Warwickshire Area Health Authority

The utility and validity of perinatal mortality rates (PNMR) as indicators of the quality of health care services are analysed. A major determinant of the PNMR is the birthweight distribution, and this may be determined in a large part through social factors rather than health care services. A means of standardizing the PNMR according to birthweight, in the same way that an SMR is standardized according to the age and sex distribution of a popu-lation, is proposed and demonstrated. The particular advantages and problems arising from the use of the method are presented. Means of further improvement are identified. The perinatal mortality rate (PNMR) is widely used as an indicator of the quality of obstetric and early neonatal care. Thus, the Court Committee1 based several of its conclusions upon the PNMR, making comparisons between different parts of the United Kingdom and between this and other countries. Unfortunately, usage of the PNMR fails to discriminate obstetric and paediatric factors on the one hand and socioeconomic factors on the other. Among other effects, the latter strongly influence the proportion of premature infants, which in turn strongly influences the stillbirth and neonatal death rates.2 In view of the caution with which other crude mortality data are generally treated bot