Title
Differences in perinatal mortality and suboptimal care between 10 European regions: Results of an international audit
Author
Richardus, J.H.
Graafmans, W.C.
Verloove-Vanhorick, S.P.
Mackenbach, J.P.
Masuy-Stroobant, G.
Alderdice, F.
Blondel, B.
Kaminski, M.
Leidinger, J.
Da Purificação Araújo, M.
Lopes De Oliveira, L.F.
Bergsjø, P.
Lloyd, D.J.
Bakketeig, L.S.
Bannon, E.M.
Borkent-Polet, M.
Davidson, L.L.
Defoort, P.
Leitão, A.E.
Langhoff-Roos, J.
Garcia, A.M.
Papantoniou, N.E.
Wennergren, M.
Aelvoet, W.
Bødker, B.
Lindmark, G.
Penney, G.
Macfarlane, A.
Rantakalli, P.
Hartikainen, A.L.
Gissler, M.
Bakoula, C.
Lekea, V.
van der Pal, K.
Amelink-Verburg, M.
Holt, J.
Rebagliato, M.
Bolumar, F.
Publication year
2003
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 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.
Subject
Health
Belgium
Congenital malformation
Controlled study
Denmark
Europe
Fetus death
Finland
Gestational age
Greece
Health care
Intrauterine growth retardation
Major clinical study
Medical audit
Netherlands
Newborn death
Norway
Outcomes research
Perinatal mortality
Solutio placentae
Spain
Sweden
United Kingdom
Abruptio Placentae
Europe
Female
Fetal Growth Retardation
Gestational Age
Humans
Infant Mortality
Infant, Newborn
Medical Audit
Pregnancy
Prenatal Care
Quality of Health Care
Retrospective Studies
Smoking
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http://resolver.tudelft.nl/uuid:2b5bb4bf-3f6d-4755-99f4-ba3ac9baf12b
DOI
https://doi.org/10.1046/j.1471-0528.2003.02053.x
TNO identifier
236963
ISSN
1470-0328
Source
BJOG: An International Journal of Obstetrics and Gynaecology, 110 (2), 97-105
Document type
article