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Early neonatal mortality, asphyxia related deaths, and timing of low risk births in Hesse, Germany, 1990-8: observational study

BMJ 2000; 321 doi: (Published 29 July 2000) Cite this as: BMJ 2000;321:274
  1. Günther Heller (, assistant professora,
  2. Björn Misselwitz, public health researcherc,
  3. Stephan Schmidt, professor of gynaecology and obstetricsb
  1. a Institute of Medical Sociology and Social Medicine, Medical Centre of Methodology and Health Research, Philipps-University of Marburg, Medical School, D 35033 Marburg, Germany
  2. b Department of Obstetrics, Centre of Gynaecology and Obstetrics, Philipps-University of Marburg
  3. c Institute of Quality Assurance Hesse, D 65760 Eschborn, Germany
  1. Correspondence to: G Heller
  • Accepted 17 April 2000

A higher neonatal mortality related to intrapartum events during the night has been reported in Great Britain.1 2 We investigated whether the time of birth affects early neonatal mortality or deaths related to asphyxia in low risk births.

Participants, methods, and results

Data from the perinatal birth register of the federal state of Hesse, Germany, 1990-8, were used ( The register comprises detailed information about all infants born in birth clinics (more than 95% of all births in Hesse); about the mother, including the pregnancy; and about the delivery, as documented by the obstetrician in charge of the birth, using an evaluated standardised questionnaire comprising 67 items.3 Detailed information is available about the child's morbidity and reasons for death coded in 40 predefined categories adapted from ICD-9 (international classification of diseases, 9th revision).

Outcome events were deaths during labour or within the …

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