Perinatal Mortality Rates: Holland Versus The Hunter Valley
Authors: Lawson Gerald W. 
Published: February 2008

EDITORIAL COMMENT: This paper highlights the problem of the different definitions used for stillbirth and neonatal death in different countries and unfortunately in different Australian States. It must be emphasised that there are differences between the legal definitions which determine when a live or stillbirth must be registered, and the definitions used for statistical collections. For example, in Victoria, a stillbirth must be registered as such if the pregnancy has been of more than 20 weeks' duration and the infant does not, after being born, show any signs of life. If the period of gestation is not known, the determining factor is a birth‐weight of 400 g. Any child regardless of maturity or birth‐weight which breathes or shows any other signs of life after being born must be registered as a livebirth (and, if it subsequently dies within 28 days, as a neonatal death). These are legal definitions and the figures collected and published by the Australian Bureau of Statistics are compiled from these registered births after exclusion of those cases where the infant weighed less than 500 g at birth or 22 weeks' gestation when birth‐weight was unknown in accordance with the WHO definitions (see below). Legal definitions are unlikely to be changed so that it is imperative for academic purposes that presentation of perinatal mortality statistics use birth‐weight as the main criterion for inclusion — period of gestation is a more unreliable yardstick than birth‐weight. It is recommended that the WHO definitions be used for statistical purposes. These are: Neonatal death is a death occurring within 28 days of birth in an infant whose birth‐weight was at least 500 g or if the weight is not known, an infant born after at least 22 weeks' gestation. Stillbirth is a deadborn infant weighing at least 500 g or if the weight is not known, born after at least 22 weeks' gestation. Perinatal mortality rate is the number of perinatal deaths (neonatal plus stillbirths) per 1,000 births, live and still. Ultimately, agreement will probably be reached and all centres will report perinatal results according to weight of the infant at birth; fetuses weighing less than 500 g (or 22 weeks' gestation when birth‐weight is unknown) will be classified as cases of abortion.

The legal definitions of neonatal death and to a lesser extent stillbirth, which has a birth‐weight criterion when the period of gestation is unknown, are most unsatisfactory for academic purposes and for administrative purposes in midwifery hospitals; if strictly observed, many abortuses weighing 200–300 g or even less, who move slightly after birth or have a transient heart beat recorded, would be registered as neonatal deaths, and tiny fetuses in cases of missed abortion delivered after 20 weeks' gestation would also be included. Use of a birth‐weight criterion would do away with the need to exercise judgement in such cases and facilitate comparison of results from different centres. It would also make it possible for midwifery staff to obey the Law of the Land as well as the dictates of commonsense. The Editorial Board of this Journal strongly recommends the use of the WHO criteria for neonatal death, stillbirth and perinatal mortality rate in all publications.

Summary: A public comment to the effect that Holland has a superior perinatal mortality rate to that in Australia prompted an analysis of this proposition. In the region of Newcastle and The Hunter Valley of New South Wales, detailed information on perinatal mortality over a 5‐year period (1983–1987) was available. The data suggest that the perinatal mortality rate in this region is, in fact, superior to that in Holland. The definition of perinatal mortality differs greatly between the 2 countries; and this fact, perhaps unappreciated, might lead to the superficial perception that Holland's perinatal mortality rate is superior to our own.