Audit of perinatal deaths in a tertiary level hospital in Latvia (1995-1999) using the Nordic-Baltic perinatal death classification: Evidence of suboptimal care

Objective. The objective of this study was to explore applicability of the Nordic-Baltic perinatal death (PND) classification in a single hospital via evaluation of changes of the preventability of PND over the time period in a tertiary level perinatal care center in Latvia. Method. All PND cases during the period 1995-1999 at a tertiary referral perinatal care center, the Riga Maternity Hospital (RMH), were analyzed using the common Nordic-Baltic PND classification. Results. The total perinatal mortality rate (PNMR) did not decline at the RMH over the study period. The rate of antenatal and intrapartum deaths at <28 weeks of gestation increased (p < 0.01). Early neonatal deaths at 28-33 weeks of gestation with a low 5-minute Apgar score became less frequent (p < 0.05). There was a trend towards more cases of probably suboptimal care (p < 0.005) and the proportion of preventable PND cases increased from 14.7% in 1995 to 36.4% in 1999 (p = 0.01). Conclusion. The perinatal audit performed at the RMH using the Nordic-Baltic PND classification disclosed a requirement for further improvement of perinatal care in the hospital. The classification can be used to evaluate the preventability of perinatal death cases in a single hospital, and its application in other hospitals in Latvia could provide information necessary for the improvement of perinatal care in the country.