Bonsel Gouke J, Steegers Eric A P
Erasmus Medische Centrum, afd. Verloskunde en Gynaecologie, Rotterdam.
Ned Tijdschr Geneeskd. 2011;155:A3112.
The Dutch perinatal mortality rate is relatively high when viewed in a European perspective. There appear to be also substantial differences in perinatal mortality between provinces, large cities and even between neighbourhoods. Accumulation of obstetric risk factors as well as socioeconomic and urban risks seems to be involved as well. This should be taken into account in the process of risk selection to define a high risk population needing hospital care. In 85% of all cases of perinatal mortality, one or more of the following perinatal morbidities are present, designated as the 'Big 4': congenital abnormalities, preterm birth, intrauterine growth restriction and low Apgar score (< 7; 5 min after birth). Differences in perinatal mortality, the evaluation of organisational features of care and determinants like travel time from home to hospital should always be related to the case mix represented by this 'Big 4'.
从欧洲的角度来看，荷兰的围产期死亡率相对较高。各省之间、大城市之间甚至邻里之间的围产期死亡率似乎也存在很大差异。产科风险因素以及社会经济和城市风险的累积似乎也与之有关。在风险选择过程中应考虑到这一点，以确定需要住院治疗的高危人群。在所有围产期死亡病例中，85%存在以下一种或多种围产期疾病，即所谓的“四大”：先天性异常、早产、宫内生长受限和低阿氏评分（<7；出生后5分钟）。围产期死亡率的差异、护理组织特征的评估以及诸如从家到医院的出行时间等决定因素，都应始终与由这“四大”所代表的病例组合相关联。
