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Decreasing perinatal mortality in The Netherlands, 2000–2006: a record linkage study
  1. A C J Ravelli1,
  2. M Tromp1,
  3. M van Huis2,
  4. E A P Steegers,
  5. P Tamminga3,
  6. M Eskes1,
  7. G J Bonsel
  1. 1
    Department of Medical Informatics, 2Department of Obstetrics and Gynecology, 3Department of Neonatology and Pediatrics, Academic Medical Center, Amsterdam, The Netherlands
  2. 2
    Division of Obstetrics and Prenatal Medicine, University Medical Center, Rotterdam, The Netherlands
  3. 3
    Department of Health Policy and Management, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr A C J Ravelli, Department of Medical Informatics, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands; a.c.ravelli{at}


Background: The European PERISTAT-1 study showed that, in 1999, perinatal mortality, especially fetal mortality, was substantially higher in The Netherlands than in other European countries. The aim of this study was to analyse the recent trend in Dutch perinatal mortality and the influence of risk factors.

Methods: A nationwide retrospective cohort study of 1 246 440 singleton births in 2000–2006 in The Netherlands. The source data were available from three linked registries: the midwifery registry, the obstetrics registry and the neonatology/paediatrics registry. The outcome measure was perinatal mortality (fetal and early neonatal mortality). The trend was studied with and without risk adjustment. Five clinical distinct groups with different perinatal mortality risks were used to gain further insight.

Results: Perinatal mortality among singletons declined from 10.5 to 9.1 per 1000 total births in the period 2000–2006. This trend remained significant after full adjustment (odds ratio 0.97; 95% CI 0.96 to 0.98) and was present in both fetal and neonatal mortality. The decline was most prominent among births complicated by congenital anomalies, among premature births (32.0–36.6 weeks) and among term births. Home births showed the lowest mortality risk.

Conclusions: Dutch perinatal mortality declined steadily over this period, which could not be explained by changes in known risk factors including high maternal age and non-western ethnicity. The decline was present in all risk groups except in very premature births. The mortality level is still high compared with European standards.

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  • Funding None.

  • Competing interests None declared.

  • Ethics approval Anonymous registry data, so no ethical approval needed. The Dutch perinatal registry has given permission for the analysis of their data.