title: [Audit of severe acute maternal morbidity (SAMM) in the Netherlands].
abstract: OBJECTIVE
  To describe the audit of severe acute maternal morbidity in the Netherlands, indicating the audit procedure and possible points for improvement.
  
  
  METHODS
  Descriptive audit investigation.
  
  
  METHODS
  Eight audit meetings were held concerning cases of severe acute maternal morbidity selected from a prospective, population-based, cohort investigation at all 98 obstetric departments in the Netherlands. Before the start of each meeting, details of the cases were sent to panel members for individual analysis. During the plenary meeting the findings were discussed, and more detailed information was available if required from the patient dossier. Substandard care was identified on the basis of the opinion of the majority of panel members.
  
  
  RESULTS
  Substandard care was identified in almost 80% of the SAMM cases discussed. Specific recommendations were formulated concerning the procedure of audit and also concerning local and national implementation of guidelines.
  
  
  CONCLUSIONS
  Audit merits an important place both nationally and locally in Dutch obstetric practice. Quality improvement is generally possible without large changes to the system, specifically by optimising existing guidelines and putting them into practice.
authors.affiliation: UMC St Radboud, afd. Verloskunde en Gynaecologie, Nijmegen, The Netherlands. j.vandillen@obgyn.umcn.nl
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.forename: Jeanette A J M
authors.initials: JA
authors.lastname: Mesman
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Zwart
authors.forename: Kitty W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006801:Humans; D008485:Medical Audit; D009426:Netherlands; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care / Q000592:standards; D011446:Prospective Studies; D011787:Quality of Health Care