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

Richardus, J H; Graafmans, W C; Bergsjö, P; Lloyd, D J; Bakketeig, L S; Bannon, E M; Borkent-Polet, M; Davidson, L L; Defoort, P and Esparteiro Leitao, A, et al. (2003) In Journal of Maternal-Fetal & Neonatal Medicine 14(4). p.267-276
Abstract
Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results.

Methods: Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified. The categories of death chosen for the study were singleton fetal deaths at 28 or more weeks of gestational age, all intrapartum deaths at 28 or more weeks of gestational age and neonatal deaths at 34 or more weeks of gestational age. Deaths with major congenital anomalies were excluded. An international audit panel used explicit criteria to review all cases, which were blinded... (More)
Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results.

Methods: Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified. The categories of death chosen for the study were singleton fetal deaths at 28 or more weeks of gestational age, all intrapartum deaths at 28 or more weeks of gestational age and neonatal deaths at 34 or more weeks of gestational age. Deaths with major congenital anomalies were excluded. An international audit panel used explicit criteria to review all cases, which were blinded for region. Subjective interpretation was used in cases of events or interventions where explicit criteria did not exist. Suboptimal factors were identified in the antenatal, intrapartum and neonatal periods, and classified as 'maternal/social', due to 'infrastructure/service organization', or due to 'professional care delivery'. The contribution of each suboptimal factor to the fatal outcome was listed and consensus was reached on a final grade using a procedure that included correspondence and plenary meetings.

Results: In all regions combined, 90% of all known or estimated cases in the selected categories were included in the audit. In total, 1619 cases of perinatal death were audited. Consensus was reached in 1543 (95%) cases. In 75% of all cases, the grade was based on explicit criteria. In the remaining cases, consensus was reached within subpanels without reference to predefined criteria. There was reasonable to good agreement between and within subpanels, and within panel members.

Conclusions: 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. (Less)
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PERINATAL AUDIT, PERINATAL MORTALITY, SUBOPTIMAL CARE
in
Journal of Maternal-Fetal & Neonatal Medicine
volume
14
issue
4
pages
267 - 276
publisher
Taylor & Francis
external identifiers
  • scopus:10744228627
ISSN
1476-7058
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language
English
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no
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259366fa-538f-410e-8643-f997e3e58540 (old id 1127916)
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http://www.ncbi.nlm.nih.gov/pubmed/14738174
http://informahealthcare.com/doi/abs/10.1080/jmf.14.4.267.276
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2013-10-09 14:11:29
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2018-05-29 09:44:40
@article{259366fa-538f-410e-8643-f997e3e58540,
  abstract     = {Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results.<br/><br>
Methods: Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified. The categories of death chosen for the study were singleton fetal deaths at 28 or more weeks of gestational age, all intrapartum deaths at 28 or more weeks of gestational age and neonatal deaths at 34 or more weeks of gestational age. Deaths with major congenital anomalies were excluded. An international audit panel used explicit criteria to review all cases, which were blinded for region. Subjective interpretation was used in cases of events or interventions where explicit criteria did not exist. Suboptimal factors were identified in the antenatal, intrapartum and neonatal periods, and classified as 'maternal/social', due to 'infrastructure/service organization', or due to 'professional care delivery'. The contribution of each suboptimal factor to the fatal outcome was listed and consensus was reached on a final grade using a procedure that included correspondence and plenary meetings.<br/><br>
Results: In all regions combined, 90% of all known or estimated cases in the selected categories were included in the audit. In total, 1619 cases of perinatal death were audited. Consensus was reached in 1543 (95%) cases. In 75% of all cases, the grade was based on explicit criteria. In the remaining cases, consensus was reached within subpanels without reference to predefined criteria. There was reasonable to good agreement between and within subpanels, and within panel members.<br/><br>
Conclusions: 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.},
  author       = {Richardus, J H and Graafmans, W C and Bergsjö, P and Lloyd, D J and Bakketeig, L S and Bannon, E M and Borkent-Polet, M and Davidson, L L and Defoort, P and Esparteiro Leitao, A and Langhoff-Roos, J and Moral Garcia, A and Papantoniou, N E and Wennergren, M and Amelink-Verburg, M P and Verloove-Vanhorick, S P and MacKenbach, J P},
  issn         = {1476-7058},
  keyword      = {PERINATAL AUDIT,PERINATAL MORTALITY,SUBOPTIMAL CARE},
  language     = {eng},
  number       = {4},
  pages        = {267--276},
  publisher    = {Taylor & Francis},
  series       = {Journal of Maternal-Fetal & Neonatal Medicine},
  title        = {Suboptimal care and perinatal mortality in ten European regions:methodology and evaluation of an international audit.},
  url          = {http://dx.doi.org/},
  volume       = {14},
  year         = {2003},
}