[Analysis of stillbirths in the Czech Republic in 1998]

To identify the reasons for stagnation of stillbirth rate in the Czech Republic and to evaluate possibilities how to avoid some cases of stillbirth.

Institute for the Care of Mother and Child, Prague 4.

Retrospective analysis of individual cases of stillbirth.

Retrospective analysis of all cases of stillbirth without congenital malformations in the Czech Republic during 1998 was performed by regional perinatologists according to unified guidelines. The analysis targeted the evaluation of perinatal management with respect to possible flaws in care and with respect to avoidability of stillbirth. We prepared a questionnaire to collect data with special attention to birthweight and type of the facility (level of care) where death occurred. The data collected were analyzed in the Institute for the Care of Mother and Child.

Out of 252 cases of stillbirth (contribution to total perinatal mortality of 2.8 per 1000) only 0.2 per 1000 were among multiple pregnancies; 0.13 per 1000 were deaths during labor. We found mistakes in the content of care among 40% of cases, problems in organization of care were in every second case of stillbirth, and combination of both was frequent. Every sixth case of death had insufficient prenatal care due to pregnant women. Probable avoidability was higher among foetuses with birthweight of 2000 grams and higher. Cases of mistakes in care and avoidability was higher in terrain (out of hospital) in absolute terms, however, related to number of cared population, the mistakes and avoidability were higher in hospitals. This is related to higher concentration of complicated pregnancies in these facilities.

Based on the final evaluation of possible avoidability of some cases of stillbirth we can conclude that even in the case of ultimate success of prenatal care the contribution of stillbirth to decrease of total perinatal mortality would not exceed 0.6 per 1000; the cost of such care would increase substantially.