NTOG 2012 06

06 Nederlands tijdschrift voor Obstetrie & Gynaecologie vol. 125, augustus 2012
Abstract
Differences in perinatal mortality between perinatal
health care regions
Objective To study if living in one of the nine perinatal
health care regions has an effect on perinatal
mortality in total and among very preterm, latepreterm
and term births.
Method
The study is based on 1,526,416 singleton births
from 25.0 until 43.0 weeks of gestation without
congenital anomalies as recorded in the national
registry from 1999 until 2008. A health care region
was defined by zip code of the inhabitants.
Perinatal mortality defined as foetal and neonatal
mortality during the first week of life. With logistic
regression analysis the effect of health care region
on perinatal mortality is calculated with adjustment
for casemix factors and travel time to the
hospital.
Results
The mean perinatal mortality rate was 5.4 per
1000 births (‰), and varied between 4.7 and
5.9‰. Among very preterm births (25.0-31.6
weeks) the mortality was 220‰ (range 180-244),
among late preterm births (32.0-36.6 weeks)
the mortality was 25.6‰ (range 20.9-28.2) and
among term births (37.0-42.6 weeks) 2.6‰ (range
2.2-2.9). For the total population in health care region
D (corrected odds ratio (aOR) 1.1; 95% CI 1.05-
1.2), region C (aOR 1.1; 95%CI 1.05-1.2) and region
A (aOR 1.1; 95%CI 1.01-1.2) the perinatal mortality
increased.
The perinatal mortality among the very preterm
borns in region D (aOR 1.4; 95%CI 1.1-1.6), region
C (aOR 1.2; 95%CI 1.05-1.6) and region G (aOR 1.3;
95% CI 1.1-1.5) was increased. Among late preterm
and term birth no differences was seen in health
care regions.
Conclusion
Differences in perinatal mortality by health care region
and especially among the very preterm births
are present.
Keywords
Perinatal care, perinatal mortality, quality of care,
health care regions.
Auteurs
Dr. Anita C.J. Ravelli, epidemioloog
Dr. Martine Eskes, gynaecoloog n.p.,
Prof dr. Ameen Abu-Hanna, medisch informaticus
AMC Amsterdam, afd. Klinische Informatiekunde
Prof. dr. Joris A.M. van der Post, gynaecoloog/perinatoloog,
Prof. dr. Ben Wilem J. Mol, gynaecoloog,
AMC Amsterdam, afd. Obstetrie en Gynaecologie
Dr. Jan Jaap H.M. Erwich*, gynaecoloog-perinatoloog,
UMC Groningen, afd. Obstetrie en Gynaecologie.
Dr. H.A.A. Brouwers, neonatoloog, UMC Utrecht,
divisie Vrouw en Baby
F.G.M. (Erna) Kerkhof, MSc, verloskundige, Verloskundige
praktijk Het Verloskundig Huys, Zwolle
HOPC= Hoofden (overleg) Perinatale Centra
*Neoned = Neonatologen hoofden afdelingen neonatologie
perinatologische centra, Rotterdam, Amsterdam
AMC, Amsterdam VU, Zwolle, Utrecht,
Groningen, Maastricht, Nijmegen, Veldhoven, Leiden.
Belangenverstrengeling
Er is geen melding gemaakt van belangenverstrengeling
of van financiële ondersteuning.
Contactpersoon
Dr. A.C.J. Ravelli
e a.c.ravelli@amc.uva.nl.
AMC, afdeling Klinische Informatiekunde,
Postbus 22660, 1100 DE Amsterdam
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