Assessment of potentially avoidable perinatal mortality in a regionalized program

To obtain data regarding factors that influence perinatal mortality, a comprehensive perinatal mortality review project was prospectively developed and implemented. The resulting data cover a 21-month period and include all perinatal mortality at two perinatal centers and ten community hospitals. For each case an assessment of potential avoidability was made using the following definition: if any factor was identified that might have altered the outcome, the case was judged potentially avoidable. All other mortality was classified as either unavoidable or undetermined (if sufficient data were not available). During the review period there were a total of 26,937 live births and 591 cases of perinatal mortality. We conclude that: (1) meaningful analysis of factors affecting perinatal mortality data can be obtained by review of all deaths using a standardized classification; (2) in 21% of perinatal mortality at least one potentially avoidable factor could be identified that might have altered the outcome, while 74% was unavoidable and 5% undetermined; and (3) implementation of the review process enabled the reviewers to recognize patterns of potentially avoidable perinatal deaths.