A critical analysis on Italian perinatal mortality in a 50-year span

Abstract

Background

Perinatal mortality rate is used as an indicator of reproductive health worldwide. In western countries, national mortality registers are usually accurate and reliable.

Methods and aims

We reviewed the data recorded in the past 50 years in Italy on perinatal and infant mortality. Each single class of mortality rate (according to WHO definitions) was assessed on temporal trends allowing a critical speculative analysis, mainly focusing on the last 20 years, in an attempt to evaluate the impact of prenatal diagnosis.

Results

Infant mortality rate (IMR) constantly decreased in the study period whereas early neonatal mortality rate progressively diminished in a 5-year comparison till the early 1990s. Perinatal mortality showed a linear negative trend until the 1980s, after which the decrease steadied at about 23% in the following 5-year period. Infant mortality attributable to congenital anomalies throughout a 20-year span (1980–2000) was steady at about 23% although a progressive reduction in general infant mortality was reported.

Conclusions

A higher reduction in neonatal and perinatal mortality rate was found before the wide availability of the ultrasonographic prenatal diagnosis and the introduction of the law on voluntary abortion in Italy. Given these data, it seems that advances in neonatal care have improved the infant survival rates more than prenatal diagnosis, whereas obstetric care is linked to a reduction of the early perinatal mortality rate.

Introduction

In the past decades the World Health Organization and many other associations strongly encouraged a uniform use of definitions in order to allow comparisons of data from different areas.

Perinatal mortality, for instance, defined as a combination of stillbirths and neonatal deaths, is widely used as an indicator of reproductive health all over the world although there is not uniformity in registration procedures [1]. The reporting system is improvable, mainly in developing countries, whereas presence of infrastructures and good service organization varies substantially among countries [2]. In western countries, present reporting systems are well defined and national registers are usually accurate and reliable.

We evaluated Italian recorded data on perinatal and infant mortality in the past 50 years carrying out a critical analysis on trends and prospects. Moreover, it is widely accepted that differences in medical practice over the years can affect health outcomes [3], resulting in confounding factors in a retrospective analysis on perinatal mortality as highlighted by the PERISTAT project [4]. For instance, screening for congenital anomalies (leading to termination of pregnancy (TOP) whenever severe fetal anomalies are detected) affects mortality rates [5]. Thus, we analysed in detail the more recent decades since the sonographic screening became widely available and the law on voluntary abortion became effective in Italy.