Understanding high rates of stillbirth and neonatal death in a disadvantaged, high‐migrant district in France: A perinatal audit. (29th March 2020) - Sauvegrain, Priscille
Abstract: Introduction: The objective of this study is to investigate factors associated with risks of perinatal death in a disadvantaged, high‐migrant French district with mortality rates above the national average. Material and methods: The study design is a perinatal audit in 2014 in all 11 maternity units in the Seine‐Saint‐Denis district (25 037 births). The data come from medical chart abstraction, maternal interviews and peer assessor confidential review of deaths. A representative sample of live births in the same district, from the 2010 French Perinatal Survey, was used for comparisons (n = 429). The main outcome measures were stillbirth and neonatal death (0‐27 days) at ≥22 weeks of gestation. Results: The audit included 218 women and 227 deaths (156 stillbirths, 71 neonatal deaths); 75 women were interviewed. In addition to primiparity and multiple pregnancy, overweight and obesity increased mortality risks (50% of cases, adjusted odds ratios [aOR] 1.7, 95% confidence interval [CI] 1.1‐2.8, and aOR 1.9 [95% CI 1.1‐3.2], respectively) as did the presence of preexisting medical/obstetric conditions (28.6% of cases, aOR 3.2, 95% CI 2.0‐5.3). Problems accessing or complying with care were noted in 25% of medical records and recounted in 50% of interviews. Assessors identified suboptimal factors in 73.2% of deaths and judged 33.9% to be possibly or probably preventable. Care not adapted to risk factors and poor healthcare coordination were frequent suboptimal factors. Possibly preventable deaths were higher ( P < .05) for women with gestational diabetes or hypertension (44.6%) than women without (29.0%). Conclusions: Preventive actions to improve healthcare referral and coordination, especially for overweight and obese women and women with medical and obstetrical risk factors, could reduce perinatal mortality in disadvantaged areas.