The reliability of perinatal mortality statistics in The Netherlands

All 13 hospitals in the municipality of Amsterdam cooperated in this study; labor ward records for the years 1981 and 1982 were personally searched for cases of perinatal death that corresponded with the World Health Organization definitions of perinatal mortality, presently applied in The Netherlands. The 360 cases that had apparently occurred in the Amsterdam hospitals were individually linked to the cases that had been entered into the national records at the Central Bureau of Statistics. The study established that the magnitude of underregistration of perinatal mortality is considerable (14.3%). Underregistration at the national level is due to underreporting by physicians and not due to errors in statistical bookkeeping. Underreporting is related to birth weight, that is, viability of the infant, and immigrant status of the mother. Recommendations are made to improve uniformity of notification criteria and reliability of perinatal mortality statistics.