[Perinatal mortality in The Netherlands: an audit is now more necessary than ever]

In 1999, The Netherlands was found to have the highest perinatal mortality rate (11.4 per thousand), according to the WHO definition, in comparison with 14 other European countries. Many explanations were given, amounting essentially to a higher percentage of women with one or more risk factors (higher age at delivery, more non-western immigrants, and more multiple pregnancies). Furthermore, screening for congenital anomalies was not yet an issue at that time in The Netherlands. Finally, Dutch obstetricians and paediatricians have a restrictive policy regarding the treatment of newborns with a very poor prognosis. There are, however, also doubts about the quality of the delivered perinatal care. In an audit feasibility study in 2004 in a representative part of The Netherlands, it was found that in 9% of the cases of perinatal mortality, substandard care was (very) probably related to the mortality. In The Netherlands, a nationwide perinatal audit programme will start this year. The Netherlands, with its specific obstetric care system, has the obligation to look for the causes of perinatal mortality and to introduce improvements based on the results of a perinatal audit. Hasty conclusions are a threat to a careful audit.