OBJECTIVE: To establish the distribution of perinatal mortality over the various levels of obstetrical care, taking into account the various causes of perinatal mortality. DESIGN: Prospective, descriptive. METHODS: Data were collected on all parturitions of @entity1 living in the region Delft-Westland-Oostland (DWO), the Netherlands, during the period 1983-1992, regardless of the ultimate setting of the parturition. A prospective regional registration system for perinatal mortality in the region was matched with the registration by the Central Statistics Office (CBS). With anonymous linking, duplicatures could be excluded. The causes of @entity204 were assessed by a gynaecologist, a paediatrician and a @entity1 pathologist. It was determined for all cases of perinatal mortality whether the antenatal care had been under the final responsibility of a midwife or a general practitioner (primary care), either at home or in the outpatient clinic, or under the final responsibility of a gynaecologist (secondary care). RESULTS: In the decade studied, 28,983 @entity1 were born in the DWO region; 51% under primary care management. The actual perinatal mortality of the region was calculated as amounting to at least 247 cases (0.85%). In 26% (n = 64) of these, the childbirth was managed under primary care responsibility, in 43% (n = 106) after risk selection from primary to secondary care, in 14% (n = 34) under the exclusive responsibility of secondary care and in 17% (n = 43) after risk selection from secondary to tertiary care. The most frequent causes of @entity204 were progressive @entity2431 and lethal @entity154 . CONCLUSIONS: The results show that further decrease of perinatal mortality may be achieved by risk selection (in primary care) with regard to lethal @entity154 and acute or progressive @entity5028 . The perinatal mortality is so low (0.85%) that further medicalization of childbirth may be expected to contribute only little to a further decrease of the perinatal mortality figures.

[Perinatal mortality in Delft and surrounds, 1983-1992: further reduction is possible by targeting lethal XXXX and @entity2431 ].

@entity1 :: ('9606', 'Species') :: ['women', 'children', 'child'] @entity154 :: ('MESH:D000013', 'Disease') :: ['congenital anomalies'] @entity5028 :: ('MESH:D010922', 'Disease') :: ['placental abnormalities'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity2431 :: ('MESH:D010927', 'Disease') :: ['placental insufficiency']
@entity154 :: (MESH:D000013,Disease) :: ['congenital abnormalities']
