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Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit.

Richardus, Jan H; Graafmans, Wilco C; Verloove-Vanhorick, S Pauline; Mackenbach, Johan P; International Audit Panel:, EuroNatal; Bergsjø, Per; Lloyd, David J; Bakketeig, Leiv S; Bannon, Elizabeth M and Borkent-Polet, Marion, et al. (2003) In BJOG: An International Journal of Obstetrics & Gynaecology2000-01-01+01:00 110(2). p.97-105
Abstract
Objective



A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death.

Design



Retrospective audit study.

Setting



Regions of 10 European countries.

Population



1619 cases of perinatal death.

Methods



Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of... (More)
Objective



A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death.

Design



Retrospective audit study.

Setting



Regions of 10 European countries.

Population



1619 cases of perinatal death.

Methods



Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of gestational age), intrapartum deaths (28 or more weeks) and neonatal deaths (34 or more weeks). Deaths with (major) congenital anomalies were excluded. Cases were blinded for region and an international audit panel reviewed them using explicit audit criteria.

Main outcome measures



Presence of suboptimal factors.

Results



The audit covered 1619 cases of perinatal death, representing 90% of eligible cases in the regions. Consensus was reached on 1543 (95%) cases. In 715 (46%) of these cases, suboptimal factors, which possibly or probably had contributed to the fatal outcome, were identified. The percentage of cases with such suboptimal care factors was significantly lower in the Finnish and Swedish regions compared with the remaining regions of Spain, the Netherlands, Scotland, Belgium, Denmark, Norway, Greece and England. Failure to detect severe IUGR (10% of all cases) and smoking in combination with severe IUGR and/or placental abruption (12%) was the most frequent suboptimal factor. There was a positive association between the proportion of cases with suboptimal factors and the overall perinatal mortality rate in the regions.

Conclusions



The findings of this international audit suggest that differences exist between the regions of the 10 European countries in the quality of antenatal, intrapartum and neonatal care, and that these differences contribute to the explanation of differences in perinatal mortality between these countries. The background to these differences in quality of care needs further investigation. (Less)
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publishing date
type
Contribution to journal
publication status
published
subject
in
BJOG: An International Journal of Obstetrics & Gynaecology2000-01-01+01:00
volume
110
issue
2
pages
97 - 105
publisher
Wiley-Blackwell
external identifiers
  • scopus:0037331251
ISSN
1471-0528
DOI
10.1016/S1470-0328(02)02053-0
language
English
LU publication?
no
id
9af6d72b-6bcf-483b-8389-5bb71e582dd1 (old id 1126879)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/12618151
http://onlinelibrary.wiley.com/doi/10.1046/j.1471-0528.2003.02053.x/abstract
date added to LUP
2013-10-09 14:55:57
date last changed
2018-01-07 09:08:19
@article{9af6d72b-6bcf-483b-8389-5bb71e582dd1,
  abstract     = {Objective<br/><br>
<br/><br>
A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death.<br/><br>
Design<br/><br>
<br/><br>
Retrospective audit study.<br/><br>
Setting<br/><br>
<br/><br>
Regions of 10 European countries.<br/><br>
Population<br/><br>
<br/><br>
1619 cases of perinatal death.<br/><br>
Methods<br/><br>
<br/><br>
Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of gestational age), intrapartum deaths (28 or more weeks) and neonatal deaths (34 or more weeks). Deaths with (major) congenital anomalies were excluded. Cases were blinded for region and an international audit panel reviewed them using explicit audit criteria.<br/><br>
Main outcome measures<br/><br>
<br/><br>
Presence of suboptimal factors.<br/><br>
Results<br/><br>
<br/><br>
The audit covered 1619 cases of perinatal death, representing 90% of eligible cases in the regions. Consensus was reached on 1543 (95%) cases. In 715 (46%) of these cases, suboptimal factors, which possibly or probably had contributed to the fatal outcome, were identified. The percentage of cases with such suboptimal care factors was significantly lower in the Finnish and Swedish regions compared with the remaining regions of Spain, the Netherlands, Scotland, Belgium, Denmark, Norway, Greece and England. Failure to detect severe IUGR (10% of all cases) and smoking in combination with severe IUGR and/or placental abruption (12%) was the most frequent suboptimal factor. There was a positive association between the proportion of cases with suboptimal factors and the overall perinatal mortality rate in the regions.<br/><br>
Conclusions<br/><br>
<br/><br>
The findings of this international audit suggest that differences exist between the regions of the 10 European countries in the quality of antenatal, intrapartum and neonatal care, and that these differences contribute to the explanation of differences in perinatal mortality between these countries. The background to these differences in quality of care needs further investigation.},
  author       = {Richardus, Jan H and Graafmans, Wilco C and Verloove-Vanhorick, S Pauline and Mackenbach, Johan P and International Audit Panel:, EuroNatal and Bergsjø, Per and Lloyd, David J and Bakketeig, Leiv S and Bannon, Elizabeth M and Borkent-Polet, Marion and Davidson, Leslie L and Defoort, Paul and Esparteiro Leitão, Amélia and Langhoff-Roos, Jens and Moral Garcia, Angel and Papantoniou, Niko E and Wennergren, Margareta and Working Group:, EuroNatal and Aelvoet, Willem and Bødker, Birgit and Lindmark, Gunilla and Penney, Gillian and Macfarlane, Alison and Rantakalli, Paula and Hartikainen, Anna-Liisa and Gissler, Mika and Bakoula, Chryssa and Lekea, Vasso and van der Pal, Karin and Amelink-Verburg, Marianne and Holt, Jan and Rebagliato, Marisa and Bolumar, Francisco},
  issn         = {1471-0528},
  language     = {eng},
  number       = {2},
  pages        = {97--105},
  publisher    = {Wiley-Blackwell},
  series       = {BJOG: An International Journal of Obstetrics & Gynaecology2000-01-01+01:00},
  title        = {Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit.},
  url          = {http://dx.doi.org/10.1016/S1470-0328(02)02053-0},
  volume       = {110},
  year         = {2003},
}