[Great regional differences in quality of obstetrical care]

In Sweden antenatal care is free of charge, easily available and utilized by practically all pregnant women. The obstetrical care is of high quality and perinatal mortality among the lowest in the world. However, there is a potential for improvement, as evidenced by the regional differences in quality of care shown in this study. Five quality indicators of antenatal and delivery care 1998-2002 are presented for all the counties in Sweden: still birth rate, smoking habits in early pregnancy, Apgar score at five minutes, neonatal mortality, and severe perineal tear. The results were adjusted for several maternal background factors as well as for pregnancy duration. In some counties the frequency of still birth, neonatal mortality, and low Apgar score at five minutes, were two to three times higher compared to the counties with the best outcome. Differences regarding severe perineal tear and smoking during early pregnancy were also evident.