Why babies die in unplanned out-of-institution births: An enquiry into perinatal deaths in Norway 1999-2013.

Introduction The aims were to describe causes of death associated with unplanned out-of-institution births, and to study whether they could be prevented. Material and methods Retrospective population-based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out-of-institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions. Results 63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub-optimal care, involving 25 cases (40%), most commonly due to sub-optimal maternal use of available care (n = 14, 22%). Conclusions Infections, neonatal, and placental causes accounted for almost two-thirds of perinatal mortality associated with unplanned out-of-institution births in Norway. Sub-optimal maternal use of available care was found in more than one-fifth of cases

Chart of part of New South Wales, with plans of the harbours [cartographic material] /

Insets: Moreton Bay and Brisbane River, 1825 -- Port Phillip and Western Port -- Port Macquarie -- Twofold Bay -- Port Hunter -- Botany Bay -- [Broken Bay] --The harbour of Port Stephens / by J. Bingle -- The entrance of Port Hunter / by J. Bingle -- The harbour of Port Jackson -- General map of Australia.; Map extending from Moreton Bay to Port Phillip showing nine counties in N.S.W., and roads. Relief shown by hachures.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.map-rm1528