The Dutch Perinatal Audit Project: a feasibility study for nationwide perinatal audit in the Netherlands

Reu, Paul De; Diem, Mariet van; Eskes, Martine; Oosterbaan, Herman P.; Smits, Luc; Merkus, Hans M.W.M.; Nijhuis, Jan G.

doi:10.1080/00016340903280990

Cited by 4 publications

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“…First, perinatal audits should include travel time to the hospital in their inquiries to determine if travel time to the healthcare centre is an aetiological factor, and to understand how travel time could have influenced the potential substandard care delivered to women 28,29 …”

Section: Discussionmentioning

confidence: 99%

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

Ravelli

Jager

Groot

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

129

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Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care.Design Population-based cohort study from 2000 up to and including 2006.Setting The Netherlands Perinatal Registry.Population A total of 751 926 singleton term hospital births. MethodsWe assessed the impact of travel time by car, calculated from the postal code of the woman's residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used.Main outcome measures Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit). ResultsThe mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time ( ‡20 minutes) and total mortality (OR 1.17, 95% CI 1.002-1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13-2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17-1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81-2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29-1.80) increased the risk of mortality.Conclusions A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care.

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Section: Discussionmentioning

confidence: 99%

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

Ravelli

Jager

Groot

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

129

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“…Perinatal audits have been shown to be efficient in the Netherlands, where perinatal mortality in 1999 was ranked the highest (11.4/ 1000) among the 25 countries of the European Union. 43,44 The use of clinical dashboards for monitoring and presenting regular healthcare performance is gaining popularity. Clinical dashboards may be useful in predicting trends in various clinical governance parameters, enabling immediate action to be taken to rectify patient safety issues.…”

Section: Discussionmentioning

confidence: 99%

How often is a low Apgar score the result of substandard care during labour?

Berglund

Pettersson

Cnattingius

et al. 2010

BJOG

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ObjectiveTo increase our knowledge of the occurrence of substandard care during labour.DesignA population-based case–control study.SettingStockholm County.PopulationInfants born in the period 2004–2006 in Stockholm County.MethodsCases and controls were identified from the Swedish Medical Birth Register, had a gestational age of ≥33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of <7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth.Main outcome measureSubstandard care during labour.ResultsWe found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for ≥45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated. Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care.ConclusionsThere was substandard care during labour of two-thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

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“…Underreporting of late neonatal death was a serious concern in the database. 6 A more recent study 12 showed that 7.1% of late perinatal deaths were not reported in the PRN. Although only 48-68% of paediatric practices participated in PRN, 100% of academic paediatric practices are included (www.perinatreg.nl).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Caesarean section rates in subgroups of women and perinatal outcomes

Zhang

Geerts

Hukkelhoven

et al. 2015

BJOG

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Objectives To identify factors that are associated with a relatively low caesarean section (CS) rate by examining the CS rate in various subgroups in the Netherlands.Design Cross-sectional analysis.Settings the Netherlands. Methods A modified classification system for CS was used to categorise all women into ten groups. Labour management, mode of delivery, maternal and neonatal morbidity and mortality were assessed according to these ten groups.Main outcome measures Caesarean section, labour induction, instrumental delivery, postpartum haemorrhage, perineal laceration, duration of second stage of labour, Apgar score, fetal and neonatal mortality.Results Total CS rate was 15.6%. Term, nulliparous and parous women with a singleton pregnancy of a fetus in cephalic position and spontaneous onset of labour had CS rates of 9.6 and 1.9% and instrumental birth rates of 19.4 and 2.4%, respectively; 17.3% of births were induced. Among women with a previous CS and term, singleton pregnancies with a fetus in cephalic presentation, 71% had trial of labour, of which 75% had a successful vaginal birth. Of women with multiple gestation, 43% had CS. Women with CS due to 'failure to progress' in the second stage of labour had a median duration of second-stage pushing of almost 2 hours in nulliparas and >90 minutes in parous women.Conclusions Several obstetric practice patterns may have contributed to the relatively low overall CS rate in the Netherlands: a relatively low CS rate in term, singleton pregnancies of a fetus in cephalic position and spontaneous onset of labour, relatively low rate of labour induction, a high rate of a trial of labour after a previous CS, the use of vacuum and forceps, and a high proportion of women being taken care of by midwives.Keywords Caesarean section, classification, labour, maternal, the Netherlands.Tweetable abstract The Netherlands has several practice patterns that may have contributed to its relatively low CS rate.

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The Dutch Perinatal Audit Project: a feasibility study for nationwide perinatal audit in the Netherlands

Cited by 4 publications

References 0 publications

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

How often is a low Apgar score the result of substandard care during labour?

Caesarean section rates in subgroups of women and perinatal outcomes

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