Portal de Periódicos da CAPES

Stillbirth in France

2014; Elsevier BV; Volume: 384; Issue: 9955 Linguagem: Inglês

10.1016/s0140-6736(14)62032-8

1474-547X

A. Serfaty,

Demographic Trends and Gender Preferences

Between 1901 and 2001, stillbirth rates in France decreased from 35 stillbirths per 1000 births to 4·8 stillbirths per 1000.1Institut national de la statistique et des études économiquesStillbirth rate by mother age per year.http://www.insee.fr/fr/themes/detail.asp?ref_id=ir-sd2005&page=irweb/sd2005/dd/sd2005_fecmort.htmDate: 2011Google Scholar However, in 2002, this rate increased to 8·2 stillbirths per 1000 births, probably because of the use of WHO thresholds for civil registration, switching from a gestational age of 28 weeks of gestation to 22 weeks in November, 2001. In 2010, stillbirth rate in France (9·2 per 1000 births) was deemed to be the highest in Europe.2Zeitlin J Mohangoo AD Delnord M Cuttini M The second European Perinatal Health Report: documenting changes over 6 years in the health of mothers and babies in Europe.J Epidemiol Community Health. 2013; 67: 983-985Crossref PubMed Scopus (62) Google Scholar Nevertheless, gestational age and birthweight are not included in civil registration, and registering stillbirths from 15 weeks of gestation, depending on parents' requests, since August, 2008, might explain why reliable stillbirth rates could not be calculated from civil registration data.To overcome this difficulty, French authorities stated that stillbirths must be registered through the hospital discharge data system. From March, 2011, a gestational age of 22 weeks or more, or a birthweight of 500 grams or more, are the criteria for stillbirth inclusion.3Ministère de la SantéInstruction DGS/DGOS/DREES/MC1/R3/BESC n° 2011-403 du 26 octobre 2011 relative au rappel des modalités d'enregistrement et de codage des mort-nés dans le PMSI nécessaires à la production de l'indicateur de mortinatalité.http://www.sante.gouv.fr/fichiers/bo/2011/11-12/ste_20110012_0100_0076.pdfGoogle ScholarThe NéMoSI project was launched in 2010–11 to improve stillbirth recording. Analyses of stillbirths recording throughout hospital discharge data started at Trousseau Hospital, Paris, in 2010, and in Academic Hospitals of eastern Paris, and pointed out that the 2011 recording stillbirth guidelines3Ministère de la SantéInstruction DGS/DGOS/DREES/MC1/R3/BESC n° 2011-403 du 26 octobre 2011 relative au rappel des modalités d'enregistrement et de codage des mort-nés dans le PMSI nécessaires à la production de l'indicateur de mortinatalité.http://www.sante.gouv.fr/fichiers/bo/2011/11-12/ste_20110012_0100_0076.pdfGoogle Scholar did not seem sufficient for stakeholders to distinguish stillbirth registration for epidemiology purposes from voluntary civil registration for families' right purposes (ie, family register, burial). Good quality and exhaustive data were not systematically integrated into practices.4Serfaty A Benifla JL What can be able to expect in stillbirth registration in Hospital Discharge Data System? A feedback from Armand Trousseau Hospital (Paris). (in French).J Gynecol Obstet Biol Reprod. 2012; 42: 101-104Crossref PubMed Scopus (5) Google ScholarThe NéMoSI project was later extended around Paris (eastern Paris in 2011, all Assistance Publique-Hôpitaux de Paris birth sites in 2012, Seine Saint Denis in 2012–13, and Val d'Oise in 2014). It covers about 85 000 births and 900 stillbirths per year, and contributed to reclassify as stillbirths mis-recorded births, register unrecorded stillbirths, type of pregnancy (eg, medical termination), and specify fetal death circumstances.These observations, and The Lancet stillbirth Series, point out that computing stillbirth rates remains a challenge for clear international comparison.4Serfaty A Benifla JL What can be able to expect in stillbirth registration in Hospital Discharge Data System? A feedback from Armand Trousseau Hospital (Paris). (in French).J Gynecol Obstet Biol Reprod. 2012; 42: 101-104Crossref PubMed Scopus (5) Google Scholar, 5Lawn JE Blencowe H Pattinson R et al.Stillbirths: where? When? Why? How to make the data count?.Lancet. 