STILLBIRTHS COMPARABLE definitions and vital Vital Registration ... - PDF document

STILLBIRTHS COMPARABLE definitions and vital Vital Registration .. mortality figures both developing the attention and demographers survey undertaken previously published sarily reflect Technical Papers, Are Live Comparable All Over used indicators Very often over time expect, given many advantages health and mortality indicators, The Social and Regional conducted under the Institut Louvain, Belgium) ��2 3 &#x/MCI; 1 ;&#x/MCI; 1 ;declared: stillbirths (or late foetal deaths), livebirths Century, various were made in order registration systems in the declaration practices (Nations Unies, United Nations (Nations Unies, and the small number the data publication procedures. Recommendations were life. When mainly postneonatal, and the not cause United Nations in the early days (Nations Unies, neonatal care for Europe Study Group facto viability European countries countries according neonatal care survey they Obstetrical practice changed accordingly, and the participating countries utero exerts and figures overall incidence their results minimum requested two more for being been suggested (Working and in reflect adequately perinatal care more on care and neonatal factors declaration practices presumubly rising, especially mortality indicators maternity wards viability concepts ��4 &#x/MCI; 0 ;&#x/MCI; 0 ;other researches those findings, was designed European National perinatal and early neonatal mortality The existence registration systems, who specialized infant health making use every country, in order infant health survey questionnaire tables to participating countries to compare. The use purposes find "Observations Made Upon statistics at an principal topic International Causes Institute and, The search Nations suggested recommendations for births and The key-questions birth and stillborn infant? The answers, though varying time, refer vital signs losses or Committee for for defining European countries, countries made use criterion, whilst the absence insufficient and Special Committee viability criterion minimum gestation criteria was suggestions were International Statistical Institute in different definition where viability of 28 length crown-heel, the latter being preferred restricted again criterion to gestation duration gestational age to distinguish between "late" ��6 7 &#x/MCI; 1 ;&#x/MCI; 1 ;loss. Information on foetal deaths should be collected in such same Sub-committee, : * :i international perinatal correspondences between were futed (gestation duration) national perinatal mortality being applied foetal losses; international comparisons,standardized perinatal mortality statistics perinatal, neonatal birthweight criterion give however ......detailed rules regarding ;; ;; ; ; ; ;;;; ;+ +define explicitely neonatal, neonatal, perinatal ICD-9 only When suggesting puzzling problems in their legal criteria tendency towards definitions for situation still ��8 9 &#x/MCI; 1 ;&#x/MCI; 1 ;,-&#x/MCI; 2 ;&#x/MCI; 2 ;Although a majority of countries (20 out of the 27 participatingcountries) make use restrict vitality to explicitely defined additional viability newborn's weight minimum life (ex-Czechoslovakia, Poland) restricted to foetal deaths according to for being additional viability gestation, or corresponding weight also required. i i j j iI register foetal preference given duration instead : : :x::. :::: coqespondence between j j f f j j a limited vital registration parents want firkt observation and changes in legal usual infant comparability over time and ��11 &#x/BBo;&#xx [4;� 54; 75; 57;] /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x /At;&#xtach;í [;&#x/Top;&#x] 00;&#x/BBo;&#xx [4;� 54; 75; 57;] /;&#xType;&#x /Pa;&#xgina;&#xtion;&#x /At;&#xtach;í [;&#x/Top;&#x] 00;10 &#x/MCI; 1 ;&#x/MCI; 1 ;When Portugal proceeded in 1955 from a registration every foetal stillbirth rates recent shift did not might have observes a sudden upward first day infant important underestimation early neonatal mortality being recent upward the last (with a in the were considered was used a Stillbirth perinatal statistics adopted all a birthweight ��12 13 &#x/MCI; 0 ;&#x/MCI; 0 ;Fig.3: Ftnland 1036-1988.Finlande 1936-1988 &#x/MCI; 1 ;&#x/MCI; 1 ;b &#x/MCI; 2 ;&#x/MCI; 2 ;"T &#x/MCI; 3 ;&#x/MCI; 3 ;+L, &#x/MCI; 4 ;&#x/MCI; 4 ;Besides their historical interest, similar implemented since do not recommendations (Table The Netherlands, child having gestation duration early neonatal Estonia. Concerning livebitthe, Latvia seven complete gestation indicated The influence mortality figures immediate, and and important (Lithuanian Health Idormation a live ��-- &#x/Att;¬he; [/;&#xTop ;&#x]/BB;&#xox [;H 5;D 7;Y 5;S ];&#x/Typ; /H;&#xr 00;&#x/Att;¬he; [/;&#xTop ;&#x]/BB;&#xox [;H 5;D 7;Y 5;S ];&#x/Typ; /H;&#xr 00;14 15 &#x/MCI; 0 ;&#x/MCI; 0 ;Fig. 4: Lithuania 1980-1991. Lithuanie 1980-1991 &#x/MCI; 1 ;&#x/MCI; 1 ;2. &#x/MCI; 2 ;&#x/MCI; 2 ;Administrative limitations processing methods, including publication Delays for and deaths across countries such registration (mainly home 8 1 I I I I I I i i I I I I I I I I I I I I I I ��16 &#x/MCI; 0 ;&#x/MCI; 0 ;mother to do the birth registration by herself: this was the case for Belgium delay changed long delays may bring about early neonatal and death countries where Northern Ireland be done Compulsory notification registered and hence may (France, Hungary, (Belgium, Luxemburg, Sweden), which seldom exceed may differ two ways: actually registered minimum legal