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British perinatal mortality survey
Longman Group ,,..O, ., , .UK . Ltd 1990
Midwifery
LETTERS TO THE EDITOR
British Perinatal Mortality Survey Dear Editor Recently, I noticed a disturbing error in the September 1990 issue of Midwifery. In a paper by K P Shah (Shah, 1990) it was claimed that 'of the 16994 deaths surveyed in the British Perinatal Mortality Survey, necropsy was performed on 148873 babies' (underlines added by me). These figures suggest that necropsies were also done on survivors! Obviously, this is not the case. In fact, the 1958 British Perinatal Mortality Survey covered two periods (Butler & Bonham, 1963). Data were requested for every birth during one week in March, 1958. This week is known as the Control Week Period. Furthermore, throughout the months of March, April and May data were collected for stillbirths and all babies born alive that died within 28 days of birth (Survey Period for the Deaths). During the Control Week 16994 singleton births were recorded of which 369 (2.2%) were stillborn and 248 (1.5%) died during the neonatal period. During the three months survey period 7117 deaths were recorded (4306 deaths occurred antepartum and 281 l deaths occurred during the neonatal period). Necropsy rate was 93% for the month of March (n = 2343). This proportion dropped to 55% in April and May (Baird & Thomson, 1969). In the first report of this survey, data were presented on the necropsy findings in deaths that occurred during the whole month of March only. From these findings it was shown that death could be attributed to intrapartum anoxia, birth trauma or both in 32.9% of the cases. Indeed, the commonest cause of mortality was due to some form of intrapartum anoxia with or without birth trauma. This category accounted for a mortality rate of 10.2 per 1000 total births. The 1958 British Perinatal Mortality Survey was a major exercise and a remarkable achievement. It is still being used as a valuable source of scientific information. Misquotation and misinterpretation do harm to the high standards of this survey. H I J Wildschut PhD Child Health Institute Division of Epidemiology St Michael's Hill Bristol BS2 8BJ, UK
References Butler N R, Bonham D G (ed) 1963 Perinatal Mortality. 152
The first report of the 1958 British Perinatal Mortality Survey. E & S Livingstone Ltd, Edinburgh Baird D, Thomson A M 1969 The survey perinatal deaths re-classified by special clinico-pathological assessment. In Butler N R, Alberman E D (eds) Perinatal Problem The Second Report of the British Perinatal Mortality survey. (E & S Livingstone Ltd./Edinburgh Shah KP 1990 Risk factors for birth asphyxia and brain damage in pregnancy and labour. Midwifery 6: 155164
Shah's reply Dear Editor Thank you for referring Dr H I J Wildschut's letter of 20 March to me, and for the chance to reply. Dr Wildschut has rightly pointed out my error in the number of necrospies which were performed. This should have been 14873 and for this I apologise. Symonds (1976) stated that out of 2519 deaths from fetal distress 1051 (41.7%) occurred during parturition. In my article (Shah, 1990) I referred to this as 'approximately' 40% as I wanted to point out that two out of five asphyxial deaths occur during the intrapaturm period. Dr Wildschut has pointed out that 7117 deaths were reported during the three months of the British Perinatal Mortality Survey of which 39.5% occurred during the neonatal period. Almost all the deaths due to asphyxia during the neonatal period were due to intrapartum asphyxia. K P Shah, 7 Chemin Des Manons, 1218 Grand Saconnex, Geneva, Switzerland.
References Symonds M 1976 Evaluation of fetal well-being in pregnancy & labour. In: Hull D (ed) Recent Advances in Paediatrics. Churchill Livingstone, London.
T h e Editor would en co u r ag e correspondence relating to any o f the published articles from readers o f the journal. Contributions should be brief and to the point, only including tables or figures if essential and with a m a x i m u m o f five references. Letters should be sent to the Editor: Miss A n n T h o m s o n , D e p a r t m e n t o f Nursing, University o f Manchester, Stopford Building, O x f o r d Road, Manchester M13 OPT, UK.
