A Perinatal Audit of Stillbirths in a Teaching Hospital in Hong Kong

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Abstract
EDITORIAL COMMENT: We have accepted this paper for publication became of the excellence of the results obtained in Hong Kong. We have previously reported in this Journal the low incidence of prematurity in Hong Kong and other Asian countries and this may be an important reason why the results published here are superior to those reported from Victoria (A). In Victoria in 1991 the stillbirth rate using the 500 g birth‐weight criterion was 5.8 per 1,000 total births and in 1992 the figure was 4.9 per 1,000. In 1992 the perinatal mortality rate in Victoria was 7.8 per 1,000 births which was a remarkable improvement on 1991 when the figure was 9.2 per 1,000. Perinatal mortality rates in teaching hospitals in Australia are almost double those of the State as a whole. For instance in the triennium 1987–1989 the perinatal mortality rate at the Mercy Hospital for Women was 14.7 per 1,000 total births. This is explained by referral of high‐risk patients especially women in premature labour or with premature rupture of the membranes. Deliveries between 20 and 28 weeks' gestation accounted for 45% of the perinatal deaths in the Mercy Hospital for Women figures referred to above for the 1987–1989 triennium. These figures are given to emphasize the excellence of the perinatal results reported in this paper from a level 3 hospital with a very high proportion of nonbooked patients. The authors were asked to include a statement about the number of terminations done for malformations of babies weighing less than 500 g at birth since this could have a potent influence on the stillbirth rate. For comparison in 1991 in Victoria there were 375 stillbirths (5.8 per 1,000 births) but excluded from this total were 138 terminations of pregnancy after prenatal diagnosis of a malformation before 20 weeks' gestation.Summary: In a 5‐year period, the stillbirth rate in a teaching hospital in Hong Kong was 4.4 per 1,000 total births, which accounted for 61% of the perinatal deaths. The stillbirth rate was 5.8 times higher in twin pregnancies, and 17 times higher in triplet pregnancies. One quarter of the patients were nonbooked, and 14.5 % had no antenatal care. The stillbirth rates were 3.8 and 8.0 per 1,000 among the booked and nonbooked cases respectively. The major causes of stillbirths were congenital abnormalities, haemoglobin Bart disease, abruptio placentae and gestational diabetes. No specific cause could be found in 46% of cases. There were 31 intrapartum deaths, of which 5 were potentially salvageable.

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