ACOG: Perinatal mortality higher in out-of-hospital births

Lani Doser, M.N., from the Oregon Health & Science University in Portland, and colleagues conducted a five-year (2004 through 2008) retrospective study to investigate the maternal and neonatal outcomes of 229 cases transferred to an Oregon tertiary care referral center during planned home or birth-center births.

Of the 223 cases with recorded neonatal outcomes, the researchers noted eight deaths; seven of which met the perinatal mortality definition 1 (PMD1) (death between 28 weeks of gestation and seven days of life) and one of which died after seven days of life. Among cases transferred to the study hospital, there was a PMD1 of 31 per 1,000 for planned out-of-hospital births. One of the eight infants who died had congenital anomalies not compatible with life. Breech presentation, pregnancy-induced hypertension or preeclampsia, and postdates gestation were high-risk conditions associated with the other seven deaths. A licensed direct entry midwife cared for seven of the cases, and an unlicensed midwife cared for the case with congenital anomalies.

"Our findings suggest that more research is needed to assess the maternal/fetal risk factors or provider-related factors that may have contributed to the higher incidence of perinatal mortality," the authors conclude.

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