Stillbirths in Western Australia 1980–1983: Influence of Race, Residence and Place of Birth

EDITORIAL COMMENT: The stillbirth rate in Western Australia for infants with birth‐weights of at least 1,000 g is commendably low at only 4.91 per 1,000 births. The authors' analysis shows that stillbirths of unknown cause are the largest group (table 3), and most of these occur at term, but before labour (table 2b). We respectfully disagree with the authors' comment that because these deaths are of unknown cause, that few are potentially avoidable/preventable by better obstetric care. The table below shows the neonatal death and stillbirth rates for Victoria for infants with birth‐weight of 1,000 g or more. Although the death rates have not reduced significantly in the past 2 years we believe that further improvement is possible; even if the stillbirth rates in Western Australia for 1984, 1985 and 1986 are the same as for 1983, we should not be prepared to accept that the limits of current obstetric care to favourably influence stillbirth rates have been reached. It should be stressed that this large group of stillbirths of ‘unknown cause’ occur in potentially salvageable infants who are mature and not malformed. The research required to prevent a significant proportion of these deaths may be no more than routine testing of glucose tolerance to diagnose all cases of gestational diabetes. Summary: All stillbirths in Western Australia from 1980–83 weighing 1,000 g and over were identified from perinatal death certificates, and their causes and demographic correlates described. The stillbirth rate was 4.91 per 1,000 total births; nearly 65% were antepartum, 25% intrapartum and in 10% the time of death was unknown. The cause of death of most stillbirths was unknown (52%) or associated with lethal congenital malformations (13%), antepartum haemorrhage (12%) or maternal hypertension (8%). Whilst Aboriginal women had much higher stillbirth rates (10.80) than non‐Aboriginal women (4.57), their patterns of time and causes of death were similar. Both antepartum and intrapartum stillbirth rates were much higher at low birth‐weights and low gestational ages in both racial groups. Women living in rural areas who delivered in the metropolitan area had much higher antepartum (11.02) and intrapartum (3.31) stillbirth rates than either rural women delivering in rural areas (1.89 and 1.34) or metropolitan women delivering in the metropolitan area (2.72, 0.98). This reflects the transfer of rural high risk pregnant women or those with fetal death in utero, for delivery in metropolitan specialist hospitals.