The past 50 years has seen major changes in the organization and level of provision of obstetric services in Western Europe, North America, and Australia and New Zealand. Because of this, and other factors, such as improved population health, education, and housing, and advances in other areas of medicine such as blood transfusion and the management of diabetes, the perinatal mortality rate (PMR) fell rapidly in the second half of the 20th century. In the United Kingdom in 1958, the British Perinatal Mortality Survey reported a PMR of 33.2/1000 total births (Butler and Bonham 1963); it is currently <8/1000 total births [Confi-dential Enquiry into Maternal and Child Health (CEMACH) 2005]. The fall in intrapartum-related deaths has been even more dramatic, 10.2/1000 in 1958 compared to 0.53/1000 in 2002 (CEMACH 2005).

The effects of this decrease in intrapartum-related mortality are many. With so few deaths, the public perception is that there is no longer any risk to a mature baby from intrapartum events, to the extent that any intrapartum death must be someone's fault. An intrapartum death engenders diffi-culties for the obstetricians and midwives involved, even when procedures were entirely appropriate to the circumstances. The decrease in intrapartum-related mortality also means that pathologists, even those working with specialized or regional obstetric units, have little experience of these deaths, particularly where there is trauma.


Obstet Gynecol Birth Asphyxia Vacuum Extraction Breech Presentation Shoulder Dystocia 
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Copyright information

© Springer-Verlag London Limited 2007

Authors and Affiliations

  • Jean W. Keeling
    • 1
  1. 1.Infirmary of Edinburgh, University of EdinburghRoyal Hospital for Sick Children and RoyalEdinburghUK

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