escape for even when legal point well known: stillbirths or early neonatal some cases, estimated survival stillbirth instead evaluate without depth surveys, clues may 4' control compliance control may and advantages parents or simple suppression condition for control forms. If control may refuse registration children dying registration). The National Statistical correct for actually registered declarable events. countries do not control (Table countries having minimum control for not available the live prescribing a ��18 19 &#x/MCI; 0 ;&#x/MCI; 0 ;Table 6.Possibilitytocontrolfor adequacy tolegal criteria. Stillbirths. Europe Countries with Survey conducted The requested form for (medical information published tables, countries apparently have met them respective importance Statistical Institutes in the expenses incured registration. This for very preterm births, aspects (rights cases induce rules. The comparative child allowances) doubtful cases religion, were sometimes argued stillbirth to baptism). Finally, political importanqe been responsible for selective healthiest infants, hence lowering more specifically early neonatal ��20 21 &#x/MCI; 0 ;&#x/MCI; 0 ;Obviously most of the invoked causes of under- or wrongregistration are mostly concerned with very preterm births (either stillborn born alive) children dying declare may vary born alive both directions exact evaluation crosschecking by vital registration some clues (The Netherlands) respective Societies correctly apply perinatal deaths. Faultly requirements for to estimate registration system. such validation variable number early neonatal deaths appears The magnitude to assess within between medical registration. The legal definitions and other not registered legal minimum gestation duration for being some confusion legal required days, whilst Belgian Civil resulting in weeks calculated those early not for time birth in the de Calais early neonatal Similar studies were found for neonatal deaths, to viability preterm infants mortality figures exercice. However, evidence from very preterm Intensive Neonatal ��22 23 &#x/MCI; 0 ;&#x/MCI; 0 ;3.4. &#x/MCI; 1 ;&#x/MCI; 1 ;Legal,sociul and psychological fcrctors &#x/MCI; 2 ;&#x/MCI; 2 ;Attitudes to viability may care. When pregnancy outcome declared miscarriage, child etc. for very to spare borderline circumstances (Keirse, Social considerations may to either unmarried teenager, early neonatal deaths. are to importance given mortality indicators social development may adverse practices days (Table was declared legal delay was considered event was only mentioned during the regime, medical mortality figures practices change same time adequate neonatal care in the were overall and where early neonatal was defined: did not hours. Figures relating these early neonatal separately and not included in the assess quality to adjust the bring about biais comparisons over time and late foetal considered for one observes (Table definitions across Europe. foetal losses sole exceptions national perinatal gestation duration measuring prematurity days gestation ��24 &#x/MCI; 1 ;&#x/MCI; 1 ;France, Italy and Luxemburg and ita operational definition in the different countries problems linked gestation duration criterion. From all on 180 days criterion medical knowledge They considered gestation duration Civil, 1805). and 180 correspond roughly to 28 menses, which correspond foetal death, medical profession (Gourbin, 1991). losses occurring legal restriction The case and statistical recommendations for including all whilst therapeutic 24 weeks gestation duration. not declared5 Vital Register, and early neonatal mortality legal definitions. made explicitely in the Italy was their 180 viability criterion a remains that the medical profession a change vital registration Committee6 considered gestational age viability criterion birthweight and determined a include every baby potentially salvagable but that a limit unlikely and clinical practice, still striking reasonable survival chances least during other hand, with gestation adverse pregnancy outcomes with different gestation duration births but legal definition constraints. figures for gestation duration, (stillbirths and neonatal deaths) European countries administrative restrictions given minimum additional requirement out-of-range liveborn till 1978) and still defined life France (and 1991 also gestation duration. Committee comprises various associations: Death registration being primarily used General Practitioners, Royal College death registration not necessary. Obstetricians and British Peadiatric their early neonatal mortality de naissance leur quotient de mortalit4 1981 1990 1365 1194 0.21 761.05 0.18 653.5 Data available Data available births with for the early neonatal mortality leur quotient de mortalit4 dea Registres not ava their early neonatal mortality leur quotient I I I I 0.22 811.74 1092 1237 469.51 0.13 0.66 756.23 0.21 0.18 464.11 0.11 Data available ��30 31 x &#x/MCI; 0 ;&#x/MCI; 0 ;m &#x/MCI; 1 ;&#x/MCI; 1 ;-.