Journal
ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA
Volume 86, Issue 4, Pages 444-450Publisher
WILEY
DOI: 10.1080/00016340701207724
Keywords
perinatal audit; stillbirths; immigrants; sub-optimal care
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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.
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