Suboptimal care and perinatal mortality in ten European regions: methodology and evaluation of an international audit

Richardus, Jan Hendrik; Graafmans, Wilco C.; Bergsjø, Per; Lloyd, D. J.; Ls, Bakketeig; Bannon, Ed; Borkent-Polet, Marion; Davidson, L.; Defoort, Paul; Leitão, A. Esparteiro; Langhoff‐Roos, Jens; García, A.; Παπαντωνίου, Ν.; Wennergren, Margareta; Amelink-Verburg, M.P.; Verloove-Vanhorick, S.P.; Mackenbach, Johan P.

doi:10.1080/jmf.14.4.267.276

Cited by 24 publications

(14 citation statements)

References 3 publications

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“…Confidential enquiries and audits have investigated various aspects of perinatal morbidity and mortality but we are not aware of other research addressing the topic of this study in detail. It was not surprising to find many sub‐optimal factors, and it is possible that we may have overlooked important issues, as studies have suggested that adverse events and near misses in out‐of‐hospital care often go unreported .…”

Section: Discussionmentioning

confidence: 99%

Why babies die in unplanned out‐of‐institution births: an enquiry into perinatal deaths in Norway 1999–2013

Gunnarsson

Fasting

Skogvoll

et al. 2017

Acta Obstet Gynecol Scand

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IntroductionThe aims were to describe causes of death associated with unplanned out‐of‐institution births, and to study whether they could be prevented.Material and methodsRetrospective population‐based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out‐of‐institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions.Results63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub‐optimal care, involving 25 cases (40%), most commonly due to sub‐optimal maternal use of available care (n = 14, 22%).ConclusionsInfections, neonatal, and placental causes accounted for almost two‐thirds of perinatal mortality associated with unplanned out‐of‐institution births in Norway. Sub‐optimal maternal use of available care was found in more than one‐fifth of cases.

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Section: Discussionmentioning

confidence: 99%

Why babies die in unplanned out‐of‐institution births: an enquiry into perinatal deaths in Norway 1999–2013

Gunnarsson

Fasting

Skogvoll

et al. 2017

Acta Obstet Gynecol Scand

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“…The differences between epidemiology and audit imply several methodological challenges due to divergent opinions of optimal care depending on experts, nations, locations and over time [5,15]. Not all maternity units have the same facilities or tradition for management of obstetric emergencies.…”

Section: Discussionmentioning

confidence: 99%

“…Several epidemiological studies of risk factors such as maternal age (≥35years), overweight, high parity, previous cesarean section, mode of delivery and severe hemorrhage have been published [1–4], but in the individual case timely and proper management of severe complications at delivery are essential. Clinical audit is a way to evaluate patient care and outcomes by use of explicit criteria and guidelines and gives the possibility to use clinical assessment of less well defined criteria such as timely and proper management [5]. …”

Section: Introductionmentioning

confidence: 99%

“…This type of research has previously mainly been performed in perinatal and maternal deaths [5–8] and cesarean section [9]. We wanted to evaluate if some peripartum hysterectomies could have been avoided, assessed from a list of explicit criteria for the minimal mandatory medical and surgical interventions preceding hysterectomy together with a clinical evaluation of timely and proper management.…”

Section: Introductionmentioning

confidence: 99%

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Potentially Avoidable Peripartum Hysterectomies in Denmark: A Population Based Clinical Audit

2016

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ObjectiveTo audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means.Material and MethodsWe developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009–2012 and made short narratives of all cases.ResultsThe most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies.ConclusionMore than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.

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“…3Y5 The development of clinical practice guidelines is just one component of the drive toward improving standards in health care. 8 Cesarean section rates have been controversially and not universally accepted as a standard of care for obstetric practice. Registration of cancers in NSW has been mandatory since 1972, but data collection needs to be standardized and expanded to include data that are related to treatment and outcomes to allow reliable comparisons to be made between indicators of quality and performance of centers.…”

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confidence: 99%

Invited Commentary

Morris¹

2009

Diseases of the Colon &Amp; Rectum

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PURPOSE: To describe a methodology for surgical audit and feedback based on hospital-level indicators of the quality of colorectal cancer care.METHODS: Process and outcome indicators were identified from a population-based database (N = 3095 patients treated by 258 surgeons at 130 hospitals across New South Wales between February 1, 2000 and January 31, 2001). Hospitals were ranked on each indicator, with those in the lowest 20th percentile receiving a score of 0 and the remainder receiving a score of 1. Scores for individual indicators were then summed for each hospital and divided by the number of relevant indicators to provide an evidence-based score and a clinical outcome score.RESULTS: Ten process and six clinical outcome indicators were identified. Hospital-level summary scores ranged from 0.14 to 1.0 for evidence-based processes and from 0.17 to 1.0 for clinical outcomes. Evidence-based score and clinical outcome score were independent (r = 0.12, P = 0.32). There was a small positive association between evidence-based score and caseload (r = 0.33, P = 0.005) but clinical outcome score and caseload were unrelated (r = 0.11, P = 0.36).CONCLUSIONS: Evidence-based score and clinical outcome score address different aspects of quality of care. The wide variability of hospitals' outcome scores and an association of evidence-based score and caseload indicate that simple scores may be useful in audit and feedback.

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Suboptimal care and perinatal mortality in ten European regions: methodology and evaluation of an international audit

Abstract: The international audit procedure proved feasible and led to consistent results. The results that relate to suboptimal care will need to be studied in depth in order to reach conclusions about their implications for assessing the quality of perinatal care in the individual regions.

Cited by 24 publications

References 3 publications

Why babies die in unplanned out‐of‐institution births: an enquiry into perinatal deaths in Norway 1999–2013

Why babies die in unplanned out‐of‐institution births: an enquiry into perinatal deaths in Norway 1999–2013

Potentially Avoidable Peripartum Hysterectomies in Denmark: A Population Based Clinical Audit

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