-&#x/MCI; 2 ;&#x/MCI; 2 ;However, besides those legal administrative rules, existing rules. after birth be discussed to the registration, inheritance, costs, psychological etc. Concerning preterm infants births, they usually also fail minimum requirements case, thinking perinatal mortality still misleading: death to stillbirth underreporting. Comparable early neonatal total infant total deaths) several countries where gestation babies dying register or Moreover, for births) registered between children thus as still6ihhs) and total stillbirths specific way establishing stillbirth significant underestimation ��32 33 F3g. 5: Infant death structure was calculated mortalit4 infantile suivant where survival during a whole week less than very specific administrative rule, early neonatal total infant will specifically affect presently wait contrary, a neonatal mortality a rather day mortality. Outside countries register earlier stage earlier registration an in depth investigation published data, produce standardized civil registration birth, stillbirth performed by National Statistical gave some indications to the mortality figures birthweight or performed between days, not being preferred during the first and the ��34 35 then,-$he+availability of birthweight or gestation duration to standardize in the data. Eight countries encounter Italy, Poland countries out recommendations for general constraints But in progresses achieved perinatal and the late A -changing reality. that the vital registration forms give perinatal statistics. developped Medical since many routinely linked with vital registration records. When organized on a compulsory obtain a perinatal deaths. in the next decade registration concerning birthweight gestation duration, some differences publication between more precise description ��36 &#x/MCI; 1 ;&#x/MCI; 1 ;their complementarity or specificity besidesthe existing vital registration concentrate more in the life, hence importance given which accounts these early preterm infants, and to care techniques. weight (less discussion concerning and their raised in criteria and produced did show time and across countries. But the have actually level (Tables overwhelming majority legal definitions to the recommendations where criteria. The revisions occurring Kingdom do reluctance in ��38 39 -�: hiPI%: to foetal logses occurring il below a well-defined viability criteria information at the vital registry in order to produce more as contlictnirl.situations may arise at the legal level: late reliable coverage of births and infant deaths and their action (infanticide) in case death during mortality indicator first-day mortality not calculated every country. procedures are impossible to often mix pregnancy outcomes often declared a higher precise recommendations are to live births low-mortality regions like Europe, In pmctice another viubility criteria (the correct evaluation to live births very low countries. These recommendations the early births, stillbirths and infant rigid cutpoint births and deaths be produced someflexibility should be given extreme rigidity administrative and legal procedures Isabelle Theys technical help. institutions and in the recommendation (already included in the Director, Population Division, published figures, be fully de Statistique, and foetal controls were Since problems regarding registration Health, Praha to reporting ��40 41 EngZund-Waka-Lithuania Office of Population Censuses and Surveys, London -Dr A. Gaizauskieve, Lithuanian Health Center, Vilnius National Bureau Health Statistics, Tallin Dr Hansen-Koenig, de la Central Statistical Hemminki, Dept. Assistant Regietrar General, General Register des Etudes Officer, Division Universit&t Berlin, Berlin Dalseth, Executive Officer, Medical Kloke, F'reie Berlin, Berlin R. Von Heinrich Heine Dr Siampos, Associate Athens University Dept. Social Demographic Survey, Statistics, Athinai Paediatrics, Athens University, Children's Demographic Survey, Casimiro, Director Iona Popa, Chercheur-DQmographe, National pour Snaedal, National Biering, National University Hospital, Dept Baldursson, Head Statistical Bureau Central Statistical Pinelli, Facoltil Statistique, Berne Pasquali, Demographic Health Statistics Head, Laboratory Krumins, University System, Research ��42 43 &#x/MCI; 0 ;&#x/MCI; 0 ;_, . .. &#x/MCI; 1 ;&#x/MCI; 1 ;-Yug~lavia(ex) . &#x/MCI; 2 ;&#x/MCI; 2 ;-&#x/MCI; 3 ;&#x/MCI; 3 ;Dr M. Rankovic, Federal statistical Office, Group for Population Registration completeness Filiation. Chapitre Premier, articles Defawe G., Roussey mortalit4 p6rinatale. en France preterm infanta definitions, terminology statistical tables related perinatal deaths. Modifications recommended Obstetnca and 'naissance vivante' 'naissance vivante' Chaire Quetelet stillbirth assessment birthweight and @station mortalit4 infantile de la qualit4 des mortality rates' do not contain The Lancet catastrophe. British Medical Psychology Information Centre. Health care and health Statistical data. Health, Lithuania, Vilnius mortalit6 infantile, comparabilit6 des d6mesociales en Europe, sous G., Buekens Perinatal health Masuy-Stroobunt G.:Legal and reality. (in press). neonatal deaths: a respiratory system. deuil p4rinatal. Bulletin de la A note factors affecting ��44 45 &#x/MCI; 0 ;&#x/MCI; 0 ;Mugford M.: A comparison of reported differences Health Statistic des statistiques $tude des pratiques nationales. &tudes de la internationale des causes de Perinatal death change? British viability and de la The international diseases. Strengthening Health Statistics Working Group the Very Birthweight Infant: pregnancy between gestation. The perinatal mortality events (live by the Louvain, Belgium). Their impact on European countries; standardized perinatal mortality figures international comparisons mgistmtion forms and the mesums de statistiques d'etat partir d'une de Louvain, Louvain-la-Neuve, pays d'Eumpe. publiees (structure Europe; Lvolutions certains pays). mesures standardisbes une analyse bulletins d'etat et des methodes de