2011; 377: 1448-1463Summary Full Text Full Text PDF PubMed Scopus (506) Google Scholar Reliable data are essential to estimate health risks. To raise awareness about these issues among families, health professionals, and authorities, and consider regulations related to stillbirth, livebirths, and voluntary or medical interruptions of pregnancy are necessary to improve data quality for international comparisons.I thank the Parisian Health Regional Agency and Paris Public Hospitals. I particularly thank the NéMoSI project team. I declare no competing interests. Between 1901 and 2001, stillbirth rates in France decreased from 35 stillbirths per 1000 births to 4·8 stillbirths per 1000.1Institut national de la statistique et des études économiquesStillbirth rate by mother age per year.http://www.insee.fr/fr/themes/detail.asp?ref_id=ir-sd2005&page=irweb/sd2005/dd/sd2005_fecmort.htmDate: 2011Google Scholar However, in 2002, this rate increased to 8·2 stillbirths per 1000 births, probably because of the use of WHO thresholds for civil registration, switching from a gestational age of 28 weeks of gestation to 22 weeks in November, 2001. In 2010, stillbirth rate in France (9·2 per 1000 births) was deemed to be the highest in Europe.2Zeitlin J Mohangoo AD Delnord M Cuttini M The second European Perinatal Health Report: documenting changes over 6 years in the health of mothers and babies in Europe.J Epidemiol Community Health. 2013; 67: 983-985Crossref PubMed Scopus (62) Google Scholar Nevertheless, gestational age and birthweight are not included in civil registration, and registering stillbirths from 15 weeks of gestation, depending on parents' requests, since August, 2008, might explain why reliable stillbirth rates could not be calculated from civil registration data. To overcome this difficulty, French authorities stated that stillbirths must be registered through the hospital discharge data system. From March, 2011, a gestational age of 22 weeks or more, or a birthweight of 500 grams or more, are the criteria for stillbirth inclusion.3Ministère de la SantéInstruction DGS/DGOS/DREES/MC1/R3/BESC n° 2011-403 du 26 octobre 2011 relative au rappel des modalités d'enregistrement et de codage des mort-nés dans le PMSI nécessaires à la production de l'indicateur de mortinatalité.http://www.sante.gouv.fr/fichiers/bo/2011/11-12/ste_20110012_0100_0076.pdfGoogle Scholar The NéMoSI project was launched in 2010–11 to improve stillbirth recording. Analyses of stillbirths recording throughout hospital discharge data started at Trousseau Hospital, Paris, in 2010, and in Academic Hospitals of eastern Paris, and pointed out that the 2011 recording stillbirth guidelines3Ministère de la SantéInstruction DGS/DGOS/DREES/MC1/R3/BESC n° 2011-403 du 26 octobre 2011 relative au rappel des modalités d'enregistrement et de codage des mort-nés dans le PMSI nécessaires à la production de l'indicateur de mortinatalité.http://www.sante.gouv.fr/fichiers/bo/2011/11-12/ste_20110012_0100_0076.pdfGoogle Scholar did not seem sufficient for stakeholders to distinguish stillbirth registration for epidemiology purposes from voluntary civil registration for families' right purposes (ie, family register, burial). Good quality and exhaustive data were not systematically integrated into practices.4Serfaty A Benifla JL What can be able to expect in stillbirth registration in Hospital Discharge Data System? A feedback from Armand Trousseau Hospital (Paris). (in French).J Gynecol Obstet Biol Reprod. 2012; 42: 101-104Crossref PubMed Scopus (5) Google Scholar The NéMoSI project was later extended around Paris (eastern Paris in 2011, all Assistance Publique-Hôpitaux de Paris birth sites in 2012, Seine Saint Denis in 2012–13, and Val d'Oise in 2014). It covers about 85 000 births and 900 stillbirths per year, and contributed to reclassify as stillbirths mis-recorded births, register unrecorded stillbirths, type of pregnancy (eg, medical termination), and specify fetal death circumstances. These observations, and The Lancet stillbirth Series, point out that computing stillbirth rates remains a challenge for clear international comparison.4Serfaty A Benifla JL What can be able to expect in stillbirth registration in Hospital Discharge Data System? A feedback from Armand Trousseau Hospital (Paris). (in French).J Gynecol Obstet Biol Reprod. 2012; 42: 101-104Crossref PubMed Scopus (5) Google Scholar, 5Lawn JE Blencowe H Pattinson R et al.Stillbirths: where? When? Why? How to make the data count?.Lancet. 2011; 377: 1448-1463Summary Full Text Full Text PDF PubMed Scopus (506) Google Scholar Reliable data are essential to estimate health risks. To raise awareness about these issues among families, health professionals, and authorities, and consider regulations related to stillbirth, livebirths, and voluntary or medical interruptions of pregnancy are necessary to improve data quality for international comparisons. I thank the Parisian Health Regional Agency and Paris Public Hospitals. I particularly thank the NéMoSI project team. I declare no competing interests.