Lessons to be learnt from a perinatal audit.

Abstract

OBJECTIVE: to analyse all perinatal deaths at National Women's Hospital, Auckland, in a two year period, in order to identify areas in which changes could be made to improve the outcome for future pregnancies. METHODS: an audit was performed of all perinatal deaths at National Women's Hospital, Auckland, in 1989 and 1990. All deaths were classified according to the primary obstetric factor which initiated the sequence of events leading to the death. The events surrounding each death were examined for the presence of avoidable factors. RESULTS: there were 293 deaths after 20 weeks gestation, which included 172 fetal deaths, 116 neonatal deaths and five infant deaths. Fetal abnormality (24%) was the commonest cause of death followed by spontaneous prematurity (19%) and infection (11%). Fifty-one percent of the multigravid women who suffered a perinatal loss of a normally formed fetus had had a poor obstetric history. Avoidable factors were detected in 25% of all deaths. CONCLUSIONS: this audit clearly identified the causes of perinatal loss where improvements can be made. Advances in medical knowledge, technology and/or expertise are required to improve the outcome for the common causes of perinatal loss--fetal abnormality, prematurity and infection. Further staff and patient education with application of current knowledge and close attention to accepted standards of care should improve the outcome for the growth retarded fetus and the asphyxiated fetus in labour.