Natural fetal deaths high in Central Va.

Central Virginia was one of six areas in the state with the highest rates of natural fetal deaths in 2006.

Planning District 11, which includes Central Virginia, had more than 230 fetuses born dead among the 2,600-plus live births — a rate of 4.66 per 1,000 women ages 15 to 44 — which was the lowest among the six areas singled out.

The highest was Planning District 22, the Hampton Roads area, with a rate of 8.25, according to “Vital Times” for August-October, published online by the Virginia Department of Health (VDH). Planning District 5, the Roanoke Valley, was also in the high group with a rate of 5.50.

Natural deaths are described as any fetus delivered without having been alive outside the mother’s womb. The number does not include induced terminations.

Although fetal mortality rates vary yearly — and early estimates for 2007 show a slightly higher rate, 5.03 for Central Virginia — the rise comes despite intense local efforts to reduce the rate.

Kim Price, Centra director of Women and Children’s Services, said the 2006 rate was not a statistically significant change compared to earlier years, but “we’re certainly not where we want to be.”

In this decade, area fetal death rates have ranged from a high of 6.07 in 2000 to a low of 4.37 in 2005.

Centra has been home base for the South Central Regional Perinatal Council for a number of years. The councils are lead agencies for the state system of perinatal regions. (Perinatal means the time around birth.) The councils have an ongoing role in coordinating systems of care and developing ways to improve care and education.

As of July this year, VDH began a realignment of the regions by health district, and Central Virginia will be one of six to come under the umbrella of The University of Virginia as lead perinatal regional agency.

The change is not in response to problems in the realigned areas, said Kathleen Moline, policy analyst for the VDH Division of Women and Infants’ Health.

In re-evaluating, health planners looked at the efficiencies, the number of births, fetal and infant deaths, “and saw an opportunity to group things a little differently to meet the needs of mothers and fathers,” said Moline. In some cases, region lines had partially crossed health district lines, making perinatal data collection difficult.

UVa is the lead agency for the new West Central Perinatal Region, but will likely subcontract with Centra, though details aren’t complete, said UVa’s Sharon T. Veith.

UVa and Centra Virginia Baptist Hospital, “already have a working relationship, which we hope will be strengthened through the realignment process,” said Veith in response to e-mail questions. “We also hope to strengthen relationships between all of the hospitals in the newly formed region.”

Current referral patterns for high-risk mothers will not change.

Centra will likely continue to have Regional Perinatal Council. Area residents may be familiar with the local council’s many efforts that include BABE store and Community Voice, which is a healthy baby outreach program, and the national Back To Sleep program.

The councils bring in a diverse group of people and are “a great set of eyes and ears as to what is going on out there, what are the issues,” said Moline. Because of the diversity, they can look at social, economic, health, poverty and education and come up with plans to decrease death and illness.

One of the critical pieces is that every region now must have a Fetal Infant Mortality Review (FIMR) team, said Veith.

Centra’s FIMR team studies every fetal death in Central Virginia in an attempt to identify any gaps in care, or factors in the community that may impact pregnant women or deter them from seeking prenatal care.

No single factor seems to be the culprit. It’s very frustrating as well as challenging, said Price. A pregnant woman who loses a baby may have done everything right.

Central Virginia generally does well in comparison with other localities, said Kristin Austin, data analyst for the VDH division of Women’s and Infant’s Health. But the area does have almost double the rate of cigarette smoking as other regions in the state. The Sudden Unexplained Death in Infancy (SUDI) rate is also slightly above the state’s SUDI rate for 2006, said Austin.

“Overall, this region has fewer problems,” she said. Other regions have significantly higher occurrences of perinatal concerns such as abortion rates, high fetal death, low infant birth rate, and very large racial disparities in infant death rates.

For more information:

http://www.vdh.state.va.us/healthstats/stats.asp

http://www.vahealth.org/perinatalcouncils/