Perinatal mortality in a tertiary obstetric institution.

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Public Health

Background:

• Analysis of 13,347 public patient records at Royal Women's Hospital, Melbourne (1987-1989).
• Identified an overall perinatal wastage rate of 20.8 per 1,000 births.
• High wastage attributed to nonbooked and emergency admissions with severe pregnancy complications.

Purpose of the Study:

• To analyze perinatal wastage patterns at a tertiary referral hospital.
• To compare these patterns with state-level data.
• To identify major causes of perinatal loss.

Main Methods:

• Retrospective analysis of hospital records.
• Comparison of data with Victorian state-level perinatal statistics.
• Categorization of perinatal losses by gestational age and cause.

Main Results:

• 74% of losses occurred before 33 weeks' gestation, contrasting with 47% statewide.
• Key causes: congenital abnormalities (19.1%), preterm labor/rupture (16.2%), multiple pregnancy (14.7%), antepartum hemorrhage (14.0%), hypertensive disorders (9.7%).
• Intrapartum stillbirths were 7.7% at the hospital vs. 27% statewide; stillborn infants >1500g were 36% vs. 55% statewide.

Conclusions:

• Perinatal wastage at the Royal Women's Hospital was significantly impacted by severe maternal complications and prematurity.
• Gestational age distribution of losses differed from state averages, with earlier losses predominating at the hospital.
• Hospital data highlights specific areas for intervention, particularly regarding intrapartum stillbirths and management of high-birth-weight stillborn infants.