Perinatale sterfte in Nederland gedurende 2000-2006; risicofactoren en risicoselectie

OBJECTIVE: To gain insight in recent perinatal mortality figures in The Netherlands and their relation with important risk factors, risk groups and risk selection among pregnant women. DESIGN: Retrospective cohort study. METHOD: The National Obstetrical Registrations and the National Neonatal Registration were linked into The Netherlands Perinatal Registry to prevent double counting. From this database, data on 1.3 million births in the years 2000-2006 were analysed with perinatal mortality as outcome measure. RESULTS: In 2006, perinatal mortality was 9.8 per 1000 total births (foetal mortality 6.8 per 1000 births and early neonatal mortality 3.1 per 1000 live births). Maternal age ( <20 and > or = 40 years) and high multiparity (> or = 4) were risk factors for perinatal mortality but showed low prevalence ( <3%). Non-Western ethnicity and nulliparity were important risk factors (relative risk of both 1.4) with a prevalence of 16% and 46%, respectively. The very preterm births (22.0-25.6 weeks of gestation) provided 29% ofall perinatal mortality with a mortality risk of 935 per 1000 births. Full-term births (> or = 37.0 weeks) accounted for 26% of all perinatal mortality with a mortality risk of 2.8 per 1000 births. In the full-term born group, perinatal mortality was 0.4 per 1000 births in home births, 2.7 per 1000 births in outpatient clinics and 4.5 per 1000 births when the women were referred to the gynaecologist before start of labour. CONCLUSION: At a population level, low or high maternal age and high parity are less important risk factors than expected. More detailed research is indicated into the mortality ofvery preterm births but also offull-term born children