TY - JOUR
T1 - Differences in perinatal mortality and suboptimal care between 10 European regions
T2 - Results of an international audit
AU - Richardus, Jan H.
AU - Graafmans, Wilco C.
AU - Verloove-Vanhorick, S. Pauline
AU - Mackenbach, Johan P.
AU - Masuy-Stroobant, Godelieve
AU - Alderdice, Fiona
AU - Blondel, Beatrice
AU - Kaminski, Monique
AU - Leidinger, Johannes
AU - Da Purificação Araújo, Maria
AU - Lopes De Oliveira, Luis F.
AU - Bergsjø, Per
AU - Lloyd, David J.
AU - Bakketeig, Leiv S.
AU - Bannon, Elizabeth M.
AU - Borkent-Polet, Marion
AU - Davidson, Leslie L.
AU - Defoort, Paul
AU - Leitão, Amélia Esparteiro
AU - Langhoff-Roos, Jens
AU - Garcia, Angel Moral
AU - Papantoniou, Niko E.
AU - Wennergren, Margareta
AU - Aelvoet, Willem
AU - Bødker, Birgit
AU - Lindmark, Gunilla
AU - Penney, Gillian
AU - Macfarlane, Alison
AU - Rantakalli, Paula
AU - Hartikainen, Anna Liisa
AU - Gissler, Mika
AU - Bakoula, Chryssa
AU - Lekea, Vasso
AU - Van Der Pal, Karin
AU - Amelink-Verburg, Marianne
AU - Holt, Jan
AU - Rebagliato, Marisa
AU - Bolumar, Francisco
N1 - Funding Information:
The EuroNatal study was funded by the BIOMED 2 program of the European Commission.
PY - 2003/2/1
Y1 - 2003/2/1
N2 - 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.
AB - 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.
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U2 - 10.1046/j.1471-0528.2003.02053.x
DO - 10.1046/j.1471-0528.2003.02053.x
M3 - Article
C2 - 12618151
AN - SCOPUS:0037331251
SN - 1470-0328
VL - 110
SP - 97
EP - 105
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 2
ER -