortality.