Perinatal mortality surveys in two small private hospitals in Cincinnati

Abstract

The difficulties in making a perinatal mortality survey in a small private hospital stem largely from the apathy of the medical staff, and the unnecessary fears of condemnation or exposure. Cooperation from doctors can be obtained if simple reporting forms are used, such as those described, and judicious analyses are made and discussed by a devoted survey committee, supported by the hospital administration. Stillbirths and neonatal deaths of babies weighing over 1,000 grams are classified as nonpreventable, possibly preventable, and preventable, and, for the latter two groups, which number almost 40 per cent of the total, the responsible factors are identified so that corrective action can be taken.Similar studies were made in 1958 in two contrasted hospitals. One was an excellent private general hospital with 3,640 births, with an obstetric staff of 10 Board-qualified obstetricans, 3 men who limited their practice to obstetrics, and 34 general practitioners. The other was a nonaccredited 13 bed maternity hospital with no laboratory, no x-ray equipment, and no facilities for cesarean section, in which 625 births took place. The poorer hospital had the slightly better perinatal mortality rate, even though it included mothers and infants transferred to other institutions, namely, 19.2/1,000 (A.M.A. Perinatal Mortality Period I).Investigation of the apparent paradox revealed the cause to be better staff discipline in the smaller hospital, specifically in the matter of (a) compulsory (and free) obstetrical consultation for a large number of complications, (b) minimal analgesia and anesthesia, and (c) immediate and competent pediatric care. An analysis of the major factors in the possibly preventable deaths in the larger hospital confirmed this explanation.