Producing valid statistics when legislation, culture, and medical practices differ for births at or before the threshold of survival: Report of a European workshop
journal contributionposted on 2020-03-20, 12:21 authored by LK Smith, B Blondel, J Zeitlin, Gerald Haidinger, Sophie Alexander, Rumyana Kolarova, Urelija Rodin, Theopisti Kyprianou, Petr Velebil, Laust Mortensen, Luule Sakkeus, Mika Gissler, Beatrice Blondel, Guenther Heller, Nicholas Lack, Aris Antsaklis, Istvan Berbik, Helga Sol Olafsdottir, Sheelagh Bonham, Marina Cuttini, Janis Misins, Jelena Isakova, Yolande Wagener, Miriam Gatt, Jan Nijhuis, Kari Klungsoyr, Katarzyna Szamotulska, Henrique Barros, Mihai Horga, Jan Cap, Natasa Tul, Francisco Bolumar, Karin Gottvall, Karin Kallen, Sylvan Berrut, Melanie Riggenbach, Alison Macfarlane, Jennifer Zeitlin, Marie Delnord, Melanie Durox, Ashna Hindori-Mohangoo
Perinatal mortality is a major population health indicator
conveying important signals about the state of maternity
care and measures of the current and future health of
mothers and newborns. International comparisons are used
to encourage countries to improve their perinatal health
and health systems. However, extensive evidence highlights
methodological challenges to ensuring valid and robust
comparisons, as a lack of standardised criteria can lead to
bias and inappropriate inferences.
One major issue is the wide international variation in the criteria for classiﬁcation and registration of deaths as a stillbirth or neonatal death at the threshold of survival.
Standard practice is to minimise this problem by using a gestational age cut-off of 24 or even 28 weeks for mortality rate calculations. However, this strategy excludes a signiﬁcant number of stillbirths, at least one in ﬁve deaths before 24 weeks of gestation and over one in three deaths before 28 weeks.
As the gestational age limit for initiation of neonatal care decreases, exclusion of these stillbirths limits the full evaluation of
care provision and outcomes at early gestational ages. Fur-
ther, it underestimates the burden of loss on parents’ men-
tal and physical health.
The Euro‐Peristat project currently receives funding from the European Commission as part of the InfAct (Information for Action) Joint Action (Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) Grant no. 801553).
CitationBJOG: An International Journal of Obstetrics and Gynaecology, February 2020, 127, 3, pp. 314-318
Author affiliationDepartment of Health Sciences
- AM (Accepted Manuscript)