Læknablaðið - 01.07.2018, Blaðsíða 22

346 LÆKNAblaðið 2018/104
R A N N S Ó K N
1. Bjarnadóttir RI. Burðarmálsdauði á Íslandi - getum við
enn lækkað tíðnina? Læknablaðið 2003; 89: 745-6.
2. Biering G, Snædal G, Sigvaldsson H, Ragnarsson J.
Fæðingar á Íslandi 1972-1981, 10. grein: Meðganga og
burðarmálsdauði. Nokkrir áhættuþættir. Læknablaðið
1983; 69: 359-62.
3. Bjarnadóttir RI, Geirsson RT, Pálsson G. Flokkun burðar-
málsdauða á Íslandi 1994-1998. Læknablaðið 1999; 85:
981-6.
4. ICD-10. International Statistical Classification of Diseases
and Related Health Problems. Instruction manual. Vol
2. 10th revision ed. Geneva: World Health Organization
2016.
5. EURO-PERISTAT Project with SCPE and EUROCAT.
European Perinatal Health Report. The health and care of
pregnant women and babies in Europe in 2010. europer-
istat.com - júní 2018.
6. Fæðingaskrá. landlaeknir.is/tolfraedi-og-rannsoknir/
gagnasofn/gagnasafn/item12340/Faedingaskra.
7. http://ec.europa.eu/eurostat/data/database?node_
code=demo_minfind - júní 2018.
8. de Galan-Roosen AE, Kuijpers JC, van der Straaten PJ,
Merkus JM. Fundamental classification of perinatal death.
Validation of a new classification system of perinatal
death. Eur J Obstet Gynecol Rep Biol 2002; 103: 30-6.
9. Winbo IG, Serenius FH, Dahlquist GG, Kallen BA. NICE, a
new cause of death classification for stillbirths and neona-
tal deaths. Neonatal and Intrauterine Death Classification
according to Etiology. Int J Epidemiol 1998; 27: 499-504.
10. Hernán MA. The Hazards of Hazard Ratios. Epidemiol
2010; 21: 13-5.
11. Geirsson RT. Ómskoðun við 18-20 vikur. Læknablaðið.
2001; 87: 403-7.
12. Helgason H. Fósturgreining, fyrir hverja? Læknablaðið
2001; 87: 395-6.
13. Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6
million neonatal deaths--what is progressing and what is
not? Sem Perinatol 2010; 34: 371-86.
14. Jónsdóttir G, Bjarnadóttir RI, Geirsson RT, Smárason A.
Eru tengsl á milli tíðni keisaraskurða og burðarmálsdauða
á Íslandi undanfarin 15 ár? Læknablaðið 2006; 92: 191-5.
15. Johnsen B. Orsakir burðarmálsdauða á Íslandi 1955-1976.
Læknablaðið 1983; 69: 191-8.
16. Þórkelsson Þ. Lífslíkur fyrirbura. Læknablaðið 2009; 95:
105.
17. Tveit JVH, Saastad E, Stray-Pedersen B, Børdahl PE,
Flenady V, Fretts R, et al. Reduction of late stillbirth
with the introduction of fetal movement information
and guidelines – a clinical quality improvement. BMC
Pregnancy Childbirth 2009; 9: 32.
18. Heazell AEP, Weir CJ, Stock SJE, Calderwood CJ, Burley
SC, Froen JF, et al. Can promoting awareness of fetal
movements and focusing interventions reduce fetal morta-
lity? A stepped-wedge cluster randomised trial (AFFIRM).
BMJ Open 2017; 7:e014813.
19. Lög um réttindi sjúklinga. althingi.is/lagas/123a/1997074.
html1999 - júní 2018.
20. Siðareglur lækna. landlaeknir.is/gaedi-og-eftirlit/heil-
brigdisstarfsfolk/starfsleyfi/sidareglur/item13353/ - júní
2018.
Heimildir
Barst til blaðsins 25. október 2017, samþykkt til birtingar 26. júní 2018.
Ragnhildur Hauksdóttir1,4
Þórður Þórkelsson1,2,3
Gestur Pálsson1,2,3
Ragnheiður I. Bjarnadóttir1,2,4
Introduction
Perinatal mortality refers to stillbirth and neonatal death
during the first week of life. Recently perinatal mortality rate
in Iceland has been among the lowest in the world. The aim
of the study was to evaluate how perinatal mortality rate and
its causes have changed in Iceland during the last 30 years,
particularly to see if it is possible to lower the perinatal
mortality rate even more.
Cases and methods
The study was retrospective and included all infants that
were stillborn or died during the first week of life in 1988-
2017. Information was obtained from the Icelandic Medical
Birth Registry, the annual reports on births in Iceland. A
classification focusing on identifying groups of perinatal
death that are potentially avoidable was used. An annual
percent change was calculated with Poisson regression.
Results
The perinatal mortality rate declined on average by 3,3%
per year in the period based on ≥28+0 weeks gestation. The
number of infants that died because of congenital anomalies
decreased on average by 4,8% per year. The number of
growth restricted stillborn singletons after ≥28+0 weeks of
gestation decreased on average by 3,1% per year. The num-
ber of non growth restricted stillborn singletons after ≥28+0
weeks of gestation did not decrease significantly.
Conclusion
Perinatal mortality rate has declined substantially in Iceland
during 30 years. Deaths because of congenital anom-
alies have decreased considerably due to improvement
in prenatal diagnosis. Stillbirths associated with growth
restriction have decreased but stillbirths that are not associ-
ated with growth restriction have not. Thus it is important to
emphasize that women seek medical attention when they
experience decreased fetal movements.
Perinatal mortality in Iceland 1988-2017
ENGLISH SUMMARY
1Landspítali University Hospital, 2Faculty of Medicine – University of Iceland, 3Childrens hospital – Landspítali University Hospital, 4department of
obstetrics and gynecology – Landspítali University Hospital.
Key words: perinatal mortality, stillbirth, congenital anomaly, asphyxia, Nordic Baltic Perinatal Death Classification.
Correspondence: Ragnheiður I. Bjarnadóttir, ragnhib@landspitali.is