Print Email Facebook Twitter Evaluation of 280 000 cases in Dutch midwifery practices: A descriptive study Title Evaluation of 280 000 cases in Dutch midwifery practices: A descriptive study Author Amelink-Verburg, M.P. Verloove-Vanhorick, S.P. Hakkenberg, R.M.A. Veldhuijzen, I.M.E. Bennebroek Gravenhorst, J. Buitendijk, S.E. TNO Kwaliteit van Leven Publication year 2008 Abstract Objective: To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design: Descriptive study. Setting: Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001-03). Population: Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods: Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures: Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results: In our study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001).On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions: Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives. © 2008 The Authors.PZ,V&P.WI (wetenschappelijk Internationaal) Subject HealthNeonatal outcomePerinatal registryPlanned home birthChildbirthControlled studyDeliveryFetus distressIntrapartum careMedical practiceMidwifeOutcome assessmentPerinatal deathPostpartum hemorrhageFemaleHome ChildbirthHospitalizationHumansInfant, NewbornMidwiferyNetherlandsObstetric Labor ComplicationsPerinatal CarePregnancyPregnancy OutcomePrenatal CarePrimary Health CareProfessional PracticeProgram EvaluationReferral and Consultation To reference this document use: http://resolver.tudelft.nl/uuid:593174d2-bb50-404b-b880-9b3ed51b55af DOI https://doi.org/10.1111/j.1471-0528.2007.01580.x TNO identifier 240726 ISSN 1470-0328 Source BJOG: An International Journal of Obstetrics and Gynaecology, 115 (5), 570-578 Document type article Files To receive the publication files, please send an e-mail request to TNO Library.