Abstract
To investigate developments in perinatal care, all fetal and neonatal deaths among those born after at least 24 weeks of gestation at the University Hospital of Tromsø, Norway from 1976 to 1989, were subjected to medical audit. A decrease in total mortality rate was found when based on maturity (≥24 weeks; 19.9–13.4%; p<0.01), and/or birth weight (≥500 g; 19.2–13.4%; p<0.05). This was mainly due to a decrease in fetal deaths (14.8–6.6%; p<0.0001). Deaths during labor (5.4–1.1%; p<0.001), and deaths before the onset of labour (9.4–5.5%; p<0.05) declined. The neonatal death rate remained virtually constant (5.2–6.8%). The incidence of conditions affecting the placenta and the umbilical cord, causing asphyxia and intra-uterine growth retardation, declined, from 9.2 to 5.0% (p<0.01), as did that caused by immaturity (2.8–1.3%; p<0.05). The rates of death caused by cerebral hemorrhage, respiratory distress syndrome, infections, and malformations did not change. There was no significant proportional change in the causes of death from the first to the last period. The rate of fetal death following suboptimal care declined (2.4–0.4%; p<0.01), while the corresponding neonatal death rate remained unchanged (0.9–1.1%). The proportions of both fetal and neonatal deaths occurring after suboptimal care were low (fetal: 16.2, 8.8, and 5.6%; neonatal: 17.1, 23.5, and 16.2%). These differences did not reach statistical significance. The ratio of neonatal to fetal deaths increased from the first (26.1%) to the last period (50.7%; p<0.01), due mainly to a significant shift from fetal to neonatal death among those weighing 500–999 g (19.6–56.0%; p<0.01). It is concluded that prophylactic efforts to avoid preterm birth and IUGR, and further therapeutic efforts in neonatal intensive care are needed to bring down mortality rates at our hospital in the future.