Perinatal death beyond 41 weeks pregnancy: an evaluation of causes and substandard care factors as identified in perinatal audit in the Netherlands

ObjectiveTo assess the implementation and first results of a term perinatal internal audit by a standardised method.DesignPopulation-based cohort study.SettingAll 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG).PopulationThe population consisted of 943 registered term perinatal deaths occurring in 2010–2012 with detailed information, including 707 cases with completed audit results.Main outcome measuresParticipation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour.ResultsAfter the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001).ConclusionsThe perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality.

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Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2464-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Solveig Bjellmo ◽

Sissel Hjelle ◽

Lone Krebs ◽

Elisabeth Magnussen ◽

Torstein Vik

Keyword(s):

Caesarean Delivery ◽

Case Control Study ◽

Perinatal Death ◽

Population Based ◽

Case Control ◽

Case Group ◽

National Guidelines ◽

Breech Delivery ◽

Perinatal Audit ◽

Control Study

Abstract Background In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. Material and methods Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. Results Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. Conclusion All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.

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

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.3109/00016340903280990 ◽

2009 ◽

Vol 88 (11) ◽

pp. 1201-1208 ◽

Cited By ~ 11

Author(s):

Paul De Reu ◽

Mariet Van Diem ◽

Martine Eskes ◽

Herman Oosterbaan ◽

Luc Smits ◽

...

Keyword(s):

The Netherlands ◽

Feasibility Study ◽

Perinatal Audit ◽

Audit Project

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A qualitative perinatal audit at a rural health facility in Eldoret, Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20200413 ◽

2020 ◽

Vol 7 (2) ◽

pp. 449

Author(s):

Kimbley Omwodo

Keyword(s):

Rural Health ◽

Perinatal Mortality ◽

Health Facility ◽

Perinatal Death ◽

Gestational Hypertension ◽

Medical Condition ◽

World Health ◽

Maternal Condition ◽

Perinatal Deaths ◽

Perinatal Audit

Background: Objectives of the study were to ascertain the pattern of occurrence of perinatal mortality by applying the World Health Organization (WHO), International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period, ICD perinatal mortality (ICD-PM), following the introduction of a qualitative perinatal audit process at a rural health facility in Kenya.Methods: A single centre retrospective analysis demonstrating the application of the WHO, ICD-PM. Data pertaining to perinatal deaths for the period from 1st May 2017 to 31st August 2018 was obtained from Plateau Mission Hospital perinatal audit records.Results: There were 22 perinatal deaths during the study period, 17 were included in the study. The overall perinatal death rate was 11 per 1000 births. Antepartum deaths were as a consequence of fetal growth related problems (33.3%), infection (33.3%) or unexplained (33.3%) with pregnancy-related hypertensive disorders (gestational hypertension, pre-eclampsia and eclampsia) being the most frequent medical condition associated with the mortalities. Neonatal deaths (47.1%) were the most frequent in the study and were a consequence of low birth weight and prematurity (25.0%), Convulsions and disorders of cerebral status (25.0%). The maternal condition in most of these cases being complications of placenta, cord and membranes. Acute intrapartum events and were least in this setting accounting for 17.4% of deaths.Conclusions: The ICD-PM is generalizable and its use in perinatal death classification emphasises focus on both mother and baby. Our study showed the majority of perinatal deaths occurred in the early neonatal period & affected mostly preterm infants.

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Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.2008.01702.x ◽

2008 ◽

Vol 115 (6) ◽

pp. 732-736 ◽

Cited By ~ 82

Author(s):

JM Schutte ◽

NWE Schuitemaker ◽

J van Roosmalen ◽

EAP Steegers ◽

Keyword(s):

The Netherlands ◽

Maternal Mortality ◽

Hypertensive Disease ◽

Substandard Care ◽

In Pregnancy

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Future options to reduce RhD immunization in addition to a high coverage prevention program of antenatal and postnatal RhIg: a nationwide cohort study

10.22541/au.162689910.05228720/v1 ◽

2021 ◽

Author(s):

Yolentha Slootweg ◽

Carolien Zwiers ◽

Johanna Koelewijn ◽

Ellen van der Schoot ◽

Dick Oepkes ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

The Netherlands ◽

Perinatal Death ◽

Significant Risk ◽

Surgical Removal ◽

Additional Risk Factor ◽

Miscarriage Rate ◽

High Coverage ◽

Surgical Interventions

Objective: To evaluate which risk factors for RhD immunization remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. Assessment of the prevalence of RhD immunizations. Design: Prospective cohort Setting: The Netherlands. Population: Two-year nationwide cohort. Methods: RhD-negative women in their first RhD immunized pregnancy and their foregoing non-immunized pregnancy. Risk factors for RhD immunization were compared with population data. Main outcomes measures: Risk factors for FMH and subsequently RhD immunization, prevalence of RhD immunizations. Results: The prevalence of newly detected RhD immunizations was 0.31% (79/25,170) of all RhD-negative pregnant women in the Netherlands. After exclusion, 193 women remained. Significant risk factors found in the group of 113 parous women (previous pregnancy >16 weeks, RhD positive child) were; caesarean section (CS) (OR 1.7, 95% CI 1.1-2.6), perinatal death (OR 3.5, 95% CI 1.1-10.9), gestational age over 42 weeks (OR 6.1, 95% CI 2.2-16.6), postnatal bleeding (>1000mL) (OR 2.0 95% CI 1.1-3.6), surgical removal of the placenta (SRP) (OR 4.3, 95% CI 2.0-9.3). The miscarriage rate in the group of women without a previous RhD positive child was significantly higher than in the Dutch population (35% vs 12.5% p<0.001). Conclusion: Complicated deliveries, including cases of major bleeding and surgical interventions (CS, SRP) need to be recognized as risk factor, requiring determination of FMH volume and adjustment of RhIg dosing. Miscarriage may be an additional risk factor for RhD immunization, requiring further studies. Funding: This research was partly funded by a grant from Sanquin Amsterdam.

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