Suboptimal care in stillbirths - a retrospective audit study

Acta Obstet Gynecol Scand. 2007;86(4):444-50. doi: 10.1080/00016340701207724.


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.

MeSH terms

  • Adult
  • Communication
  • Communication Barriers
  • Ethnic Groups
  • Female
  • Fetal Growth Retardation / diagnosis
  • Fetal Growth Retardation / mortality*
  • Humans
  • Medical Audit
  • Mothers / psychology*
  • Multivariate Analysis
  • Norway / epidemiology
  • Obstetric Labor Complications / mortality
  • Odds Ratio
  • Perinatal Care / standards*
  • Pregnancy
  • Prenatal Care / standards
  • Prenatal Diagnosis
  • Quality of Health Care*
  • Retrospective Studies
  • Risk Factors
  • Self Care
  • Stillbirth / epidemiology*
  • Stillbirth / ethnology*