Suboptimal care in stillbirths - a retrospective audit study

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 86; no. 4; pp. 444 - 450
• Main Authors: Saastad, Eli, Vangen, Siri, Frederik Frøen, J
• Format: Journal Article
• Language: English
• Published: Oxford, UK Informa UK Ltd 01.01.2007; Blackwell Publishing Ltd; Taylor & Francis
• Subjects: Adult; Biological and medical sciences; Communication; Communication Barriers; Ethnic Groups; Female; Fetal Growth Retardation - diagnosis; Fetal Growth Retardation - mortality; Gynecology. Andrology. Obstetrics; Humans; immigrants; Medical Audit; Medical sciences; Mothers - psychology; Multivariate Analysis; Norway - epidemiology; Obstetric Labor Complications - mortality; Odds Ratio; Perinatal audit; Perinatal Care - standards; Pregnancy; Prenatal Care - standards; Prenatal Diagnosis; Quality of Health Care; Retrospective Studies; Risk Factors; Self Care; Stillbirth - epidemiology; Stillbirth - ethnology; stillbirths; Norway; Stillborn; Immigrant; Perinatal audit; Gynecology; Perinatal; Obstetrics; Death in utero; Retrospective; Care; Audit; stillbirths; sub-optimal care; immigrants
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1080/00016340701207724

Background. Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub-optimal factors in stillbirths were more frequent among non-western than western women. Methods. Population-based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998-2003 (4.2 per 1,000 deliveries); of these 31% were born to non-western women. By audit, the stillbirths were attributed to optimal or sub-optimal care factors. Multivariate methods were used to analyse the data. Results. Sub-optimal factors were identified in 37% of the deaths. When compared to western women, non-western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3-3.8), and an increased risk of sub-optimal care (OR: 2.4; 95% CI: 1.5-3.9). More often, non-western women received sub-optimal obstetric care (p<0.001), as e.g. failure to act on non-reassuring fetal status or incorrect assessment of labour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non-western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non-western mothers; an interpreter was used in 29% of these cases. Conclusions. Non-western women constituted a risk group for sub-optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non-western women.