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. 2018 Sep 20;18(1):380.
doi: 10.1186/s12884-018-1973-0.

Perinatal death beyond 41 weeks pregnancy: an evaluation of causes and substandard care factors as identified in perinatal audit in the Netherlands

Joep C Kortekaas  1   2 , Anke C Scheuer  3 , Esteriek de Miranda  4 , Aimée E van Dijk  5 , Judit K J Keulen  4 , Aafke Bruinsma  4 , Ben W J Mol  6 , Frank P H A Vandenbussche  3 , Jeroen van Dillen  3
Affiliations

Perinatal death beyond 41 weeks pregnancy: an evaluation of causes and substandard care factors as identified in perinatal audit in the Netherlands

Joep C Kortekaas et al. BMC Pregnancy Childbirth. .

Abstract

Background: Late- and postterm pregnancy are associated with adverse perinatal outcomes, like perinatal death. We evaluated causes of death and substandard care factors (SSFs) in term and postterm perinatal death.

Methods: We used data from the Perinatal Audit Registry of the Netherlands (PARS). Women with a term perinatal death registered in PARS were stratified by gestational age into early-/full-term (37.0-40.6) and late-/postterm (≥41.0 weeks) death. Cause of death and SSFs ≥41 weeks were scored and classified by the local perinatal audit teams.

Results: During 2010-2012, 947/479,097 (0.21%) term deaths occurred, from which 707 cases (75%) were registered and could be used for analyses. Five hundred ninety-eight early-/full-term and 109 late-/postterm audited deaths were registered in the PARS database. Of all audited cases of perinatal death in the PARS database, 55.2% in the early-/fullterm group occurred antepartum compared to 42.2% in the late-/postterm group, while intrapartum death occurred in 7.2% in the early-/full-term group compared to 19.3% in the late-/postterm group in the audited cases from the PARS database. According to the local perinatal audit, the most relevant causes of perinatal death ≥41 weeks were antepartum asphyxia (7.3%), intrapartum asphyxia (9.2%), neonatal asphyxia (10.1%) and placental insufficiency (10.1%). In the group with perinatal death ≥41 weeks there was ≥1SSF identified in 68.8%. The most frequent SSFs concerned inadequate cardiotocography (CTG) evaluation and/or classification (10.1%), incomplete registration or documentation in medical files (4.6%) or inadequate action on decreased foetal movements (4.6%).

Conclusions: In the Netherlands Perinatal Audit Registry, stillbirth occurred relatively less often antepartum and more often intrapartum in pregnancies ≥41 weeks compared to pregnancies at 37.0-40.6 weeks in the audited cases from the PARS database. Foetal, intrapartum and neonatal asphyxia were identified more frequently as cause of death in pregnancies ≥41 weeks. The most identified SSFs related to death in pregnancies ≥41 weeks concerned inadequate CTG monitoring (evaluation, classification, registration or documentation) and inadequate action on decreased foetal movements.

Keywords: CTG; Delivery; Foetal monitoring; Late-term pregnancy; Mortality; Postterm pregnancy; Pregnancy; Stillbirth.

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Conflict of interest statement

Ethics approval and consent to participate

No ethical approval was needed according to the Dutch Central Committee of Human Research, because of the retrospective cohort study.

Consent for publication

Not applicable.

Competing interests

JvD is a member of the editorial board (associate editor) of the BMC Pregnancy and Childbirth. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of selection of cases of perinatal death ≥37 weeks between 2010 and 2012 Perinatal Registry Netherlands 2010–2012: all birth outcomes in pregnancies ≥22 weeks of gestation
Fig. 2
Fig. 2
Most relevant condition of death in 109 cases of perinatal death in late−/postterm pregnancy with an incidence of > 1%
See this image and copyright information in PMC

References

    1. Vayssiere C, Haumonte JB, Chantry A, Coatleven F, Debord MP, Gomez C, Le Ray C, Lopez E, Salomon LJ, Senat MV, et al. Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF) Eur J Obstet Gynecol Reprod Biol. 2013;169(1):10–16. doi: 10.1016/j.ejogrb.2013.01.026. - DOI - PubMed
    1. Zeitlin J, Blondel B, Alexander S, Breart G, Group P Variation in rates of postterm birth in Europe: reality or artefact? BJOG. 2007;114(9):1097–1103. doi: 10.1111/j.1471-0528.2007.01328.x. - DOI - PubMed
    1. Whitworth J. Data sharing: reaching consensus. Bull World Health Organ. 2010;88(6):467–468. doi: 10.2471/BLT.10.079202. - DOI - PMC - PubMed
    1. Carbonne B, Sentilhes L, Vayssiere C. Intra uterine growth retardation: guidelines for clinical practice--introduction. J Gynecol Obstet Biol Reprod (Paris) 2013;42(8):868–869. doi: 10.1016/j.jgyn.2013.09.010. - DOI - PubMed
    1. Roos N, Sahlin L, Ekman-Ordeberg G, Kieler H, Stephansson O. Maternal risk factors for postterm pregnancy and cesarean delivery following labor induction. Acta Obstet Gynecol Scand. 2010;89(8):1003–1010. doi: 10.3109/00016349.2010.500009. - DOI - PubMed