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 number 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 anomalies have decreased considerably due to improvement in prenatal diagnosis. Stillbirths associated with growth restriction have decreased but stillbirths that are not associated with growth restriction have not. Thus it is important to emphasize that women seek medical attention when they experience decreased fetal movements.

 

Table I  The change in the NBPDC groups of perinatal death in the period. Groups IV and VII were not included because gestation length was under 28+0 weeks. Number of cases (n) is the combined deaths the whole period in each group.

 

Table II  Perinatal death 1988-2017. The number of children for every 1000 born that died in their perinatal period each year 1988-2017.

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