title: Substandard care in delivery-related asphyxia among term infants: prospective cohort study.
abstract: OBJECTIVE
  To assess substandard care factors in the case of delivery-related asphyxia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Catchment area of the Neonatal Intensive Care Unit (NICU) of the University Medical Center Utrecht; a region in the middle of the Netherlands covering 13% of the Dutch population.
  
  
  METHODS
  Term infants, without congenital malformations, who died intrapartum or were admitted to the Neonatal Intensive Care Unit due to asphyxia.
  
  
  METHODS
  During a two-year period, cases were prospectively collected and audited by an expert panel.
  
  
  METHODS
  Substandard care factors.
  
  
  RESULTS
  37 735 term infants without congenital malformations were born. There were 19 intrapartum deaths, and 89 NICU admissions of which 12 neonates died. In 63 (58%) cases a substandard care factor was identified that was possibly (n= 47, 43%) or probably (n= 16, 15%) related to perinatal death or NICU admission. In primary care, substandard care factors were mainly the low frequency of examination during labor and delay in referral to secondary care. In secondary care, misinterpretation of cardiotocography and failure to respond adequately to clinical signs of fetal distress were the most common substandard care factors.
  
  
  CONCLUSIONS
  Substandard care is present in a substantial number of cases with delivery-related asphyxia resulting in perinatal death or NICU admission. Improving the organization of obstetric care in the Netherlands as well as training of obstetric caregivers might reduce adverse outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands. a.evers@umcutrecht.nl
authors.forename: Annemieke C C
authors.initials: AC
authors.lastname: Evers
authors.forename: Hens A A
authors.initials: HA
authors.lastname: Brouwers
authors.forename: Peter G J
authors.initials: PG
authors.lastname: Nikkels
authors.forename: Janine
authors.initials: J
authors.lastname: Boon
authors.forename: Anneke
authors.initials: A
authors.lastname: VAN Egmond-Linden
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Claartje
authors.initials: C
authors.lastname: Hart
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hillegersberg
authors.forename: Yvette S
authors.initials: YS
authors.lastname: Snuif
authors.forename: Sietske
authors.initials: S
authors.lastname: Sterken-Hooisma
authors.forename: Charlotte N Steins
authors.initials: CN
authors.lastname: Bisschop
authors.forename: Michelle E M H
authors.initials: ME
authors.lastname: Westerhuis
authors.forename: Hein W
authors.initials: HW
authors.lastname: Bruinse
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology / Q000209:etiology*; D015148:Cardiotocography; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors