The birth survey in Germany--education and quality control in perinatology

Perinatal mortality in Germany fell during the past four decades from 5% in 1955 to 0.5-0.6% in 1992. This decrease was achieved by organisational health improvements: movement from home to hospital deliveries, mother protection law, guiding principles for prenatal care, pregnancy passport, regionalisation of high risk cases; and medical achievements: fetal monitoring before and during labor, ultrasound technics and neonatal intensive care units with neonatal monitoring, PEEP ventilation and surfactant application. This movement has been supported in the last decade by the implementation of a perinatal survey, starting in Munich, Bavaria in 1975 and distributed, since 1980, over all the states of Germany. The perinatal review is a birth data assessment on a voluntary basis, which provides the opportunity to compare the data with the mean of the participating hospitals. It is therefore an instrument for selfeducation and selfcontrol. It is also used for analysing long-term trends (i.e. caesarean section rate) and for estimating implemented obstetrical managements (i.e. corticosteroid treatment) on a large data pool. Perinatal reviews support the goal to keep the perinatal mortality low or even to achieve a further decrease.