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573 LONGITUDINAL PATTERNS OF PERINATAL DEATHS BY DIAGNOS1B AND BIRTHWEIGHT DISTRIBUTION

We have reviewed 934 perinatal deaths from 1976 through 1983 among 28,000 inborn births in an urban perinatal center hospital. During perinatal mortality review the principal cause of death was assigned by one individual (JBP) into 7 fetal and 7 neonatal major diagnostic groupings; autopsy information contributed to assignment in 80%. Perinatal asphyxia accounted for approximately 50% of the neonatal deaths; over time there tended to be a redistribution with increased contribution from the 500-750g group. Congenital anomalies decreased from 11.7% to 9.1% while infection tripled from 8.3% to 25%. The most impressive change was the decrease in immaturity as the principal cause from 21% to 4.5%; this change may represent an artifact of having more information available for the review process. For 33% of fetal deaths cause was undetermined. The next common cause was placental abruption, 18.5% overall, with no real change over time; in contrast maternal disease and Rh disease decreased from 12% to 10% respectively to 2.3% for each group. The wt specific distribution of perinatal mortality, except for >2500g, has been progressively towards the <1000g infant, now accounting for over 2/3 of perinatal mortality and clearly identifying prematurity as the most important unsolved problem. In addition, these data identify other causes of death to direct education and intervention programs to improve outcome for both the fetus and newborn.