{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T23:11:27Z","timestamp":1770505887343,"version":"3.49.0"},"reference-count":10,"publisher":"BMJ","issue":"6881","license":[{"start":{"date-parts":[[1993,3,27]],"date-time":"1993-03-27T00:00:00Z","timestamp":733190400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1993,3,27]]},"abstract":"<jats:p>OBJECTIVE--To evaluate perinatal mortality rates as a method of auditing obstetric and neonatal care after account had been taken of transfer between hospitals during pregnancy and case mix. DESIGN--Case-control study of perinatal deaths. SETTING--Leicestershire health district. SUBJECTS--1179 singleton perinatal deaths and their selected live born controls among 114,362 singleton births to women whose place of residence was Leicestershire during 1978-87. MAIN OUTCOME MEASURE--Crude perinatal mortality rates and rates adjusted for case mix. RESULTS--An estimated 11,701 of the 28,750 women booked for delivery in general practitioner maternity units were transferred to consultant units during their pregnancy. These 11,701 women had a high perinatal mortality rate (16.8\/1000 deliveries). Perinatal mortality rates by place of booking showed little difference between general practitioner units (8.8\/1000) and consultant units (9.3-11.7\/1000). Perinatal mortality rates by place of delivery, however, showed substantial differences between general practitioner units (3.3\/1000) and consultant units (9.4-12.6\/1000) because of the selective referral of high risk women from general practitioner units to consultant units. Adjustment for risk factors made little difference to the rates except when the subset of deaths due to immaturity was adjusted for birth weight. CONCLUSION--Perinatal mortality rates should be adjusted for case mix and referral patterns to get a meaningful result. Even when this is done it is difficult to compare the effectiveness of hospital units with perinatal mortality rates because of the increasingly small subset of perinatal deaths that are amenable to medical intervention.<\/jats:p>","DOI":"10.1136\/bmj.306.6881.824","type":"journal-article","created":{"date-parts":[[2009,3,30]],"date-time":"2009-03-30T08:16:37Z","timestamp":1238400997000},"page":"824-827","source":"Crossref","is-referenced-by-count":15,"title":["Evaluating perinatal mortality rates: effects of referral and case mix."],"prefix":"10.1136","volume":"306","author":[{"given":"M","family":"Clarke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E S","family":"Mason","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"MacVicar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D G","family":"Clayton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,3,27]]},"reference":[{"key":"ref_1","article-title":"Report on confidential enquiries into maternal deaths in England and Wales 1979-1981","author":"Department of Health and Social Security","year":"1986","unstructured":"Department of Health and Social Security. Report on confidential enquiries into maternal deaths in England and Wales 1979-1981. London: HMSO, 1986."},{"key":"ref_2","article-title":"Working group on the confidential enquiry into stillbirths and deaths in infancy. Report of the working group set up by the chief medical officer","year":"1990","unstructured":"Working group on the confidential enquiry into stillbirths and deaths in infancy. Report of the working group set up by the chief medical officer. London: Department of Health, 1990."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1136\/bmj.297.6645.384","article-title":"Asian mothers' risk of perinatal death-the same or different? A 10 year review of Leicestershire perinatal deaths","volume":"297","author":"Clarke, M.; Clayton, D.G.; Mason, E.S.; MacVicar, J.","year":"1988","unstructured":"Clarke M, Clayton DG, Mason ES, MacVicar J. Asian mothers' risk of perinatal death-the same or different? A 10 year review of Leicestershire perinatal deaths. BMJ 1988;297:384-7.","journal-title":"BMJ"},{"key":"ref_4","first-page":"1198","article-title":"Logistic regression analysis and efficient design for two stage studies","volume":"128","author":"Cain, K.C.; Breslow, N.E.","year":"1988","unstructured":"Cain KC, Breslow NE. Logistic regression analysis and efficient design for two stage studies.AmJEpidemiol 1988;128:1198-206.","journal-title":"AmJEpidemiol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/S0140-6736(80)92717-8","article-title":"Monitoring perinatal mortality: a pathophysiological approach","volume":"ii:","author":"Wigglesworth, J.","year":"1980","unstructured":"Wigglesworth J. Monitoring perinatal mortality: a pathophysiological approach. Lancet 1980;ii:684-6.","journal-title":"Lancet"},{"key":"ref_6","article-title":"Introductory notes on lying-in institutions","author":"Nightingale, F.","year":"1871","unstructured":"Nightingale F. Introductory notes on lying-in institutions. London: Longmans, Green, 1871."},{"key":"ref_7","article-title":"The report of the National Confidential Enquiry into Penoperative Deaths 1990","author":"Campling, E.A.; Devlin, H.B.; Hoile, R.W.; Lunn, J.N.","year":"1992","unstructured":"Campling EA, Devlin HB, Hoile RW, Lunn JN. The report of the National Confidential Enquiry into Penoperative Deaths 1990. London: National Confidential Enquiry into Perioperative Deaths, 1992."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/00005650-198904000-00001","article-title":"The condition of the literature on differences in hospital mortality","volume":"27","author":"Fink, A.; Yano, E.M.; Brook, R.H.","year":"1989","unstructured":"Fink A, Yano EM, Brook RH. The condition of the literature on differences in hospital mortality. Med Care 1989;27:315-36.","journal-title":"Med Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1136\/bmj.289.6447.721","article-title":"Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery","volume":"289","author":"Campbell, R.; MacDonald Davies, I.; Macfarlane, A.; Beral, V.","year":"1984","unstructured":"Campbell R, MacDonald Davies I, Macfarlane A, Beral V. Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery. BMJ 1984;289:721-4.","journal-title":"BMJ"},{"key":"ref_10","first-page":"390","article-title":"Place of birth and perinatal mortality","volume":"35","author":"Tew, M.","year":"1985","unstructured":"Tew M. Place of birth and perinatal mortality. J R Coll Gen Pract 1985;35: 390-4.","journal-title":"J R Coll Gen Pract"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.306.6881.824","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.306.6881.824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T17:08:11Z","timestamp":1766423291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.306.6881.824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,3,27]]},"references-count":10,"journal-issue":{"issue":"6881","published-online":{"date-parts":[[1993,3,27]]},"published-print":{"date-parts":[[1993,3,27]]}},"alternative-id":["10.1136\/bmj.306.6881.824"],"URL":"https:\/\/doi.org\/10.1136\/bmj.306.6881.824","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1993,3,27]]}}}