Midwifery
LETTERS TO THE EDITOR
British Perinatal Mortality Survey Dear Editor Recently, I noticed a disturbing error in the September 1990 issue of Midwifery. In a paper by K P Shah (Shah, 1990) it was claimed that 'of the 16994 deaths surveyed in the British Perinatal Mortality Survey, necropsy was performed on 148873 babies' (underlines added by me). These figures suggest that necropsies were also done on survivors! Obviously, this is not the case. In fact, the 1958 British Perinatal Mortality Survey covered two periods (Butler & Bonham, 1963). Data were requested for every birth during one week in March, 1958. This week is known as the Control Week Period. Furthermore, throughout the months of March, April and May data were collected for stillbirths and all babies born alive that died within 28 days of birth (Survey Period for the Deaths). During the Control Week 16994 singleton births were recorded of which 369 (2.2%) were stillborn and 248 (1.5%) died during the neonatal period. During the three months survey period 7117 deaths were recorded (4306 deaths occurred antepartum and 281 l deaths occurred during the neonatal period). Necropsy rate was 93% for the month of March (n = 2343). This proportion dropped to 55% in April and May (Baird & Thomson, 1969). In the first report of this survey, data were presented on the necropsy findings in deaths that occurred during the whole month of March only. From these findings it was shown that death could be attributed to intrapartum anoxia, birth trauma or both in 32.9% of the cases. Indeed, the commonest cause of mortality was due to some form of intrapartum anoxia with or without birth trauma. This category accounted for a mortality rate of 10.2 per 1000 total births. The 1958 British Perinatal Mortality Survey was a major exercise and a remarkable achievement. It is still being used as a valuable source of scientific information. Misquotation and misinterpretation do harm to the high standards of this survey. H I J Wildschut PhD Child Health Institute Division of Epidemiology St Michael's Hill Bristol BS2 8BJ, UK
References Butler N R, Bonham D G (ed) 1963 Perinatal Mortality. 152
The first report of the 1958 British Perinatal Mortality Survey. E & S Livingstone Ltd, Edinburgh Baird D, Thomson A M 1969 The survey perinatal deaths re-classified by special clinico-pathological assessment. In Butler N R, Alberman E D (eds) Perinatal Problem The Second Report of the British Perinatal Mortality survey. (E & S Livingstone Ltd./Edinburgh Shah KP 1990 Risk factors for birth asphyxia and brain damage in pregnancy and labour. Midwifery 6: 155164
Shah's reply Dear Editor Thank you for referring Dr H I J Wildschut's letter of 20 March to me, and for the chance to reply. Dr Wildschut has rightly pointed out my error in the number of necrospies which were performed. This should have been 14873 and for this I apologise. Symonds (1976) stated that out of 2519 deaths from fetal distress 1051 (41.7%) occurred during parturition. In my article (Shah, 1990) I referred to this as 'approximately' 40% as I wanted to point out that two out of five asphyxial deaths occur during the intrapaturm period. Dr Wildschut has pointed out that 7117 deaths were reported during the three months of the British Perinatal Mortality Survey of which 39.5% occurred during the neonatal period. Almost all the deaths due to asphyxia during the neonatal period were due to intrapartum asphyxia. K P Shah, 7 Chemin Des Manons, 1218 Grand Saconnex, Geneva, Switzerland.
References Symonds M 1976 Evaluation of fetal well-being in pregnancy & labour. In: Hull D (ed) Recent Advances in Paediatrics. Churchill Livingstone, London.
T h e Editor would en co u r ag e correspondence relating to any o f the published articles from readers o f the journal. Contributions should be brief and to the point, only including tables or figures if essential and with a m a x i m u m o f five references. Letters should be sent to the Editor: Miss A n n T h o m s o n , D e p a r t m e n t o f Nursing, University o f Manchester, Stopford Building, O x f o r d Road, Manchester M13 OPT, UK.