It is well known that monitoring of perinatal health in European countries by using the same methodogical criteria (harmonisation of definitions for gathering and calculation of the indicators) enables fair comparisons between countries. Croatia became a Euro-Peristat member very recently, two years ago and our perinatal data couldn't be included in the European Perinatal Health Reports (EPHR) on 2004 and 2010 births. However, participation in this EPHR 2015 has been very useful and the opportunity for comparison provides important information for the decision-making process among health policy-makers, managers and clinicians, especially obstetricians and neonatologists, for improving perinatal health care on the national level.

Below are the highlights from the EPHR 2015 which could help Croatian perinatologists and the Ministry of Health in future perinatal care planning:

1. The key indicators for measuring fetal and infant health outcomes in Croatia are worse than in many other members of the Euro-Peristat Network (EPN):

-          fetal mortality ≥24 gestational weeks was 4.3‰ (EPN median rate 3.4‰)

-          fetal mortality ≥28 gestational weeks was 3.2‰ (EPN median rate 2.7‰)

-          neonatal mortality ≥22 gestational age was 3.2‰ (EPN median rate 2.2‰)

-          early neonatal mortality ≥22 gestational age was 2.3‰ (EPN range 0.6‰ to 3.1‰)

-          late neonatal mortality ≥22 gestational age was 0.9‰ (EPN range 0.1‰ to 1.3‰)

-          infant mortality (cohort) was 3.8‰ (EPN median rate 3.1‰)

2. Premature birth, especially extreme prematuirty before 32 weeks of pregnancy, is closely related to poor perinatal outcome, including high mortality and long-term or permanent impairment. Consequently, it is important to know the proportion of premature births for the purpose of planning and the development of appropriate intensive neonatal care unit networks:

-          percentage of premature births <37 weeks of pregnancy was 6.5% of livebirths (EPN median rate 7.3%; range 5.4% to 12%)

-          percentage of very premature births <32 weeks of pregnancy was 0.9% (EPN range 0.8% to 1.4%)

-          percentage of low birth weight <2500 g was 5.1% (EPN range 4.2% to 10.6%)

3. Any death of a woman in pregnancy, childbirth or puerperium is recorded as maternal death, either due to direct causes (a disease or disorder directly related to pregnancy or childbirth) or indirect reasons (any cause related to or aggravated by the pregnancy like malignant or other chronic illness). It is considered that due to missing links between health and cause-of-death data systems, the number of deceased women in pregnancy, childbirth or puerperium can be underestimated. However, in Croatia, we have a link between these two systems and we can provide „enhanced“ data. Multiple linkage and matching is performed between death certificates, records from hospital discharge databases, medical birth databases and abortion databases of the Croatian Institute for Public Health:

-       maternal mortality ratio for direct and indirect causes of death in the period 2011-2015 was 5.5/100.000 livebirths (EPN range 0-24.7/100.000 livebirths)

Measures for improving maternal and perinatal health care in Croatia

Measures for improving maternal and perinatal health in Croatia are directed towards health promotion, prevention, early detection and treatment of complications in pregnancy as well as treatment of severe obstetric complications and severe disorders in newborns, very similar to other European countries.

It is questionable what to do for better perinatal outcomes and better perinatal care according to Croatian perinatal indicators published in EPHR 2015.

Strategic priorities in Croatia should be:

-         to maintain the low proportion of pregnant women who are overweight or obese and the low proportion of maternal smoking by developing health literacy (public awareness campaigns and health   information websites)

-         to maintain relatively low proportion of cesarean sections, using it according evidence-based standards and protocols

-         to establish a regional organization of perinatal care with the aim of reducing neonatal and infant mortality caused by immaturity and very low birth weight

-          to develop perinatal audit in order ensure adequate quality control and evaluation of perinatal care